Archive for the ‘HIN Blog’ Category

One-Minute Health Metrics Video: Mobile Health

November 14th, 2013 by Jackie Lyons

Used a smartphone app for health reasons lately? Chances are your patients and health plan members have, too. The use of mobile health (mHealth) technologies has transformed the exchange of healthcare data, with mobile apps monitoring everything from blood sugar to medication adherence, and text-based reminders urging smokers not to give into that craving.

In fact, some studies predict that mHealth technologies can save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014. This One-Minute Metrics video summarizes mobile health practices of 150 healthcare organizations from HIN's first mHealth e-survey conducted in March 2013.

Click here for other mobile health resources.

HINfographic: Healthcare Strategic Planning for 2014

October 16th, 2013 by Jackie Lyons

Sustained growth in emerging reimbursement models, including accountable care, bundled payments and shared savings will continue to have an impact on innovation within the healthcare industry in 2014 as providers and payors struggle to find more ways to reduce costs within their systems and better manage the care they provide.

Hospital readmissions dropped by nearly 70,000 in 2012, and this trend is expected to accelerate through 2014, according to a new HINfographic from the Healthcare Intelligence Network. This HINfographic identifies current healthcare industry trends, and provides details on what to expect in 2014.


Healthcare Strategic Planning for 2014

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Information presented in this infographic was excerpted from: Healthcare Trends & Forecasts in 2014: A Strategic Planning Session. If you would like to learn more about healthcare trends and forecasts in 2014, this resource includes a detailed and actionable roadmap to the key issues, challenges and opportunities for healthcare providers and payors in 2014.

Have an infographic you'd like featured on our site? Click here for submission guidelines.

HINfographic on Defining the Dually Eligible: 16 Things to Know for Population Health Management

June 24th, 2013 by Jackie Lyons

There are about 9 million individuals in the United States eligible for both Medicare and Medicaid. Care coordination of these dual eligibles has been identified by PricewaterhouseCoopers LLP as one of the top 10 healthcare priorities for 2013.

Before developing a case management or population health management approach for this population, it is vital to first identify the group's characteristics.

This HINfographic on dual eligibles illustrates 16 things to know for population health management, including criteria for dual eligibility, specific health and financial characteristics of the population, differences between the duals and Medicare population, and keys to successfully managing dual eligibles.

dual eligibles infographic

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: Population Health Management for Dual Eligibles: Blueprint for Care Coordination.

HIN Guidelines for Guest Bloggers

June 15th, 2012 by Melanie Matthews

Passionate about healthcare? The Healthcare Intelligence Network blog is happy to consider guest posts from bloggers who are looking for a new outlet to publish original content for the healthcare industry. Our blog is well established (since 2004) with a community that includes healthcare executives and industry thought leaders.

If you are thinking of writing a guest post for us, here are some guidelines to keep in mind:

Topics: Any topic found under the "Category" heading on the left side of the HIN bookstore home page. Other topical healthcare business news and trends will be considered on a case-by-case basis.

Length: 500-1,000 words

Format: Microsoft Word (.doc) only

Style: Well-written and carefully edited informational and/or editorial content: news, trends, data and ideas to help healthcare executives improve healthcare delivery and quality, population health outcomes and health spend. No blatantly self-promotional or sales/marketing posts, please, and no product promotion. Include a 3- to 4-sentence biography about yourself and/or your organization. Original posts only.

Links: You can include a link to your business site in your biography. We like internal linking, too, so feel free to link to one or two relevant posts from this blog.

Images: You may submit for consideration (as attachment) a single image with your post, 640px maximum width. Be sure your image file names are descriptive. Insert Comments in your Word document where you want the image displayed. In addition, you can attach a head shot or logo, no larger than 100px x 150px.

Questions or Submissions: Email pdonovan@hin.com to discuss your idea or submit a post for consideration.

