20 March 2012

Midwest Edition
Calendar
April 25
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Midwest Has High Quality Scores

Minnesota is at Top of Commonwealth Survey
The upper Midwest and the Northeast ranked highest in quality of care on a new scorecard released by the Commonwealth Fund. This was the rst time the organization has drilled down to the local level to rank tangibles such as access, insurance coverage rates and hospital readmissions. The Scorecard on Local Health System Performance examined 306 communities and found that where one lives actually makes a difference in the healthcare they receive. Cities ranked at the very top of the list included: St. Paul, Rochester, Minneapolis and St. Cloud in Minnesota, Dubuque, Iowa, and Appleton and LaCrosse, Wisc. High-ranking locales tended to perform well in most areas and those near the bottom ranked lower across the board. There were no fast and hard rules to the ndings. But, large cities tended to have better performance than smaller ones. And overall, the communities with the highest poverty rates tended to perform worse than others. No community where more than 20% of people living below the federal poverty level ranked in the top 75 on access to healthcare. The one factor that most often proved to create higher performance was access. Uninsurance numbers were high in the south, where performance was lower, said David Radley, a co-author of the report. The maps almost overlap with access and quality. If people cant get in the door they cant receive high-quality care. They also found that indicators of poor lifestyles, like smoking, obesity and lack of access to dental care, were more than ve times prevalent in lower ranking areas than higher ones. They concluded that, if all areas performed as well as the top ranking ones, 30 million more individuals would be insured; there would be 1.4 million fewer Medicare hospital admissions and readmissions annually, saving over $8 billion; and 1.3 million fewer Medicare beneciaries would receive unsafe prescriptions. Dave Dillon, spokesperson for the Missouri Hospital Association, said this kind of data is very valuable. What you can measure you manage, he said. I just think having measurements will be helpful and it will help create a community-based approach to meet needs. This kind of data will be particularly helpful for nonprot hospitals as they work to report on ways to provide more community benet, a requirement under health reform, Dillon said. It may be a higher-level view than

April 27-28
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June 11-13
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Continued on Next Page

WEBINAR
E-Mail info@payersandproviders.com with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting.

Thursday, March 29, 2012

Noon CDT

REDUCING READMISSIONS: COLLATERAL EFFECTS

Please join Warren Hosseinion, M.D., chief executive officer, Apollo Management Executive Director, Association for Community Health Improvement, and Daniel Cusator, M.D., vice president of The Camden Group, to discuss the upcoming changes on avoiding preventable readmissions and their financial impact on hospitals, physicians and patients.

http://www.healthwebsummit.com/pp032912.htm

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Top Placement... Bottomless Potential

NEWS
Commonwealth Fund
they need, but it can help inform them of needs in their service areas. Cathy Schoen, senior vice president of the Commonwealth Fund and a report co-author, said they are starting to see communities across the country use similar tools to create a community health approach to local challenges. Communities are starting to ask what are our pressing population issues, where can we make a difference and how can we partner on broader health initiatives? she said. This has occurred in Cincinnati, where the Hamilton County General Health District released a data set in February that has quickly brought about health improvements in the community. Called Community Access to Hamilton County Epidemiology & Assessment!Data!(AHEAD), it provides statistics on mortality, injuries, communicable diseases and maternal and infant health by city. There are several indicators divided by the community we serve, said Mike Samet, public information ofcer for the health
(Continued from Page One)

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In Brief
Chicago Doctor Convicted of Defrauding Illinois Blues
Jaswinder Rai Chhibber, M.D., owner of the former Cottage Grove Community Clinic on the South side of Chicago was convicted this past week of committing healthcare fraud against Medicare and Blue Cross Blue Shield of Illinois from 2007 to 2010. The 43-year-old physician was convicted on nine counts of fraud and making false statements and found not guilty on seven other counts in a federal court. Chhibbers actions included ordering medically unnecessary tests, falsifying patients records, using false codes on claim forms and administering an unusually high number of tests like echocardiograms and ultrasounds. The Medicare Fraud Strike Force, part of the Justice Department and the Department of Health and Human Services conducted the investigation. Chhibber faces maximum penalties of 10 years in prison for each count of fraud, ve years for each false statement and a $250,000 ne per count.

district. It provides users with mapping tools and we hope community leaders will go out and identify problems and put together remediation tactics. With data provided by the district, one community took on the issue of access to healthy food. In an area that Samet said is a predominantly African-American food desert, residents approached a convenience store and talked them into frequently shipping in fresh produce. The community took the initiative and we provided grant money, he said. It is a community that has done wonders. The district also built a park, the daycare centers signed a pledge to build in time for physical activity for the children, smoking cessation efforts for the employees and healthier menus. Information is power, Samet said. People know they have poor access and know their diets and exercise habits are not the best. Thats where we come in; we are able to provide grant money and resources and it is a very collaborative effort.

