Posts Tagged ‘ACA’

Healthcare Business Week in Review: Children’s Health Coverage, ACOs, Reducing ED Visits

January 10th, 2014 by Cheryl Miller

Some good news to welcome in the new year: nearly two-thirds of the nation’s leading healthcare executives believe the healthcare system will be somewhat or significantly better by 2020 than it is today as a result of national healthcare reform, according to a study published in the Health Affairs blog.

Additionally, 93 percent believe that the quality of care provided by their own hospital or health system will improve during that time period. The findings, based on research by the University of Pennsylvania and the Children’s Hospital of Philadelphia, includes responses from 74 senior executives from large hospitals and health systems across the United States.

More good news: doctors, hospitals and other healthcare providers have formed 123 new Medicare ACOs, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States.

According to a CMS announcement, the new ACOs include a diverse cross-section of healthcare providers across the country, including providers delivering care in underserved areas. More than half of ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately one in five ACOs include community health centers, rural health clinics, and critical access hospitals that serve low-income and rural communities, CMS said.

Good news extends to low-income children as well, with our report that 23 states received over $307 million in bonuses for improving access to children’s health coverage and successfully enrolling eligible children in Medicaid, according to CMS.

States that met at least five out of eight specific features to streamline enrollment, including using data-matching to reduce paperwork and eliminating face-to-face interview requirements, received performance bonuses, designed to offset the costs of insuring this demographic, and initiated by The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

Some news to ponder: contrary to the idea that convenience prompts many privately insured people to seek care in emergency departments (EDs), those most likely to use EDs believe they urgently need medical attention, according to a new study by the Center for Studying Health System Change (HSC).

Only rarely did respondents cite convenience as a reason for choosing ED care. About one in four people (24.8 percent) reported their doctor’s office was closed when they needed help, and close to a quarter (24.1 percent) indicated their physician instructed them to go to an ED.

Wondering what healthcare industry areas are ripest for expansion in 2014? Check out our latest HINfographic: 7 Value-Based Priorities for Healthcare’s Smart Money, based on the latest HIN market research.

Healthcare Business Year in Review: A Look Back at 2013’s Top Stories

January 9th, 2014 by Cheryl Miller

From an early surge in Medicare accountable care collaborations to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 was nothing short of unpredictable.

But in this issue, as in “Best of” issues past, we bring you the stories that resonated most with you. Your top story was one that ran nearly a year ago: Post-Hospital Telephonic Outreach Reduces Readmissions by 22 Percent for High Risk Patients. This initiative from Cigna monitored telephonic outreach by health plan case managers within 24 hours of hospital discharge, finding that they reduced future readmissions by 22 percent. Resulting in more physician visits and prescription drug fills, the timing and prioritizing of the calls was critical to its success.

Case managers’ roles in long term care also spiked your interest in our featured white paper: Case Management in 2013: Achieving Results with Cardiovascular Disease; Long-Term Care Next Frontier for Embedded Case Managers. As care coordination by healthcare case managers continues to drive clinical and financial outcomes in population health management, expect to see lots more case managers — not just coordinating care telephonically like Cigna, but co-located in nursing home, long-term care (LTC) and assisted living settings.

Other top stories included CMS’ announcement that Medicare beneficiaries saw significant out-of-pocket savings due to the ACA, including provisions to close the prescription-drug “donut hole” that saved more than 7.1 million seniors and people with disabilities $8.3 billion on their prescription drugs since it took effect.

How the ACO model figures in most hospitals’ futures also topped your reading list, as did a story on how 24 states and the District of Columbia chose a benchmark health insurance plan that met the ACA’s essential health benefit requirement, which is scheduled to begin next month, January 2014. Researchers found that 19 of the states that selected plans chose existing small-group plans, employer-based plans for businesses with fewer than 50 employees. The remaining five states selected HMO or state employee benefit plans.

An infographic on 2013’s Most Significant Healthcare Issues, and our podcast on Physician Hospital Organizations: Developing a Collaborative Structure for Shared Savings Agreements also attracted the most views.

We will continue to provide you with the kind of up-to-the-minute coverage you need to stay informed.

And as with issues past, we send our best wishes to all of you for a happy, healthy, prosperous and peaceful new year.

Healthcare Business Week in Review: Infectious Disease Threats, Health Insurance, Bundled Payments

December 23rd, 2013 by Cheryl Miller

From antibiotic-resistant superbugs to salmonella to the seasonal flu, infectious diseases are disrupting lives throughout the country at an alarming rate, and driving up medical costs, and most states are unable to counter them, according to a report by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).

The problem? Outdated systems and limited resources. In fact, 34 states scored five or lower out of 10 key indicators of policies and capabilities to protect against infectious disease threats.

