Archive for December, 2013

Infographic: Health Insurance in the Individual Market

December 20th, 2013 by Jackie Lyons

So far in 2013, the healthcare market has been unpredictable and volatile. The Affordable Care Act (ACA) continues to affect millions of individuals and numerous aspects of healthcare.

Only 5.7 percent of Americans buy their health insurance through the individual insurance market, according to a new infographic from Families USA. This infographic breaks down the ACA, the healthcare insurance market and more.

Health Insurance in the Individual Market

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You may also be interested in this related resource: Plunkett’s Health Care Industry Almanac 2014.

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Healthcare Business Week in Review: Meaningful Use, Hospital Pricing, Telehealth, Health Insurance Marketplaces

December 20th, 2013 by Cheryl Miller

CMS has proposed delaying the start of Stage 3 of the meaningful use program for the Medicare and Medicaid EHR Incentive Programs, while the Office of the National Coordinator for Health Information Technology (ONC) has proposed adjustments to its certification process, according to a December 6th post on the HHS blog site Health IT Buzz.

Under CMS’ revised meaningful use timeline, the start of Stage 2 has not been changed, but it has been extended through 2016; and the start of Stage 3 has been postponed, and will begin in 2017 for healthcare providers who have completed at least two years in Stage 2 of the program.

Whether this delay sways hospital executives looking at implementing an accountable care organization (ACO) remains to be seen. EHR utilization is among the reasons nearly half of the hospital executives recently surveyed have no plans to implement the care model in the near future, according to a new survey from Purdue Healthcare Advisors. The respondents, who were categorized according to their progress with meaningful use implementation, voiced concern about the technology, particularly its interoperability with other providers, and staff readiness and training. .

Interoperability of sorts is at the core of a qualitative study by the Center for Studying Health System Change (HSC), which focused on the effects of California’s reference pricing initiative to guide consumers to hospitals that provide routine hip and knee replacements below a certain price threshold. Researchers found that the cost of these surgeries ranged from as little as $15,000 to as much as $110,000.

While the initiative was effective in setting a threshold for hospital facility payments for both procedures and designating certain hospitals that met certain quality standards, whether it contributed to overall healthcare savings was debated in the study.

But sometimes the high cost is well worth it, as in the area of telehealth and telemedicine services, according to our latest market research data.

Despite the significant financial costs of remote monitoring technologies, adopters report impressive gains in medication adherence and care of remote and rural patients, as well as a decrease in health complications. Active users of telehealth and telemedicine also experience fewer hospitalizations, hospital readmissions, ER visits and bed days.

And speaking of technology, nearly 365,000 Americans selected plans in the Health Insurance Marketplace (HIM) in October and November, and enrollment in November was more than four times greater than October’s reported federal enrollment number, according to HHS Secretary Kathleen Sebelius.

The numbers reflect the technical improvements to HealthCare.gov, which has been unreliable since its launch in October. The open enrollment period is six months long and continues to March 31, 2014.

And lastly, don’t forget to take our current e-survey, Reducing Hospital Readmissions in 2013. Describe how your organization is working to reduce hospital readmissions by taking HIN’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an e-summary of the results once they are compiled.

Infographic: Informal Care Givers – $234 Billion Job Goes Unpaid

December 19th, 2013 by Jackie Lyons

Nearly nine in 10 Americans who need some form of long-term care (LTC) get assistance from family members or friends who volunteer their time. An estimate of this work adds up to $234 billion, according to a new infographic from PBS.

This infographic also shows how this compares to the GDP and total U.S. LTC costs, and reasons why these costs will continue to grow.

$234 Billion Job Goes Unpaid

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You may also be interested in this related resource: Implementing Culture Change in Long-Term Care: Benchmarks and Strategies for Management and Practice.

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Infographic: How Will the ACA Affect Senior Citizens?

December 18th, 2013 by Jackie Lyons

The Affordable Care Act (ACA) will cut Medicare funding by $716 billion from 2013 to 2022, according to a new infographic from AssistedLivingFacilities.org. This has several implications for high-income earners and low-income Medicare beneficiaries alike.

