HMT: HMT ACOs, Telehealth, HIX, and more
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Health Management Technology News
December 23, 2013

In this issue:

2 ACOs share successful strategies

Bill seeks to clean telehealth state regulations mess

Lessons from New Mexico's small business health exchange

Obamacare catastrophic-level policies prove hard sell so far

2 ACOs Share Successful Strategies

About 18 percent of hospital executives report having an accountable care organization in place, and that is expected to double by the end of 2014, according to Premier's 2013 Fall Economic Outlook. While more hospitals get involved in the new care delivery model and population health management, certain trends are emerging in ACO composition and how they improve the health of their populations.

Leaders from two ACOs joined a press call Dec. 18, hosted by Premier, to discuss what their organization is doing to achieve the triple aim goal of accountable care.

Health IT

Hospitals cannot successfully manage the health of a population, in an ACO or in general, without health IT systems. "Robust IT is critical to success" in population health management, Stephen A. Morgan, MD, senior vice president and chief medical information for Roanoke, Va.-based Carilion Clinic, said during the press call. Carilion Clinic is a Medicare Shared Savings Program participant.

The system spent years integrating each of its care settings on a unified electronic medical record system and database, but, according to Dr. Morgan, the system "quickly realized an EMR would not provide all the data we would need." So now, Carilion Clinic mixes claims and clinical data to "provide a more robust picture" of what patients are doing inside and outside the system. And the eight-hospital system is not alone: 72.5 percent of Premier's survey respondents integrate clinical and claims data to better manage population health.

According to the Premier survey, many hospitals are taking health IT a step further. Half of respondents said they use predictive analytics to forecast patient and population needs ó something Dr. Morgan said is also happening at Carilion Clinic.

Read the full Beckerís Hospital Article here

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Bill seeks to clean telehealth state regulations mess

Telehealth regulations differ in each of the 50 states, inhibiting use of technology to treat patients, say proposed law's sponsors.

Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH) have introduced a bill in Congress that creates a federal definition of telehealth and that provides guidance to states on how to regulate this burgeoning field.

"Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," the announcement of the bill stated. "However, there currently are 50 separate sets of rules [in different states] as to what type of care can be provided. This often leaves both providers and patients in a state of uncertainty. The Telehealth Modernization Act will provide guidance to states as they look to utilize telehealth technologies in the safest, most secure manner possible."

The Matsui-Johnson bill grew out of legislation that was recently adopted in California. Among other things, that state law broadens the definition of telehealth to include store-and-forward technology and home monitoring of patients. It also allows the state's Medicaid program to cover doctor-patient communications that take place outside of hospitals, physician offices, and skilled nursing facilities.

Read the full Information Week article here

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Lessons from New Mexico's small business health exchange

Last month, Albuquerque small business owner Don Leonard sat down in front of a computer with his insurance broker to shop for employee coverage on NMHIX, New Mexicoís health insurance exchange. They entered into the system the names, birth dates, and other data heíd gathered on his 20 employees and, inside of an hour, Leonard Tire and Automotive Repair became one of the first small employers in the country to buy insurance under Obamacare.

Many states have ceded the mechanics of health-care reform to the federal government or concentrated on developing their own insurance marketplaces for individuals. New Mexico stands out because it, along with Utah, first tackled getting small business owners and their employees covered through a state-run online marketplace known as a SHOP, or Small Business Health Options Program. Since New Mexicoís SHOP launched on Oct. 1, almost 1,400 employers have created accounts and 157 small companies have finalized their enrollment for coverage beginning in 2014.

These marketplaces, meant to give small employers an easy way to shop for health plans, are open only to businesses with 50 or fewer employees; employers of this size arenít required to offer health coverage by the Affordable Care Act. Perhaps even more confusing, the federal SHOP exchange has been postponed for a year, though the 19 states that built or are building their own SHOPs are unaffected by the delay.

Read the full Business Week article here

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Obamacare catastrophic-level policies prove hard sell so far

The Obama administrationís decision this week to allow people to buy catastrophic-level policies if their individual health plans had been canceled comes amid reports that few people have bought these less expensive policies sold in new online insurance marketplaces.

In California, only 1 percent of those who had picked a plan in the first two months since the marketplace opened had chosen a catastrophic plan. In Kentucky and Connecticut, just 2 percent have chosen a catastrophic plan from their stateís online exchange. In Washington state, just 0.4 percent of consumers have chosen catastrophic plan. The federal government, which is running the portal for 36 states, has not released data showing what types of plans consumers are choosing.

A catastrophic health insurance plan covers all essential health benefits like doctor and hospital visits but has a very high deductible. Premiums for catastrophic plans may be lower than traditional health insurance plans, but deductibles are usually much higher.

As expected, the most common level policy being purchased so far are silver plans, according to officials in California and other states that have disclosed the data.

Sabrina Corlette, research professor at Georgetown University, said sheís not surprised the catastrophic plans have had little pickup. Thatís because the plans were previously available only to people under 30 and to those offered employer coverage considered unaffordable because it costs more than 8 percent of the consumerís income. Despite having lower premiums with catastrophic plans, consumers canít get tax subsidies or cost-sharing reductions.

People with incomes under 400 percent of the federal poverty level, which is $45,800 this year, may get a better deal buying silver or bronze type policies that have lower out-of-pocket costs, experts say.

Read the full article at KHN

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Industry News

HIMSS Foundation and National eHealth Collaborative merge
Focused on better health and greater value through information technology, the HIMSS Foundation and the...
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Telehealth legislation introduced
Congresswoman Doris Matsui (D-CA) and Congressman Bill...
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Texting may be good for your health
New University of Michigan research says that a simple tool right in your back pocket may help...
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HIMSS statement on Dr. Karen DeSalvo's appointment as National Coordinator for Health IT
Statement from Carla M. Smith, MA, CNM, FHIMSS, Executive Vice President HHS Secretary...
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Karen DeSalvo to become country's next health IT chief
Today, New Orleans Health Commissioner and Senior Health Policy Advisor Dr. Karen DeSalvo...
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