Archive for October, 2012

Infographic: The Cost of a Hospital Stay

October 31st, 2012 by Melanie Matthews

The average cost of a hospital stay in the United States almost doubled in a decade, according to an infographic by Face the Facts USA.

The average cost rose from just over $17,000 in 2000 to $33,000 in 2010. See how this compares with other industrialized nations in the infographic.

The Cost of a Hospital Stay

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Infographic: Understanding the Diabetic Patient’s Experience

October 30th, 2012 by Melanie Matthews

Some 65 percent of surveyed diabetic patients report that the services they receive should be greatly improved, according to a new infographic by DHP Research.

Learn the high priority areas for these patients and key perceptions and contextual considerations in improving diabetes care.

Interpreting the Diabetes Patient Profile

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Infographic: Accountable Care Organizations: An Industry Overview

October 29th, 2012 by Melanie Matthews

There are over 250 accountable care organizations operating in the United States, according to a new infographic from Greenway Medical.

The infographic also highlights the leading ACOs, types of ACO models, quality measure requirements, states with the most ACOs and more.

Accountable Care Organizations: An Industry Overview

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Majority of Americans Still Paying High Medical Costs Despite Recession

October 29th, 2012 by Cheryl Miller

The recession hasn’t impacted high medical cost burdens for a majority of Americans, according to a recent study from the Center for Studying Health System Change (HSC). Nearly one in five families spent at least 10 percent of their pre-tax family income on out-of-pocket health insurance premiums and medical care in 2009, roughly the same as 2006 despite widespread job losses, more uninsured, and declining incomes during the recession. Researchers attributed decreasing family income among the reasons for the lack of change.

CMS financial penalties haven’t impacted the rate of hospital-acquired infections (HAIs), according to a report from the Harvard Pilgrim Health Care Institute. The study included data on 398 hospitals from 41 states and found no evidence that 2008 CMS policies reducing Medicare payments to hospitals for HAIs had a positive impact. Instead, the study found that infection rates declined steadily throughout this period independent of penalties. Among the reasons cited in the report was the size of the financial incentives – they were very small and failed to spark reform.

Population health management strategies could have an impact on patient care, and healthcare costs, but physician practices need to put readiness plans together. Chief among the challenges to implementation are increased administrative burdens, cost, and time, but researchers stress that the short-term disruptions to patient care are worth the longer term benefits.

What might have an impact on our offices here on the Jersey coast is Hurricane Sandy, set to land right around the time this newsletter goes to press. So we’re in readiness mode, hoping that a boardwalk clogged with sand will be the only short-term disruption from the storm, but well worth the ocean viewing afterward.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

Infographic: Health Insurance Exchanges

October 26th, 2012 by Melanie Matthews

Facing a November 16th deadline to declare intention and readiness to build a health insurance exchange, the majority of states are expected to let the government take over by default, according to the Pew Center on the States.

Only 15 states and the District of Columbia have chosen to establish state exchanges. In this infographic by the Pew Center on the States, see which states plan to establish exchanges and the amount of federal funding each state has received for exchange planning and implementation.

Health Insurance Exchanges

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Infographic: 10 Tips for Creating a Healthier Workplace

October 25th, 2012 by Melanie Matthews

Sponsoring healthy activities at the office and providing health and wellness information to employees are just some of the ways that employers can encourage a healthier workforce.

Learn additional ways to encourage a healthier workplace in this infographic by Central Health.

Featured By:

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Efforts to Embed Exercise in EHRs Improves Patient Care, Quality: Study

October 24th, 2012 by Cheryl Miller

“Your blood pressure, pulse, temperature are all normal, but your exercise level is low. Let’s talk about this further.”

This might be a potential new line of discussion in the doctor’s office, if exercise habits join the fray of typical vital statistics now taken in routine outpatient medical visits. A new initiative created by Kaiser Permanente systematically records patients’ exercise data into their EHRs, giving clinicians the opportunity to counsel them during these routine visits if it turns out they are not meeting national guidelines for physical activity. Designed to maximize findings showing the correlation between regular exercise and better health, the tool also has the potential to provide information about the relationship between exercise and healthcare utilization, cost and chronic disease, researchers say.