Publication Policy: We reserve the right to accept, edit, not publish posts and schedule publication at our discretion. All content published on our blog becomes the intellectual property of the Healthcare Intelligence Network. If your article is accepted, you consent to the full article, extracts, samples or examples appearing in other Healthcare Intelligence Network products and/or services. We will give you full credit as author. You may republish extracts – for example, on your own site – but the article in its entirety cannot appear elsewhere.

Disclaimer for Guest Blog Posts: The following disclaimer will be added to each published guest post:

The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Meet Case Manager Stacey B. Hodgman: Patient Advocacy, Resource Utilization, Discharge Planning Keys to Success

February 29th, 2012 by Cheryl Miller


This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.

Stacey B. Hodgman, MS, RN-BC, CCDS, CPUM, District Director of Case Management for Kindred Healthcare, Board of Directors for the Case Management Society of New England

HIN: What was your first job out of college and how did you get into case management?

Stacey Hodgman: My first career out of nursing school was working for the VA Hospital in New Hampshire. I only worked there for a short time before transferring to a local acute care hospital where I worked the night shift to avoid having to place my three children in day care. About eight years out of nursing school, and in addition to working at the acute care hospital, I accepted a part-time job as a work site wellness nurse for a steel manufacturing plant. Although the job title was not ‘case manager,’ I found that my daily interactions with the employees were in fact all about case management. I was listening, evaluating, educating, promoting lifestyle changes and optimal health and found sincere satisfaction in this role. Building trusting relationships that helped the employees make healthy changes to their lifestyle was truly rewarding.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

About two years later, a new managed care organization (MCO) came to town. They were hiring case managers. My children were all in school and I loved the idea of working a ‘normal’ schedule and being home together as a family at night. So I accepted a position with the MCO and learned so much about case management, utilization review and the business side of healthcare, which I found fascinating. I couldn’t learn enough, fast enough.

In brief, describe your organization.

I am currently district director of case management for Kindred Healthcare, a national post acute for-profit healthcare company; I work in the Long-Term Acute Care Hospital (LTACH) division. Our company has over 120 LTACHs, 224 skilled nursing facilities (SNF), five inpatient rehabilitation facilities and 47 home care and hospice locations. We consider ourselves to be the provider of choice for patients, post acute care needs.

What are two or three important concepts or rules that you follow in case management?

First and foremost; patient advocacy. I tell new case managers that if they have a need to be popular, case management may not be the career choice for them. Case managers have an obligation to the patient first, then to the organization. Oftentimes, this can cause conflict between administration and case management.

Secondly, ensuring stewardship for both the patient and for the organization one works for. Simply said, this means ensuring that the patient receives the right care, in the right setting, at the right time. Continuing inpatient care in the hospital longer than a patient needs to be there not only places them at risk for hospital-acquired conditions, but also continues to utilize their hospital benefit and in the Medicare population, this is limited. Hospitals are often paid as a prospective payment system, meaning they receive one amount regardless of length of stay or resource consumption. The case manager helps ensure appropriate utilization of resources and timely discharge planning.

Lastly, that discharge planning is probably the case manager’s most important responsibility. Ensuring resources are in place, that patient/caregiver teaching has been completed, and that they are able to verbalize an understanding of the discharge plan are critical steps in facilitating a safe appropriate discharge plan. The role of the case manager is to facilitate this through the entire interdisciplinary team; ensuring pharmacy has reconciled medications, diabetic teaching has been completed by the nurse, equipment needs and use have been reviewed by physical or occupational therapy, care for a percutaneous endoscopic gastrostomy (PEG) tube or wound has thoroughly been reviewed with the patient and/or their caregivers. The case manager also ensures that there is a solid understanding of who the post discharge caregivers are, what appointments need to be made or kept and a phone number to call if there are any issues that arise post discharge from the hospital. Not only is thorough discharge planning critical to patient safety, but also to preventing rehospitalizations.

What is the single most successful thing that your organization is doing now?

We continue to improve our efforts with care coordination and care management as we strategize to become the post acute care provider of choice for our market areas in the country. We are working with the Pioneer ACOs to identify ways we can help ensure progression of care through the continuum and reduce readmissions. This is an exciting time for us, as it is for our nation, as we embark upon a new healthcare delivery system.

