Healthcare Intelligence Network

Even though the specifics of Medicare's Shared Savings Program have yet to be defined, physician organizations can still position themselves to achieve cost savings through an independent accountable care organization (ACO), notes Jeffrey R. Ruggiero, Esq., a partner in the law firm of Arnold and Porter LLP, who is advising the Queens County Medical Society on its ACO approach. The advisor to one of New York State's largest physician ACOs describes the advantages of a physician-run ACO as well as some of the regulatory, compliance and operational factors to consider prior to ACO launch. Ruggiero described the Queens County Medical Society's ACO development approach during "Physician-Owned ACOs: Overcoming the Legal and Regulatory Compliance Challenges," a 45-minute webinar on January 19, 2011.

Was 2010 a better year for healthcare than 2009, and what were the best and worst business ideas in healthcare over the last 12 months? In this month's healthcare performance benchmarks podcast, Healthcare Intelligence Network's Melanie Matthews reviews the top healthcare trends and concerns for 2011 derived from HIN's October 2010 survey results. More actionable data on healthcare trends as well as 2011 industry forecasts from healthcare thought leaders William Shea of Cognizant Business Consulting and Steven T. Valentine from The Camden Group are contained in "Healthcare Trends and Forecasts in 2011: Performance Expectations for the Healthcare Industry," a 35-page report that reviews the industry landscape for 2011 and suggests how healthcare organizations can best position themselves for the 12 months to come.

Co-locating healthcare case managers in care settings can improve communication with patients as they move through the continuum of care, says Jan Van der Mei, regional director of continuum case management for Sutter Health Sacramento Sierra Region. Ms. Van der Mei describes the major issues that case managers face while helping patients navigate the Sutter system, as well as the key role of case managers in reducing hospital readmissions. Ms. Van der Mei is one of five contributors to the "Guide to Patient-Centered Case Management," a 110-page resource of best practices in identifying, stratifying and monitoring individuals for case management. It documents the returns generated by targeted case management interventions in place at Geisinger Health System and other organizations, and the Q and A chapter answers more than 50 questions on patient-centered case management.

The accountable care organization (ACO) is a staple of healthcare reform. CMS will launch its Shared Savings Program --- an ACO for Medicare patients --- in January 2012. John Harris, principal with the consulting firm of DGA Partners, advises potential participants in an ACO to lay the groundwork now. In this interview, he recommends eight elements of an ACO infrastructure and weighs in on the patient-centered medical home's role in an ACO. Harris is one of five contributors to "Essential Guide to Accountable Care Organizations: Challenges, Risks and Opportunities of the ACO Model," a 60-page resource that answers key questions surrounding ACOs so that hospitals, PHOs, IPAs and other physician organizations, networks or group practices can weigh the merits now of creating or joining an ACO before CMS's ACO launches next year.

More than a third of healthcare organizations have launched nurse advice lines to reduce avoidable emergency room use and direct patients to the most appropriate care venue, according to a July 2010 survey by the Healthcare Intelligence Network. The staffing and operation of Optima Health's nurse advice line is influenced by many factors, explains Patricia Curtis, director of operations, clinical care services for Optima Health. Curtis describes the distinct responsibilities of the LPNs and RNs who staff the advice line as well as the diverse needs of the member populations who call the advice line. Curtis will share how Optima's nurse advice line has evolved from a call center that supported a staff model HMO to a critical component of the organization's effort to improve the efficiency of healthcare utilization during "Maximizing the Nurse Advice Line To Ensure Appropriate Healthcare Utilization," a 45-minute webinar on January 6, 2011.

Thinking about creating an accountable care organization? The clinical integration of healthcare providers can be the first step, facilitating the coordination of services required for shared accountability and reward. Dr. Mark Shields, senior medical director with Advocate Physician Partners, describes the logistics of training 3,400 providers on clinical integration, the importance of the physician peer group in this effort, and the business case for the devotion of three of Advocate's 41 performance measures to smoking cessation and prevention. Dr. Shields will share Advocate's clinical integration strategy during "How To Create an ACO Framework Through Clinical Integration with Independent Physicians," a 45-minute webinar on December 1, 2010.

In the face of healthcare reform and new models of care delivery such as the patient-centered medical home, primary care physicians don't have to fly solo anymore, advises Dr. David Eitrheim, a family physician with the Mayo Clinic Health System in Wisconsin. Dr. Eitrheim describes how his practice's team-based approach has changed the nature of the patient visit as well as the nurses' workload, and provides the secret to a productive patient visit. Dr Eitrheim will share how his practice made the transformation from a traditional practice to a team-based approach during "Redesigning the Physician Practice for Improved Efficiency and Increased Revenue," a 45-minute webinar on December 15, 2010.

Who's using health risk assessments (HRAs), and how are they administered? What are the top incentives driving HRA completion, and what are the top three uses for HRA data? What completion rates can be expected? In this month's healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on HRA use. This month's metrics are derived from HIN's June 2010 survey on HRAs, with commentary from Dr. Marcia Wade, Aetna Medicare's senior medical director. More actionable data on ways that 116 healthcare organizations are using HRAs is contained in "2010 Performance Benchmarks in Health Risk Assessment Use," a 60-page resource providing metrics and measures on current and planned HRA initiatives as well as lessons learned and results from successful health assessment programs.

In an atmosphere of increased state and federal oversight of health plan rates, healthcare organizations need a sound strategy for determining premium rate increases that meet regulatory approval. HealthScape Advisors managing directors Steve Young and John Steele describe the challenges of setting rates in this environment and the essential experience that can best prepare health plans for dealing with commercial plans. Young and Steele will share how health plans can develop a sound policy for premium rate increases that will meet with regulatory approval during "Health Plan Rate Setting: Balancing Premium Increases Against Regulatory Oversight," a 45-minute webinar on December 8, 2010.

Medicaid managed care organizations can turn the tide on the rising cost of care management for their high-need, high-cost members by implementing integrated programs that simultaneously address medical and behavioral health conditions, says Dr. Sam Toney, Health Integrated's chief medical officer. In this podcast, Dr. Toney describes how integrated case management and integrated chronic condition management are especially beneficial to Medicaid's mostly vulnerable members as they navigate acute health crises as well as longer-term, sustainable efforts to improve their health status. For more information on Health Integrated, please visit: http://www.healthintegrated.com or call 800-323-0286.