Helping patients overcome their objections to taking medication could vastly improve their medication adherence levels, says a new report from the University of Missouri. Studies show that nearly half of all patients taking medications for chronic conditions do not follow their prescribed medication regimens because of fears of long-term effects and dependency, among other concerns. But failure to use medications as directed increases patients’ risk for side effects, hospitalizations, reduced quality of life and shortened lifespans, the report states.

The study focused on older patients with high blood pressure, a condition that affects nearly 70 million adults in the United States and can lead to heart disease and stroke. It found that patients rejected medication in favor of other methods that had been proven successful in treating high blood pressure, like walking or cutting down on salt. Physicians need to be more proactive in helping patients amend their behaviors.

Those dealing with the advanced ill can help them to better manage their situations with education and emotional support, says Dr. Joseph Agostini, senior medical director of Aetna Medicare about Aetna’s Compassionate Care program. A lack of understanding about care options is one of the primary barriers when dealing with end-of-life patients; once options are in place, getting all parties to agree about a treatment plan is another.

Medicare beneficiaries’ care and savings will improve significantly when new ACA-enacted Medicare policies are rolled out between now and 2014, according to a new Commonwealth Fund report. The new policies will reward four- and five-star plans and cut $12.7 billion in annual overpayments to private plans with three major changes, including rewards for quality and new benchmark rates.

Read all of these stories in their entirety in this week’s Healthcare Business Weekly Update.

Infographic: Predicting Medication Non-Adherence

October 24th, 2012 by Melanie Matthews

The U.S. spent $317.4 billion last year treating unnecessary medical complications that could have been avoided if patients had taken their medications as prescribed, according to an infographic by Express Scripts.

Some 69 percent of medication non-adherence is behavioral, a missed dose or late renewal. Express Scripts provides in this infographic, strategies for tailoring medication adherence initiatives and a sample risk index score for medication non-adherence.

Predicting Medication Non-Adherence

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Q&A: Florida Blue Applies PCMH Principle of Increased Access

October 24th, 2012 by Jessica Fornarotto

Providing six hours per week of after-hours coverage is a requirement of the Florida Blue patient-centered medical home (PCMH) so that members have complete access to their physicians no matter what time of day, says Barbara Haasis, R.N., CCRN, senior clinical lead of quality reward and recognition programs at Florida Blue.

During an interview prior to her presentation for a May 10, 2012 webinar on “The Patient-Centered Medical Home: Lessons from a Statewide Rollout”, Haasis discusses requirements for their PCMH pilot, the role of a nurse educator in the PCMH to disease management and future plans for embedding case managers in their practices.

HIN: Your organization is several months into a statewide rollout of a PCMH pilot with more than 1600 primary care providers participating. We realize it’s too early to discuss any hard outcomes, but one requirement for the practices that are participating in the pilot is the availability of at least six hours per week of after-hours coverage. Why did Florida Blue make that a requirement for participation in the medical home pilot?

(Barbara Haasis): Florida Blue chose to add that because we are following, by the letter, the principles of a PCMH, as described by organizations such as the American Academy of Family Physicians. And one of the principles is increased access. In today’s society, where almost everybody is a working adult, and our program is for commercial members under 65 only, we wanted to make sure that our members could see their physicians either before work, after work, or on the weekends, if it was not a medical emergency.

HIN: Are any Florida Blue case managers currently working inside participating practices, or are there any future plans to embed health plan case managers in the practices?

(Barbara Haasis): At this point, our case managers are still inside of Blue Cross Blue Shield. We have expedited the process of referring a patient to our case managers, and we are looking at doing a pilot with one of our vendors that works with chronic diseases, wellness education, etc. That is still in the discussion phase, though.

We’re planning to put together a small pilot of about four or five practices and to put a nurse in the office who is not a case manager but a practice coordinator. One of the roles of this nurse would be to identify patients to move into Blue Cross case management or one of our disease or wellness programs.

HIN: Could you describe the duties of the nurse educators in the medical home pilot, especially as they relate to patients with any of the pilot’s five focus health conditions, which are diabetes, COPD, coronary artery disease, asthma, and CHF?