Mich. Program Cuts Hospice Costs

Program Saved More Than $3,000 Per Month
A Michigan program has exhibited cost savings of more than $3,000 a month and improved quality of care by moving end-of-life services from providers and hospitals to the home. The results were found during a pilot program by the nonprot Hospice of Michigan, the largest hospice program in the state, which cares for 900 patients daily. The group examined service utilization and cost for patients in advanced stages of illness. Patients and caregivers took part in the hospices @HOMe Support program, introduced in 2007. The program is a homebased tool that offers services and education in the areas of disease management, symptom relief, assistance with navigating the healthcare system and caregiver support. The program focuses on advanced disease management with services provided by nurses, social workers and patient-family advocates. Access to assistance is provided on a 24/7 basis and while it is intended to support home caregivers, it is created to link with a primary care and other providers as needed. "This is a groundbreaking study that has signicant implications for reducing high-cost medical services during the last 24 months of life and addresses the desire of older adults to receive care at home," said Dottie Deremo, president and CEO of Hospice of Michigan in a prepared statement. The study examined in-home support costs as well as inpatient, outpatient and emergency room services. Home support costs increased during the study, as expected. But costs for patients in the other three areas were reduced. One group of patients saw an average reduction in costs of $3,416 a month (from $9,294 prior to the study. Funding for the program was provided by the Blue Cross Blue Shield of Michigan Foundation. The pilot was conducted by Hospice of Michigan's Maggie Allesee Center for Quality of Life with Wayne State University's School of Social Work.

Fresh Food Boosted For Low-Income Minnesotans

A collaborative effort between the local government and organizations like Blue Cross Communities Putting Prevention to Work has increased the availability of food from farmers markets to individuals receiving food support in Minnesota. In 1998, nutrition assistance was available via EBT cards.

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CBO Revises Future ACA Spending

Projects Outlays Will Top $1 Trillion In Next Decade
The Congressional Budget Ofce has released a revised report on its 10-year estimates of outlays for Medicare spending and the impact of the Affordable Care Act. A report released this month projects spending to grow from $559.6 billion to $1.057 trillion over the next decade. Medicaid spending is also expected to continue to grow. The CBO projects an increase from $275 billion in 2011 to $622 billion in 2022. The average annual growth rate is expected to be about 9%. The increase in Medicaid spending looks to be attributable largely to rising costs instead of increased enrollment. Enrollment is expected to grow by an average of 3% through 2020, while the expected average annual federal spending per enrollee will rise by 9% during the same period. Children are the least costly enrollees, with spending at $2,854 per year; the elderly are the most costly at $19,373 annually (up from $12,380 in 2011). The CBO has also estimated that the insurance coverage portion of the Affordable Care Act will cost just under $1.1 trillion through 2021. This number is about $50 billion less than last years projection. The ofce has projected a net decrease in the federal decit of $210 billion through 2021 as a result of the reform overall. This is due to reductions in Medicare spending and provisions that will increase tax revenues. The act is now estimated to reduce the number of nonelderly uninsured by 30 million to 33 million, about two million less than previously expected. About 20 million to 23 million will be covered in state exchanges and 16 million to 17 million in Medicaid and CHIP.

In Brief
Farmers markets in Minnesota have since added machines to process these cards, starting with one in 2006 to 24 this year. The markets also provide $5 in Market Bucks for the first $5 spent with EBT cards to encourage their use. In a survey of EBT farmers market shoppers, a large majority said they found good prices and quality of fruits and vegetables. They also shop there more and eat more fruits and vegetables because EBTs are accepted there. Organizations taking part in the efforts were the City of Minneapolis/Saint Paul, Ramsey County, the Minnesota Farmers Market Association, and the Statewide Health Improvement Program.

EHR Cost Savings Stirs Up Debate

Efficacy Questioned in Health Affairs, Blog Post
Electronic medical records may not be the cost-saving tool that the Obama administration and health experts have suggested, according to a recent article in Health Affairs. Danny McCormick, M.D., and colleagues at Cambridge Health Alliance studied more than 28,000 patient visits at ofce-based practices nationwide in 2008. The goal was to see if having access to computerized imaging results reduced the number of tests being ordered. What they found was that physicians with electronic access to results were 40% to 70% more likely to order tests than those without. The tests included MRIs and CT scans. It was also associated with ordering additional blood tests. The authors surmise that it may be features of the system that entice physicians to order more tests. Shortly after its release, the report was criticized in a blog by Farzad Mostashari, M.D., the National Coordinator for Health Information Technology. Mostashari claimed that the data was old that the study authors had reached beyond their scope of cause and effect in claiming that the study shows that EHRs will not save money overall.