Do you see a trend or path that you have to lock onto for 2012?

It is critical that we do not lose sight of what is happening with healthcare reform, and continually plan for the effects it will have on balancing patient outcomes through care transitions along with pay for performance and changes to provider reimbursement methods.

What is the most satisfying thing about being a case manager?

There are so many potential answers to this question! But personally, I would say that as a case manager, I learn something new every day of my practice, that it is continually both challenging and rewarding and there is never a day where I look at the clock and say ‘It’s only 3:00?’ On the contrary, I look at the clock and say ‘It’s already 3:00?!’

Where did you grow up?

I was born and raised in Boston, Massachusetts on the North shore. Being near the sea is something I would never sacrifice!

What college did you attend? Is there a moment from that time that stands out?

I attended Rivier College in Nashua, NH for my undergraduate degrees and George Washington University for my Master’s degree. The most important thing I took away from my master’s program was gaining an understanding of the value of other’s perspectives — perception is reality — and the extremely positive impact that has had on my world view.

Are you married? Do you have children?

My husband and I will be celebrating our 30th wedding anniversary this year. We have three children in their 20’s whom we are very proud of; one is an attorney, one is a teacher, and one is a nursing student.

What is your favorite hobby and how did it develop in your life?

My absolute favorite hobby is travel. I have created a ‘bucket list’ of things I would like to do, places I would like to visit. Hopefully, Italy and Hawaii will be next on our itinerary! I also enjoy research, writing and have an interest in historical fashion trends.

Is there a book you recently read or movie you saw that you would recommend?

I am currently reading ‘Transforming Ourselves and the Relationships that Matter Most’ by Lisa Oz, wife of Dr. Mehmet Oz. I enjoy ‘self-help’ books and always look for ways to better understand human behavior and relationships. As a case manager, it is imperative that we understand human behavior and how we can help influence patients to make lifestyle changes that they want to make while promoting optimal health. Relationships define us both personally and professionally and understanding how to make the best of each one can only lead to a happier, more fulfilling life.

Any additional comments?

I would be remiss to let this opportunity to ‘add a comment’ go by without espousing that I believe case management is one of the top professions for nurses and social workers. Patients need case managers to help them navigate the ever-changing world of access to healthcare and other resources. It is a very rewarding career that is always challenging, never boring and always manages to bring a tear of joy along with those of sadness as we continually advocate and empathize with our patients and families.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Medicare Weighs in on Obesity Counseling for Seniors

December 15th, 2011 by Cheryl Miller

Call it Medicare meets the Biggest Loser.

CMS is now swallowing the costs of screening and counseling for beneficiaries considered to be obese, or at risk for obesity. Doctors determine patients' eligibility, and those who meet the requirements, or have a BMI greater than or equal to 30 kg/m2, get to participate in the program.

Eligible "contestants" receive dietary and nutritional assessments and face-to-face counseling sessions in a physician's office each week for a month, and then every other week for an additional five months. The "biggest losers," or those that lose at least 6.6 pounds, or 3 kg during those six months, get continued sessions for up to a year.

The benefits of the program far outweigh the costs, given the burden that obesity places on states: a recent study from Duke University showed that obesity costs states $15 billion a year in medical expenses. And according to the CMS, over 30 percent of both men and women in the Medicare population are estimated to be obese, a condition that is directly and indirectly associated with many chronic diseases, including those that disproportionately affect racial and ethnic minorities such as cardiovascular disease and diabetes.

Efforts to help curb the epidemic aren't new; as we reported in our recent survey on Obesity and Weight Management, nearly 72 percent of respondents said they were implementing programs to manage weight or prevent obesity. While adults accounted for the largest population target, 6.4 percent of respondents said that they were targeting the Medicare population with their weight control programs.

