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From the editor

Dear Healthcare Intelligence Network Client,

HIN Managing Editor Patricia Donovan

Starting in January, payors will have to spend 80 to 85 percent of collected premiums on medical services and quality improvements. While the HHS awaits the NAIC's final recommendations on the final medical loss ratio (MLR) formula, a featured story this week estimates the financial impact of MLR compliance on insurers.

According to HealthScape Advisors Managing Director John Steele, advance planning can soften the financial blow. During a recent webinar on preparing for January's MLR compliance regulations, Steele had this advice for payors:

Get together a team to look at some of the immediate compliance requirements on quality improvement, allocation methodologies, aggregation by the segment, as well as that preliminary financial impact and some preferred approaches. It may not be all accounting -related. It could be looking at your product portfolio, or some of your cost management. Look at all of those areas and try to do a longer term forecast that would then flow into overall strategy development — looking at where youíre going to go, not only from the accounting side but also opportunities to diversify products. Look at total cost management.

Also this week, learn how continuing diabetes education for Medicare and commercial populations is paying off for these insurers. You can also join the more than 80 healthcare companies that have weighed in on the benefits of health coaching. Take our third annual Health Coaching survey by August 31 and get a free e-summary of the results next month.

Your colleague in the business of healthcare,
Patricia Donovan
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to pdonovan@hin.com.

HIN Associate Editor Jessica Papay
Associate Editor:
Jessica Papay, jpapay@hin.com

Publisher:
Melanie Matthews, mmatthews@hin.com

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August 16, 2010
Vol. XII, No. 30

Sponsored by:
Best Practices in Case Management Patient Contact, Monitoring and Follow-up

This week's industry news:

  1. Diabetes Education Reduces Admissions, Improves Medication Compliance
  2. Case Studies from Diabetes Medical Home Pilots
  3. Care Transition Programs on Rise in 2010
  4. 2010 Performance Benchmarks in Managing Care Transitions
  5. Healthcare Business White Paper: Encouraging Independence — Promoting CDHPs
  6. Nearly 1 in 5 Californians Report Need for Mental Health Services
  7. New Chart: Targeted Conditions for Medication Adherence
  8. Managing Behavioral Healthcare
  9. Drug Coverage Under Medicare Part D Increases Antibiotic Use Among Seniors
  10. 2010 Healthcare Benchmarks: Patient Education
  11. Healthcare Reformís MLR Requirements Could Cost Insurers More Than Expected
  12. Minimum Medical Loss Ratios
  13. HealthSounds Podcast: Case Management of High-Risk Patients
Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy and learn about our other news services.

Missed the last issue? Read it here.

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This week's industry news

1.) Diabetes Education Reduces Admissions, Improves Medication Compliance

Ongoing diabetes education continues to deliver results of better health and reduced private insurance and Medicare claims, according to preliminary data from a study of private insurance and Medicare claims commissioned by the American Association of Diabetes Educators (AADE).

Get the full story.

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2.) Case Studies from Diabetes Medical Home Pilots: Key Processes, Tools, Metrics and Outcomes

Case Studies from Diabetes Medical Home Pilots This resource offers a detailed look at two physician-health plan partnerships in diabetes disease management — a care coordination pilot for New Jersey state employees with diabetes and a hands-on case manager-driven initiative for Medicaid beneficiaries with diabetes in North Carolina.

Learn more about this resource.

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3.) Care Transition Programs on Rise in 2010

A new study on care transition management has found that 85 percent of respondents have launched programs for older adults with complex acute or chronic conditions to close care gaps, avoid unnecessary hospitalizations, readmissions and ER visits, reduce medication errors and raise the bar on care quality.

Get the full story.

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4.) 2010 Performance Benchmarks in Managing Care Transitions

2010 Performance Benchmarks in Managing Care Transitions This resource provides actionable information from 87 healthcare organizations on their strategies to smooth patientsí transitions from one care site to another and reduce rehospitalizations. Based on responses to HINís May 2010 Industry Survey on Care Transitions Management, this 60-page report documents the latest trends and metrics on care transitions programs in use by primary care providers, health plans, hospitals and others.

Learn more about this resource.

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5.) Healthcare Business White Paper: Encouraging Independence — Promoting CDHPs and Decision Support Tools in the Workplace

A strategic communications program can encourage employee adoption of new services such as consumer-driven health plans (CDHPs) and decision-support tools at a cost that quickly pays for itself. Discover the elements of such a communication strategy in this white paper.

Download this complimentary white paper.

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6.) Nearly 1 in 5 Californians Report Need for Mental Health Services

In a comprehensive new study on mental health status and the use of mental health services by Californians, researchers at the UCLA Center for Health Policy Research found that nearly one in five adults in the state — about 4.9 million people — said they needed help for a mental or emotional health problem.

Get the full story.

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7.) New Chart: Targeted Conditions for Medication Adherence

Targeted Conditions for Medication Adherence

Medication adherence programs can improve patient care and lower healthcare costs by more effectively managing chronic medication utilization. We wanted to see which targeted conditions pose the greatest opportunity to improve medication adherence.

Click here to view the chart.

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8.) Managing Behavioral Healthcare, 3rd Edition

Managing Behavioral Healthcare This 424-page manual provides behavioral health medical review policies, Ďbenefit interpretationsí criteria, benchmarks and guidelines for inpatient, day hospital, residential and outpatient care. A practical model for a quality-based and cost-effective care management approach as well as coverage determinations. The manual also contains numerous policies, procedures, tools and forms vital to prepare for accreditation or certification surveys and strategies for quality-based efficient delivery of integrated behavioral healthcare. This manual is updated annually.

Learn more about this resource.

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9.) Drug Coverage Under Medicare Part D Increases Antibiotic Use Among Seniors

Improved drug coverage under Medicare Part D has led to an increase in the use of antibiotics by seniors, particularly of brand-name and more expensive drugs, according to a University of Pittsburgh Graduate School of Public Health (GSPH) study.

Get the full story.

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10.) 2010 Healthcare Benchmarks: Patient Education and Outreach

2010 Healthcare Benchmarks: Patient Education and Outreach This resource provides actionable information from 134 healthcare organizations on their efforts to educate patients and put them on the road to self-management. This 24-page resource documents trends and metrics on patient education programs that are taking shape in the primary care office, the ER, at hospital discharge and in the patient's home.

Learn more about this resource.

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11.) Healthcare Reformís MLR Requirements Could Cost Insurers More Than Expected

Compliance with medical loss ratio (MLR) requirements in the new health reform law could cost the nationís health insurers far more than most analysts expected, according to a new study by Weiss Ratings.

Get the full story.

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12.) Minimum Medical Loss Ratios: How Health Plans Should Prepare for the January Compliance Requirements

Minimum Medical Loss Ratios During this webinar, two industry experts provided an in-depth analysis of what health plans must do now to comply with the January deadline for minimum MLRs and how this might impact health plans operationally and financially.

Learn more about this resource.

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13.) HealthSounds Podcast: Case Management of High-Risk Patients

Rebecca Ramsay As part of CareOregon's initiative to create a more robust care management program, the organization has found new ways of stratifying members and identifying high-risk members, explains Rebecca Ramsay, B.S.N., M.P.H., CareOregon's senior manager of care support and clinical programs. Ms. Ramsay also explains how daily data from CareOregon's emergency departments is informing their member outreach strategy.

Listen to this podcast.

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