One solution offered in this comprehensive analysis is to be more vigilant with vaccinations; only one-quarter of states vaccinated at least half of their population against the seasonal flu, which affects 20 percent of Americans each year. Details inside.

Rising medical costs were the primary driver of recent rate increases by health insurers, accounting for three-quarters or more of the larger premium hikes requested between July 2012 and June 2013, a new Commonwealth Fund study finds.

The analysis is the first such report to take a national look at the explanations insurers file with federal and state authorities to justify rate increases of 10 percent or more, as required by the ACA. Currently, insurers are only required to submit rate increase explanations for non-grandfathered plans, or those plans that became available after the enactment of the health reform law.

People whose existing healthcare insurance has been canceled because of the ACA will not be hit with tax penalties for failing to line up new coverage as required under the law, according to Health and Human Services Secretary Kathleen Sebelius. Under a “temporary hardship exemption,” they will be able to buy a bare-bones catastrophic plan regardless of their age.

Reducing health insurance premiums is one strategy employers are using to incent their employees to self-manage their health. Healthcare companies have grown increasingly creative in their use of economic and benefit-based incentives to drive engagement and participation in health and wellness programs, according to Healthcare Intelligence Network research.

Reducing joint replacement payments – specifically knees, which, at 600,000 annually, are the most commonly performed knee replacement procedure in the United States – is the aim of Florida Blue and Mayo Clinic’s knee replacement bundled payment agreement, first introduced in 2012. They have announced they are extending it, and their overall network agreement to include thousands of Florida Blue’s commercially insured members throughout the state who are now able to access Mayo Clinic as an in-network provider.

And lastly, there is no replacement for a little TLC, in the form of paraprofessionals or nurses visiting the homes of low income pregnant women and their children. Researchers from the University of Colorado School of Medicine found that these helpers, part of the Nurse-Family Partnership, helped improve the health and development outcomes for the children ages six through nine.

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, 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.

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.

Healthcare Business Week in Review: Patient Satisfaction; Health Insurance Marketplaces; Physician Shortage

November 15th, 2013 by Cheryl Miller

Familiarity does not breed contempt; instead, it leads to increased patient satisfaction scores, according to a new Vanderbilt study.

Realizing that nearly 90 percent of medical patients are unable to correctly name their treating physician following inpatient admission, researchers studied the effects of giving a randomized group of patients a simple biosketch card about their doctor. Patient satisfaction scores for the group receiving the card were 22 percent higher than those who did not receive the card. With Medicare reimbursements linked to HCAHPS patient satisfaction scores, this study has significant ramifications.

Some good news about the health insurance marketplaces: despite widespread difficulty accessing the online sites, public awareness has tripled since their October 1st launch, and a majority of those unable to access them will try again, according to a new Commonwealth Fund survey.

According to the survey brief, more than half (58 percent) of those who are potentially eligible for coverage but who have not yet enrolled say they are likely to try to enroll or find out about financial help by March 31, 2014, the end of the open enrollment period. Seventeen percent of Americans who are potentially eligible for coverage have visited new health insurance marketplaces to buy coverage, via mail, Internet, phone, or in person. And nearly a third of adults who visited the marketplaces ranked their experiences as good or excellent. The extensive tracking survey is expected to come out again in December.

The expected glut of newly insured Americans seeking healthcare under the ACA could result in anticipated shortage of primary care physicians (PCPs) over the next decade, according to a new RAND Corporation study.

Expanding the role of nurse practitioners and physician assistants could help eliminate this. By using new models of healthcare that depend more on non-physicians, such as patient-centered medical homes (PCMHs) and nurse-managed health centers, more than 50 percent of the expected shortage predicted to hit the United States over the next decade could be eliminated.

One way to keep Americans healthy: offer them incentives. And while offering NASCAR® tickets for completing a health risk assessment (HRA) might not be successful for everyone, they were the right incentive for one trucking company surveyed by Buck Consultants’ National Clinical Practice, says principal Patricia Curran. Many companies offer employees incentives for wellness participation, but they need to look at their population and determine what would most motivate them. We detail more in this week’s featured book excerpt.

Need an incentive to finish our current online survey on Healthcare Trends in 2014? How about a training DVD of the “2014 Healthcare Trends and Forecasts” webinar recorded on October 30, 2013? One lucky respondent to our survey will win it, so please tell us about the last 12 months and how your organization is preparing for 2014 by completing HIN’s ninth annual survey by November 18, 2013.