This infographic includes a summary of Medicare and the health insurance marketplace, data on prescription drugs and doctor shortages, the impact of Medicare cuts on individuals and healthcare in general, and more.

How Will the ACA Affect Senior Citizens?

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You may also be interested in this related resource: Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management, 3rd Edition.

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Infographic: Big Data is Healthcare’s Biggest Threat And Likely Savior

December 17th, 2013 by Jackie Lyons

Data use may be the cure for the modern healthcare industry, which misspends $600 billion annually, according to a new infographic from ReferralMD. Research suggests that the use of big data can provide better, yet cheaper care.

This infographic also shows the U.S. healthcare expenditure on data, who uses health data and how, the future of mobile health apps and more.

Big Data is Healthcare's Biggest Threat - And Likely Savior

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You may also be interested in this related resource: mHealth: Global Opportunities and Challenges.

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Engaging Members in Health Management Post-Discharge with Case Managers, Outreach Calls

December 17th, 2013 by Jessica Fornarotto

“Member engagement is always the challenge, and it is no different for telephonic engagement,” states Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA), as he discusses how CBHA engages members in their telephonic case management program post-discharge. “We’ve found multiple venues to attract attention and begin the engagement process, including letters, outreach calls to members, and partnering with the discharging hospital. We want to be part of the discharge process, so telephonic case management is as much a part of the discharge plan as their visit with the doctor or therapist, medication regime, etc.

In HIN’s special report, Telephonic Case Management Protocols to Engage Vulnerable Populations, Jay Hale further describes the engagement process for CBHA’s telephonic case management program.

We are a small regional managed behavioral healthcare organization (MBHO), so our case managers also do utilization management. They identify the cases early and are able to talk to the utilization review (UR) people at the hospital and say, “This is someone that we have identified,” which helps with that discharge process. The earlier we can talk to members, the better. We want to talk to members as quickly after discharge as possible. Having the support of that hospital adds weight to what we do, so it is key that they do not receive a random call. We want it to be something that is related to their treatment process. That is why we want to be part of that discharging.

The next step is to call the member once they have been discharged. We obtain contact information from our records or from the hospital. Our records are based on what the person gave to human resources at some point along the line, so they may not always be updated. The hospital frequently has the most recent phone contact information.

We obtain the discharge recommendation, which is part of our UR process, including appointment times. I contact the member and engage them in the process to assure that they attend their appointments. We also call their providers to say that we want to make sure that the individual attends their appointment. We are the people who are authorizing the care, and these are in-network providers for us. Therefore, that is a relatively easy process. I feel comfortable with that because it is part of the treatment payment healthcare operations process. It also lets our providers know that we are doing this, so they should support us. It also lets them know we are not there just to plan, but also support what they do.

Once we get in contact with someone, we are going to describe this service in the way of how it can help him or her. “This is a service that helps you see how well you are doing.” Other phrases we use include, “We are here to support you in your recovery,” or “We are here to help you and your son/daughter.” We speak in a positive way, and we let them know that there is no cost to them for the program. This is part of their health plan, and we provide this service to help them see how well they are doing. That phrase works for them because it has a positive tone to it.

We also want to match case managers to the members as much as possible. As we manage care, we can see that individuals are more comfortable with a male or a female based on our UR information. They may be more comfortable with someone based on their issues, so we want to try to have the appropriate person do an outreach call to them. Because of that, we may learn about varying times of day to call.

We also found it is important for the case managers to know the therapeutic language that the member has learned. Specifically in substance abuse, we want people who are familiar with that language so that they can talk about supporting recovery, working a program, avoiding old playmates and playgrounds, working the steps, the big book and sponsors. There are certain words that are very specific to that language and to that program. If we can use that language comfortably, then that increases member engagement.

Infographic: The Costs of Opting Out of the Medicaid Expansion

December 16th, 2013 by Jackie Lyons

The Affordable Care Act (ACA) allows states to expand Medicaid coverage to more low-income people and offsets this with additional federal funding to participating states. States that don’t participate in the ACA’s Medicaid expansion will lose out on billions of dollars in federal funds, according to a new infographic from The Commonwealth Fund.