(Barbara Haasis): Right now we have three nurse educators. They are each assigned to a specific practice so that they can establish a relationship with that practice. Part of the scorecards that we give to our physicians on a quarterly basis includes metrics that measure whether or not our diabetics have received their preventive screenings and their chronic disease management.

If a practice is having an issue with a specific disease entity, the nurses can offer them some suggestions on how they may be able to improve compliance. If there are issues with cost, we may be able to work on that with our case managers. The nurses have a relationship with the practice. Where the practice is having an issue with the patient, they can call their nurse educator and get assistance that way. They’re also aware of the external opportunities, such as the American Diabetes Association, that our practices can refer their patients to.

Healthcare Delivery Advice for 2013: Shore Up Payment Before Shifting Model

October 23rd, 2012 by Patricia Donovan

Eying a move to an ACO or the patient-centered medical home model in 2013? First, adjust the payment structure to support it, advises Steven Valentine, president of the Camden Group. Shifting to one of the popular post-reform healthcare delivery models before changing the payment system is courting financial disaster, Valentine warned during HIN’s ninth annual Healthcare Trends & Forecasts strategic planning session.

Valentine charted anticipated trends for healthcare providers in 2013, while Hank Osowski and Dennis Eder, both managing directors for Strategic Health Group, covered business opportunities for health plans during the 60-minute webinar.

All of the analysts agreed that the outcome of next month’s presidential election would have little impact on healthcare reform.

“Regardless of who gets elected president, many of the things I’m talking about — bundled payment, patient-centered medical home, co-management agreements, clinical integration, accountable care organizations — are all going happen due to the economics of healthcare.”

“The reform train has left the station,” agreed Eder. “Folks who are waiting around to see what happens in the election, or who waited around for the Supreme Court decision on the Affordable Care Act, are too late.”

The election results will “likely influence the pace of change to the healthcare system, but probably not the direction,” added Osowski. The continued acquisitions and consolidations evident in the industry are proof in the market’s belief in the longevity of reform-based initiatives, he said.

Common ground across the industry continuum includes potential from collaborations — hospital-physician co-management service agreements on the provider side, and strategic partnerships in population health management on the payor side. Partnership opportunities are more plentiful now than at any time in recent healthcare history, noted Eder. “I was involved in the original integrated health world in the mid-1980’s when systems were buying both hospitals and physician organizations and starting health plans. The sincerity and the desire to work as true partners are unlike any time I’ve seen before.”

The speakers identified the strategic focus for each sector, with Valentine indicating that the key investment for providers should be on growing their population — getting as large a defined population base at the bottom of the pyramid as possible, which encompasses the access points and primary care, he said.

For payors, the industry’s increasingly population-centric, value over volume sensibility offers many opportunities in coordinated care, particularly for Medicaid-Medicare dual eligibles, said Osowski. “Duals comprise about 18 percent of the state Medicaid population, and yet they account for almost a little more than a third of the total spend on Medicaid,” he said.

Duals are a complex population with unique health concerns, requiring a strong behavioral health component. “Duals tend to be very costly because they’re typically non-compliant patients and don’t really follow what is being asked of them in terms of their healthcare,” said Valentine.

“The dual population is not just frail elders; the dual population is 40 percent people under 65,” added Eder. And the vast majority of the people under 65 are disabled because of behavioral health-related issues. So for organizations considering getting into the dual market, if you’ve just done frail elderly programs and you think you’re going to be working with that same cohort of members, it’s going to be a painful learning.”

In other trends, the industry should expect delays in implementation of health insurance exchanges (HIEs), which face significant funding hurdles, said Osowski.

Healthcare may also see the reemergence of narrow networks, in which health plan members or employers benefit from lower costs when staying within their own health systems. Individuals will still have the choice of going outside the system, but face much higher copays.

“We’re leaving choice in place, but we are getting much better at directing back to a smaller, more narrow network that will help to steer volume back to the providers, and reduce the total cost of care and the out of pocket cost for the employee,” concluded Valentine.

Listen to an interview with Dennis Eder, Hank Osowski and Steven Valentine.