Healthcare Business Week in Review: Medicare beneficiaries, Pediatric Mental Health, Hospital Scorecards

November 8th, 2013 by Cheryl Miller

The insurance marketplace rollout continues to be problematic for many consumers, but there is some good news for Medicare beneficiaries: they are seeing significant out-of-pocket savings since the ACA was implemented, savings that will most likely continue through 2014, CMS officials say. Plus, they don’t need to sign up for the new health insurance marketplaces, as they are already covered by Medicare.

Some disturbing news from the Annual American Academy of Pediatrics: mental health diagnoses for children have jumped 30 percent in the last four years, with ADHD leading the pack, followed by anxiety, depression, and eating disorders. Mental health diagnoses run about a third higher for children with Medicaid insurance compared with commercial coverage, researchers say, and clinicians need to seek a deeper understanding as to why. More inside.

Nearly 440,000 Americans are dying annually from preventable hospital errors, making them the third leading cause of death in the United States, according to a Fall 2013 update to The Leapfrog Group Hospital Safety Score report.

The annual report, which also assigns A, B, C, D and F grades to more than 2,500 U.S. general hospitals, shows that many hospitals are making headway in addressing errors, accidents, injuries and infections that kill or hurt patients, but overall progress is slow.

The extensive report also lists the states that earned the highest and lowest grades: among them, Maine claims the number one spot for the state with the highest percentage of “A” hospitals.

A significant and growing performance gap exists between dual eligible and non-dual eligible members when it comes to CMS Five-Star Quality rating measures, according to a study from Inovalon, Inc., a leading provider of data-driven healthcare solutions.

The study finds that a significant association exists between Medicare-Medicaid dual eligible status and lower performance on specific Part C and D measure Star ratings. The results point to the integral role that income, race/ethnicity, and gender play on the HEDIS® and CMS Part D measures used in the Five-Star rating system.

It’s not too late to take our Healthcare Trends in 2014 survey; from an early surge in Medicare ACOs to the rocky introduction of ACA-mandated health insurance exchanges during a government shutdown, healthcare in 2013 has been nothing short of unpredictable. Please tell us about the last 12 months and how your organization is preparing for 2014 by completing HIN’s ninth annual survey on Healthcare Trends by November 18, 2013. You’ll receive a free executive summary of the compiled results, and your responses will be kept strictly confidential. One respondent will win a training DVD of the “2014 Healthcare Trends and Forecasts” webinar recorded on October 30, 2013.

Healthcare Business Week in Review: Affordable Care Act, Medical Apps, Cardiac Care Costs

October 4th, 2013 by Cheryl Miller


Technological problems hindered aspects of the October 1st rollout of the new health insurance exchanges — both at the state and federal level. According to New York Times reports, some aspects of the eagerly awaited exchanges in several states, including Oregon, Colorado, District of Columbia and Nevada, may not be fully operational for weeks and even months, with some officials referring to October as a “soft launch” period.

Last week, the Obama administration acknowledged it will not be ready to accept online applications from small businesses when the program officially launches October 1st.

Once fully operable, the exchanges, one-stop online shopping sites for consumers’ health insurance needs, will enable consumers to comparison shop for health benefits much like they do now for airline tickets or hotel rooms, and see if they qualify for tax credits. Plans are categorized according to levels of coverage and co-pays, and no one can be denied coverage because of preexisting conditions. There will be a six-month open enrollment period that runs through March 2014, and coverage should begin as early as January 1st.

Smart phones can now diagnose abnormal heart rhythms, act as ultrasound devices, or function as the “central command” for a glucose meter used by a person with insulin-dependent diabetes. To ensure that patients’ safety isn’t compromised for the sake of technological innovation, the FDA is clamping down on those apps considered dangerous. The agency has cleared about 100 mobile medical applications over the past decade; about 40 of those were cleared in the past two years.

The costs of patient care after heart attacks, continues to climb, according to a new study from the University of Michigan (U-M) Frankel Cardiovascular Center. Despite advancements in cardiac care and increases in less invasive procedures to treat symptoms, including more angioplasty instead of open heart surgery, hospital stays have decreased by just one day. Medicare spending to treat heart attack patients rose by 16.5 percent between 1998 and 2008, with the majority of costs incurred weeks after patients left the hospital.

According to researchers from the NYU School of Medicine, elderly nursing home residents with advanced dementia who were enrolled in a Medicare managed care insurance plan were more likely to have do-not-hospitalize orders and less likely to be hospitalized for acute illness than those residents enrolled in traditional Medicare. The frail elderly received more nursing home-based primary care visits every 90 days, and more nursing home-based nurse practitioner visits in general. The extra individual attention precluded the need for more acute treatment, and resulted in less aggressive, more humane end-of-life care.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material for the development of prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health on our Health Risks Assessments online survey by October 15, 2013 and get a FREE executive summary of the compiled results

Healthcare Business Week in Review: Managing Heart Disease; Insurance Reform; Hospital Charge Disparities

September 13th, 2013 by Cheryl Miller

Nearly one in three Americans die of cardiovascular disease (CVD), including heart disease and stroke, each year, according to the latest Vital Signs report from the CDC. In 2010 alone, more than 200,000 deaths from CVD occurred, with more than half happening to people younger than 65 years of age.