Texas is opting out of Medicaid expansion, and will therefore forgo about $9.6 billion in federal Medicaid finding in 2022. This infographic shows other examples of forgoing Medicaid expansion, as well as the effects of participating in the expansion.

The Cost of Opting Out of Medicaid Expansion

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You may also be interested in this related resource: Health Insurance Exchanges: Product Design, Promotion and Positioning.

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Infographic: How Telehealth is Helping Patients Sleep

December 13th, 2013 by Jackie Lyons

Telehealth can help patients with sleep apnea adhere to their medication, which lowers the risks associated with the disorder, according to a new infographic from Orange Healthcare.

Some 20 to 30 percent of patients discontinue their sleep apnea medication within four months of starting treatment. However, the use of telehealth results in a 5 percent reduction of patients aborting their treatment. The infographic also addresses risks associated with sleep apnea, as well as additional benefits of telehealth and details on how it can help.

How is Telehealth Helping Patients Sleep?

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You may also be interested in this related resource: 2013 Healthcare Benchmarks: Telehealth & Telemedicine .

Healthcare Business Week in Review: Care Coordination, Oncology Nurse Navigators, Readmissions, ACA

December 13th, 2013 by Cheryl Miller

Primary care outside the doctor’s office is getting its due. According to a final ruling from CMS, payment rates and policies for 2014 are focusing on improved care coordination, including a major proposal to support care management outside the routine office interaction.

The ruling also includes other policies to promote high quality care and efficiency in Medicare. CMS officials consider the care coordination policy a milestone, demonstrating Medicare’s recognition of the importance of care that occurs outside of a face-to-face visit for a wide range of beneficiaries beginning in 2015.

But there is a time and place for face-to-face visits: namely, between nurses and newly diagnosed cancer patients. According to a new study from the Group Health Research Institute, cancer patients who received support from a nurse navigator or advocate soon after being diagnosed had better experiences and fewer problems with their care, particularly in the areas of health information, care coordination and psychological and social care. Patients reported feeling that the healthcare team had gone out of its way to make them feel better emotionally. The extra help is especially welcome with new cancer patients, given that they and their caregivers need help translating medical jargon and navigating the healthcare maze, researchers say.

While the covering of catastrophic illnesses like cancer is one of the key issues behind healthcare reform, it is not enough to sell the nearly 30 percent of Americans opting out of coverage. According to the latest tracking poll from Gallup, one out of four uninsured Americans are planning on paying the government penalty rather than buy health insurance. The reason? Not what you think; details inside.

An automated prediction tool that identifies newly admitted patients at risk for readmission within 30 days of discharge has been successfully incorporated into the EHR of the University of Pennsylvania Health System.

The tool predicts at-risk patients as those who have been admitted to the hospital two or more times in the 12 months prior to admission. Once it identifies these high-risk patients, it creates a flag in their EHR, which appears next to the patient’s name in a column titled “readmission risk” once the patient is admitted.

We’d love to hear how your organization is working to reduce hospital readmissions by taking HIN’s fourth comprehensive Reducing Hospital Readmissions Benchmark Survey. Respond by January 3, 2014 and receive an e-summary of the results once they are compiled.

Infographic: Shortage of Primary Care Physicians

December 12th, 2013 by Jackie Lyons

With the implementation of the Affordable Care Act, millions of people are gaining health coverage and access to healthcare. However, there may be a shortage of doctors to treat these patients in many parts of the United States, suggests a new infographic from the Commonwealth Fund.

For example, the infographic shows the number of primary care physicians in several counties in Texas, ranging from 83 residents per one PCP in one county to 14,081 residents per PCP in another. Thirty-five Texas counties have more than 3,000 resident per primary care provider.

Top Public Health Risks

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You may also be interested in this related resource: 7 Value-Based Priorities for Healthcare’s Smart Money.