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From the editor Dear Healthcare Intelligence Network Client,
The Affordable Care Act (ACA) continues to make headlines, as many online health insurance marketplaces struggle to meet the overwhelming consumer demand of healthcare seekers, and, at least at press time, the government continues to wrestle its merits as the country remains in shutdown mode. Nearly 85 percent of the health plans offered in the health insurance marketplaces that were scheduled to launch last week are accredited by the National Committee for Quality Assurance (NCQA), the organization reports. Officials say the surge of nearly 60 health plans seeking accreditation prior to the October 1st launch date was one of the largest in NCQA’s 23-year history. Hundreds of other plans that already held NCQA accreditation modified it in order to participate in the exchange marketplaces. Those who stand to benefit the most from the ACA are newly-insured consumers under an expanded Medicaid program, according to a new RAND Corporation study. While out-of-pocket medical expenses for most Americans will decline with the new healthcare law, the estimated 11 million Americans who become newly-insured under Medicaid can expect to save approximately $1,420 annually in out-of-pocket expenses, researchers say. Those Americans who become newly insured but don't qualify for government subsidies will most likely see the largest increases in medical spending as they begin paying premiums for health coverage. The report also details the findings of states that have chosen not to expand Medicaid, and discusses the clearest benefit of the law. In other news, two healthcare organizations, naviHealth and Cigna-HealthSpring, have joined forces to maximize their acute patient care and outcomes and help reduce escalating costs. The collaboration will utilize naviHealth’s technology (which facilitates better evidenced-based decision-making), and acute inpatient case management processes for Cigna-HealthSpring members receiving skilled nursing facility (SNF) services. Expected benefits of the partnership for Cigna-HealthSpring and its members include improved patient satisfaction with personalized care plans, and more informed and efficient care delivery. Informed and efficient care delivery also prompted researchers from Penn Medicine to study whether busy intensive care units (ICUs) discharge patients more quickly than usual, compromising patient care and outcomes. Anticipating increased numbers of patients requiring critical care resources, and a projected shortage in critical care providers, researchers assumed there would be increased competition for ICU beds among greater numbers of more seriously ill patients, and shorter periods of time available in the ICU, leading to declining health outcomes. But researchers found the opposite: reductions in the number of U.S. ICU beds could yield considerable cost savings without reducing the quality of care. The study's findings have important implications for planning U.S. critical care capacity, researchers note. It’s not too late to participate in our online survey, Health Risk Assessments in 2013. 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 by October 15, 2013 and get a FREE executive summary of the compiled results. Your colleague in the business of healthcare,Cheryl Miller Editor, Healthcare Business Weekly Update Please send comments, questions and replies to [email protected].
Publisher: HIN podcasts
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This week's featured download:
Home Visits in 2013 — House Calls Foster Medication Adherence,
Patient Satisfaction
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October 7, 2013
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This week's industry news
1.) NaviHealth/Cigna-HealthSpring Partner to Improve Post-Acute Care, Costs
2.) 2013 Healthcare Benchmarks: Case Management
3.) Intensive Care Units Do Better Under Pressure: Study
4.) 33 Metrics for Care Transition Management
5.) Healthcare Business White Paper: Mobile Health in 2013 — Diabetes, Heart Disease Top Targets for Technologies
6.) Affordable Care Act Will Reduce Out-of-Pocket Medical Spending for Many Americans
7.) New Chart: Greatest Challenges of Embedding a Case Manager
Click here to view the chart.
8.) Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management
9.) 4 Out of 5 Marketplace Health Plans Hold NCQA Accreditation Almost 85 percent of the health plans offered in the Health Insurance Marketplaces that launched last week are accredited by the National Committee for Quality Assurance (NCQA). Get the full story. >>Return to this week's industry news
10.) Health Insurance Exchanges: Product Design, Promotion and Positioning
11.) 4 Steps to Creating a Care Management Team
12.) Tactics from a Top-Performing Pioneer ACO: Engaging Patients and Providers in Accountable Care
13.) Infographic: The Current State of EHRs
14.) Embedding Case Managers in an Open, Multi-Payor Community
Then there are the not insignificant contributions of the RN case manager to accountable and patient-centered care, which Ms. Watson describes in this interview.
While staff-buy-in and communication continue to challenge the embedded case manager model, the participant in CMS Innovation Center's Comprehensive Primary Care (CPC)
initiative says reimbursement for embedded case management is less of an obstacle today than in the past, due to funding-friendly care models and pilots descending from
healthcare reform.
Thank you for your readership! Please urge your colleagues to subscribe by forwarding this email or visiting http://www.hin.com/freenews2.html or by calling (888) 446-3530 or visiting the HIN Web site. While we encourage you to forward this email to your colleagues, these articles may not be redistributed in any other publication, reproduced for publication in any form, distributed on an intranet or network or by e-mail distribution or distributed for commercial purposes without the expressed written permission of the Healthcare Intelligence Network. |
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This resource provides actionable information from 118 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-
driven outcomes in healthcare utilization, cost and compliance.
This resource provides a graphic compendium of performance benchmarks in key areas impacting care transitions — from key tasks performed at hospital discharge to the
prevalence of home visits in programs to improve medication adherence.
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 its first mHealth e-survey conducted in March 2013, the Healthcare Intelligence Network (HIN) captured
current trends in emerging mHealth technologies. Nearly 150 healthcare organizations describe the technologies they use, the conditions and populations they target, and the
challenges and successes they've encountered along the way.
Care coordination by healthcare case managers is helping to drive clinical and financial outcomes in population health management and bolster emerging models of care such as the
patient-centered medical home and the accountable care organization. We wanted to see what challenges healthcare organizations face when embedding a case manager.
This webinar shares Wellcare’s strategy for meeting a broad spectrum of a member’s needs with community-based services and how these partnerships contribute to the engagement of
duals in self-management of their care.
This resource provides a comprehensive overview of this new health insurance marketplace, and outlines factors that are driving carriers’ decisions to participate in exchanges,
and includes strategies that will help providers plan for operational costs and challenges to exchange participation, such as enrollment and billing hurdles.
This resource provides first-year advice from Monarch HealthCare’s Medicare accountable care organization, one of 32 original CMS Pioneer ACOs engaged to test alternative
payment and program design models for accountable care organizations.
There's education, there's experience, and then there’s the 'right stuff' — the indefinable personality traits that earmark an individual as a change agent, collaborator
and ambassador of case management, says Annette Watson, senior vice president of community transformation for Taconic IPA (TIPA), of TIPA's requirements for the RN case
managers it hires for its advanced patient-centered medical homes.