Unlike the "Big Reveal" on the network series, we won't get to see the transformed patients, unless they land gigs with Weight Watchers or Jenny Craig. But the program might take an ever so small bite out of the existing healthcare costs facing us today, and the participants’ loved ones might get to hold onto them (figuratively?) for a little longer.

Four Transitions for Back-To-School

September 12th, 2011 by Cheryl Miller

It's back to school time, and the healthcare industry is undergoing its fair share of transitions.

  • NCQA is launching a new accreditation program for ACOs this fall. The organization worked with consumer advocates, purchasers and other healthcare and managed care experts to develop seven standards by which it will evaluate ACOs. Early bird adopters of the accreditation effort can get reduced rates on survey fees, online education tools and promotion. Order the NCQA ACO standards.
  • The one-year report card on Cigna's ACO approach with Medical Clinic of North Texas (MCNT) is in; and both healthcare systems are reporting excellent grades in four key areas: reducing avoidable emergency room visits, following evidence-based medicine, lowering medical costs and better controlling diabetes. Since the accountable care program began, MCNT has received the highest level of recognition from NCQA for meeting national quality standards for physician group medical homes. Cigna helped by sharing patient-specific data that identifies individuals who could benefit most from additional outreach and follow-up care.
  • Medical students, rather than teachers, are getting apples this year: Apple iPads. Many universities, including Yale Medical School, profiled here, are downloading curriculum onto the tablets in an effort to be more "green," save money, and protect patient confidentiality. Computer security has been a particular concern for the Yale School of Medicine, and the iPad is compliant with security and privacy laws and does not carry the same risk of information loss that a laptop might, Yale officials say.
  • And finally, a lesson that can't be taught enough: smoking just a few cigarettes can kill. A new report from the CDC shows that smokers are smoking less: the percent of daily smokers who smoke nine or fewer cigarettes per day rose to nearly 22 percent in 2010, up from an estimated 16 percent in 2005. But smokers need not be heavy or long-term smokers to be affected with a smoking-related disease, or suffer a heart attack or asthma attack, CDC officials say. And states with the toughest anti-smoking campaigns, like like Maine, New York and Washington, have the fewest smokers. Which just goes to show that even the most resistant students can be taught to change their ways.
  • Warning: Winds of Healthcare Change Ahead

    August 29th, 2011 by Cheryl Miller

    As we go to press Friday afternoon, Hurricane Irene is threatening to pummel our eastern coastline with winds greater than 80 mph; store shelves have been emptied of bottled water and batteries and anyone searching for a generator is probably out of luck.

    Healthcare, too, is preparing for the winds of change as reform laws descend upon it, and many preparations are being made in its wake. HHS just announced it is awarding $40 million in grants to identify and enroll children eligible for Medicaid and the Children's Health Insurance Program (CHIP). The two-year grants are authorized under the Children’s Health Insurance Program Reauthorization Act (CHIPRA) of 2009, and part of the administration’s push to ensure all eligible children.

    In a move to address shifting reimbursement plans, CMS is proposing four bundled payment plan models. These models are designed to align payments for services delivered during an episode of care, rather than paying for services separately. This new initiative will give providers the flexibility to determine which episodes of care and which services will be bundled together. Read more about this proposal in this week's Healthcare Business Weekly Update.

    And lastly, nearly one of every 10 mid-sized or big employers might stop offering health coverage to workers after insurance exchanges begin operating in 2014, states a recent survey from Towers Watson. The survey, which involved more than 1200 companies, says that the companies are willing to risk the ensuing fees and tax headaches that could arise with such a move. Last year, the average annual health insurance premium for employer-sponsored family coverage was $13,770 per worker, with companies picking up most of that tab,
    according to the Kaiser Family Foundation and Health Research and Educational Trust. That cost has more than doubled since 2000.

    But survey officials stress that these results aren’t written in stone, and that employers could change their minds given all the unresolved variables, not unlike the hurricane headed our way. We’ll just have to see what path the storm takes.

