Dear Healthcare Intelligence Network Client,

Despite a storm that ravaged our coastline with winds upwards of 75 mph, and sadly, many of our friends’ and neighbors’ homes and possessions, we made it to the voting stations (many fueled by generators, in addition to our need to voice our opinion) and re-elected President Obama. Reports say that his re-election will neutralize efforts to overturn the ACA, as Republicans vowed to do if elected. With the Supreme Court’s ruling in June upholding the individual mandate, and several provisions already in place, including patients’ access to insurance despite pre-existing conditions and young adults’ access to insurance on their parents’ health plans, an estimated 30 million previously uninsured consumers, among them 17 million on Medicare, will now be able to access doctors and have insurance pay for procedures in surgery centers and hospitals. The times they are a-changing,and we will keep watch on those changes ahead.

We also report on another storm of sorts: mental illness and substance abuse, two conditions that impact 26 percent of the U.S. population, 6 percent of whom suffer from serious mental illness. Many of these individuals, whose mental health status can dramatically impact how they engage with and respond to medical treatment, die 25 years earlier than the general population, researchers note. The NQF has taken steps to address this potentially preventable scourge by endorsing 10 quality measures focused on behavioral health, including such issues as alcohol and tobacco abuse, antipsychotic medication adherence, and post-care follow-up after hospitalization for mental illness.

Attempts to curb the storm of rising healthcare costs continue, with a new Walgreens study indicating that 90-day medication refills at community pharmacies for Medicaid patients drive greater medication adherence, improved cost savings and generate nominal waste across fourtherapeutic categories. This is in stark contrast to beliefs that shorter prescription refill times (30 days) result in greater savings. Many of these patients have chronic conditions and face major economic challenges affecting their ability to remain adherent to medication. Almost half (45 percent) of Medicaid beneficiaries have three or more chronic illnesses, and this population accounts for 75 percent of total Medicare costs.

And lastly, the one storm we can’t reverse: the end of life. A Medicare rule currently blocks thousands of nursing home residents with advanced dementia who have Medicare SNF care from receiving simultaneous reimbursement for hospice care, resulting in those patients receiving aggressive treatment and hospitalization, according to a new study from Brown University. Deciding between hospice and SNF care is not easy, but it makes a tremendous difference in patients' end of life care, researchers note, both emotionally and financially.

Your colleague in the business of healthcare,
Cheryl Miller
Editor, Healthcare Business Weekly Update

Please send comments, questions and replies to cmiller@hin.com.

November 12, 2012
Vol. XIV, No. 41

Sponsored by:
Readmission Penalties in 2013 — A Cross-Continuum Approach To Lessen the Financial Impact

This week's industry news:

1. 90-Day Medication Supply Drives Better Adherence, Reduces Medicaid Costs
   
2. Guide to Medication Adherence
   
3. Colorado ACO Yields Big Savings, Reduced Readmissions
   
4. The Colorado Accountable Care Collaborative: Practical Lessons from an ACO
   
5. Healthcare Business White Paper: Asthma Management in 2012
   
6. Medicare Rule Prevents Simultaneous Fees for Hospice and SNF
   
7. New Table: Healthcare Trends to Monitor in 2013
   
8. 46 Healthcare Metrics to Boost Profitability: Charting 2012 Trends
   
9. NQF Endorses 10 Behavioral Health Measures
   
10. 2012 Healthcare Benchmarks: Population Health Management
    
11. Identifying Opportunities in Care Coordination of Dual Eligibles
    
12. Healthcare Trends & Forecasts in 2013: A Strategic Planning Session
    
13. Surviving Sandy: The Aftermath
    
14. Population Health Management: Achieving Results in a Value-Based Healthcare System