Most CVD can be managed or prevented in the first place by addressing risk factors, such as reducing blood pressure and cholesterol and quitting smoking, CDC officials say, and they offer a list of recommendations for providers, communities and health departments for reducing the death rates.

Contrary to reports that individual health insurance policy costs will jump steeply under the ACA, there will be no widespread premium increase, according to a RAND analysis of 10 states and the United States.

There will be widespread differences in individual policy costs from state to state, however, as well as an increase in health insurance coverage and higher enrollment among people who purchase individual policies.

RAND researchers predicted how the ACA will likely change cost and coverage patterns in both the individual market and small group market in 10 states, including Florida, Kansas, Louisiana, Minnesota and New Mexico. Costs will be influenced by a specific range of individual factors, including age, tobacco use, geographic location, family size and amount of coverage purchases.

Geographic diversity is at the root of another study from the Center for Studying Health System Change (HSC). According to the report, hospital prices for privately insured patients — especially for outpatient care — are much higher than Medicare and vary widely within and across communities.

Within individual communities prices vary widely, even after accounting for differences in the complexity of services provided. The highest-priced hospital typically is paid 60 percent more for the same inpatient services than the lowest-priced hospital. The price gap within markets is even greater for hospital outpatient services, with the highest-priced hospital typically paid nearly double the lowest-priced hospital, according to the study.

In contrast to hospital prices, prices for PCP services generally are close to Medicare rates and vary little within markets, the study found. Prices for specialist physician services, however, are higher relative to Medicare and vary more within and across markets.

And lastly, sophisticated analytics behind today’s health risk assessments or health risk appraisals (HRAs) provide employers, payors and providers an aggregate view of population health and the raw material to develop prevention and lifestyle change programs. Tell us how your organization uses HRAs to improve population health in our Health Risk Assessments e-survey by October 15, 2013 and get a FREE executive summary of the compiled results.

Healthcare Business Week in Review: Yoga for Caregivers, Diabetes Management, Healthcare Coverage

August 2nd, 2013 by Cheryl Miller

Offering yoga and meditation classes to caregivers of seriously ill patients just prior to starting clinical meetings on palliative care issues is one detail that sets Mount Sinai Hospital’s palliative care program apart from others. Together with Denver Hospice and Optio Health Services in Colorado, and UnityPoint Health Palliative Care Program in Iowa and Illinois, these three palliative care programs received the 2013 Circle of Life Award®, along with five others that were awarded Citations of Honor from the American Hospital Association (AHA).

Other programs involve a community-wide program to embrace the growing Hispanic community, and regular outpatient and home visits to ensure proper care transitions, and help avoid unnecessary emergency room visits and readmission to the hospital. All of the programs set out to reexamine the roles palliative care plays in healthcare by creating and championing end-of-life care for patients and caregivers throughout the healthcare system.

Providers need to reexamine certain diabetes monitoring practices that solely target acute individuals, and instead take a population health management approach to improving diabetes care, according to a Phytel study published in the American Journal of Managed Care.

Researchers found that despite national attention, uncontrolled diabetes was growing, and those patients at real risk were those that waited to seek care until their condition was exacerbated to an acute phase. A broader population-based approach was required to catch at-risk patients. Researchers recommend that provider organizations take two important steps to improve their ability to help their patients better manage their diabetes, including reaching out to their entire population between office visits so patients waiting too long to get retested are motivated to have the testing done earlier.

Economists need to reexamine their data linking the employment rate with healthcare coverage. Despite economic reports showing that the recession is over, the percentage of workers with health benefits still remains low, according to a new report by the nonpartisan Employee Benefit Research Institute (EBRI).

Links between the employment rate and health insurance coverage have been documented over the years. Since most workers in the United States get their health coverage through their jobs, a rise or drop in the unemployment rate usually means a corresponding rise or drop in the uninsured rate as well, the report states.

But these facts aren’t holding up against trends that show that nearly half of the population does not have coverage.

We’d like you to examine and respond to our current e-survey on the population health management of dual eligibles. These nine million Americans eligible for both Medicare and Medicaid present unique challenges. Public and private payors are now tailoring care coordination strategies for Medicare-Medicaid beneficiaries that are both geared to their medical, social and functional needs and cost-efficient. Describe your organization’s approach to care coordination of dual eligibles by August 6, 2013 and you will receive a free summary of survey results once it is compiled.