    U-M’s Care Strategies Save Medicare $22 Million, Demonstrate ACO Benefits

    August 22nd, 2011 by Cheryl Miller

    Improving preventive and chronic care helped the University of Michigan (U-M) to save Medicare more than $22 million during a five-year Physician Group Practice Demonstration (PGPD), which was designed to show the potential benefits of ACOs. A new transitional care program assisting patients with hospital discharge and follow-up was one of the ways the health system successfully achieved savings.

    HHS has awarded $185 million in grants to 13 states and the District of Columbia to help them establish new state-based health insurance
    marketplaces. The agency is hoping that individuals, families and small businesses will be able to use the exchanges to purchase private health insurance beginning in 2014.

    And lastly, don’t forget to participate in our second annual survey on medication adherence. You'll receive a free executive summary of the survey results once they are compiled. To take the survey, please click here.

    These issues and more in this week's Healthcare Business Weekly Update.

    Less is More When it Comes to Healthcare

    August 19th, 2011 by Cheryl Miller

    Less is more, at least when it comes to certain medical procedures.

    That was the conclusion of a recent study by the American Heart Association (AHA) and reported here in a recent issue of Healthcare Business Weekly Update. Researchers compared the use of drug-eluting stents (DES) in 2004-06 to 2007, when their use decreased by nearly 25 percent. Using data from the Evaluation of Drug-Eluting Stents and Ischemic Events registry, the study found that limiting the use of DES did not increase the risk of death or heart attack, and only slightly raised the need for repeat angioplasty procedures. In fact, because the stents were reserved for use on higher risk patients, healthcare costs were reduced by an average of $410 per patient. When multiplied by the estimated 1 million angioplasty procedures performed annually, the United States is able to save nearly 400 million a year.

    A recent story in Newsweek corroborates this research, and suggests that the use of DES weren’t the only medical procedures being overused. The article goes on to state that some common tests and procedures aren’t just expensive, but can do more harm than good.

    “There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the Archives of Internal Medicine.

    The problem is that “in otherwise healthy people,” screenings can lead to false positives, and cascading tests and procedures for possible problems that might have been harmless, or gone away on their own, the article says.

    From PSA tests for prostate cancer (which more than 20 million U.S. men undergo every year) to surgery for chronic back pain to simple antiobiotics for sinus infection, a remarkable number and variety of tests and treatments are now proving either harmful or only as helpful as a placebo.

    The article doesn’t dismiss the benefits of progressive medicine; instead, it lists the procedures that have saved lives and eased suffering for millions:

    Screening tests like mammograms...can lead to early treatment of breast cancer, especially for women with hereditary risk or a strong family history of the disease. For cancer patients who report back pain, MRIs can prove invaluable for spotting tumors that have metastasized to the bones, allowing doctors to intervene before it’s too late. The years between 1980 and 2004 saw a 50 percent decline in the death rate from coronary heart disease thanks to better treatments and drugs that reduce cholesterol and blood pressure. At least 7,300 lives are saved every year thanks to colonoscopies.

    But the flip side is that procedures are being overprescribed, like colonoscopies for the elderly, which can often harm them, and CT scans for the injured. A study published by John Hopkins noted the rise in MRIs and CT use in emergency departments over a 10 year period, from 1998 to 2007. The Hopkins team found that patients with injury-related conditions were three times more likely to get a CT or MRI scan in 2007 than they were in 1998. But the team also found that diagnosis of life-threatening conditions, such as a cervical spine fracture or liver laceration, rose only slightly.

    Part of the problem is compensation: according to the Newsweek article, Medicare pays physicians more than $100 million a year for screening colonoscopies; still other procedures, like angioplasty, bypass surgery and stenting are not improving cardiac patients’ lives; but instead costing Medicare more than $1.6 billion a year.

    The solution? The study published by the AHA didn’t directly identify which patients are the best candidates for DES, although other studies are currently underway using similar patient registries to address it. And research shows that low risk heart patients can benefit more from noninvasive treatments like drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet.

    With the push for reducing healthcare costs while improving care, it’s an issue that will most probably continue to be explored.