Aetna Releases New Neurohealthcare Tool

Aetna recently announced its new interactive tool MyBrainSolutions, a Web site offering games and videos designed to improve the brain. The program, created by Brain Resource, Inc., is designed specically for employers to increase worker productivity and health. The activities are designed to relieve stress, increase positivity, and improve memory and attention. They focus on the four areas: emotion, thinking, feeling and self-regulation. Each participant has a personal dashboard that matches games to their needs, sets goals and tracks their success. The training can be completed in as little as 10 minutes a day. "There are strong linkages between brain health and overall health and well-being, said Louise Murphy, head of Aetna Behavioral Health. The addition of MyBrainSolutions...provides our members with a fun and engaging way to improve their health and wellness."

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OPINION

Page 4

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The ROI of Reducing Readmissions

Some Technology Investment Can Have Big Payoffs
When a patient checks out of a hospital, the on Health System Performance found that in last thing on their mind is returning. 2003, readmission rates for the top ve Unfortunately, many Medicare patients will performing states (Vermont, Wyoming, Iowa, nd themselves back in the hospital within 30 Oregon, and Nebraska) averaged 13.8 percent, days of being discharged from an inpatient stay; while the average readmission rate for the ve most of these readmissions are preventable. lowest performing states (Oklahoma, Maryland, Rehospitalizations are associated with Texas, Nevada, and Louisiana) was 21.8 percent. disparities in follow-up care and can result in a Evidence from a 2010 Cochrane systematic life-threatening event and review indicates that in-hospital staggering costs. Based on CMS discharge planning protocols trend reports, Medicare designed to facilitate transition of payments for unplanned patients to outpatient settings rehospitalizations in 2004 "probably brought about small accounted for about $17.4 reductions in length of hospital billion of the $102.6 billion in stay and readmissions" for older hospital payments from people admitted to a hospital Medicare, making them a large with specic medical conditions target for cost reduction. but the scalability of such an Readmissions are more common effort if done through a manual for certain conditions such as process with follow-up phone congestive heart failure and vary calls and the timeliness of followBy by race and Medicare coverage. up interventions pose a challenge Maria Lopes, M.D. to successful implementation and One study published in British Medical Journal indicates 29 to outcomes. 47 percent of elderly patients with heart failure There is, however, a potential solution as we are readmitted within three to six months of consider health information technology and the discharge. Another found that African role of remote healthcare services and Americans and dually eligible Medicare technologies to assist with the timely capture of enrollees-especially those who have clinically meaningful and actionable information experienced a stroke or have diabetes or from the patient's home to display to the asthma-may be more likely to be readmitted to clinician. the hospital. A recent MedPAC simulation There is a signicant opportunity to identify gaps found that Medicare beneciaries with endin healthcare and improve care coordination. For stage renal disease (ESRD) had above average the appropriate patient at high risk of readmission rates, indicating that some readmission, remote healthcare services and Medicare beneciaries, such as those with technologies can offer a solution. The appropriate multiple conditions, may be at increased risk patient, coupled with an individualized approach for readmissions. which may involve technology to identify preIn a large scale, two-year Geisinger remote acute trends and early decompensation, gaps in healthcare services and technologies program, care, and patient symptom assessment or nonuse of interactive voice response technology compliance, followed by actionable steps as part added on top of a very robust case of care management can improve care management program in patients deemed to be coordination and lead to care management triage, at high risk of readmission demonstrated such a trending and more real time automation of success: a surprising 44% reduction in all protocols to reduce re-hospitalizations. cause 30-day readmissions. The cost of an IVR call is minimal, but even after factoring in oneMaria Lopes, M.D., is chief medical officer for time implementation costs (which could be AMC Healthcare, a care coordination and done for around $10,000), including training post-discharge firm with offices in Los Angeles and software integration, ROIs exceed 4:1 in as and New York City. little as six months. Readmission rates also differ across hospitals, Op-ed submissions of up to 600 words are states, and geographic regions. The welcomed. Please e-mail proposals to Commonwealth Fund's 2007 State Scorecard editor@payersandproviders.com

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MARKETPLACE/EMPLOYMENT

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