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Health Management Technology News
  April 29, 2014
In this issue:

 Health Management Technology’s Resource Guide sign-up

 CHE Trinity Health taps Verisk Health to support national population health management initiatives

 IBM expands U.S. federal healthcare practice

 Medicare patients are first casualty in emerging healthcare revenue battles

 How did America end up with this healthcare system?

 Grant to support Indiana healthcare provider

 Merck in final talks to sell consumer unit for near $14 billion

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CHE Trinity Health taps Verisk Health to support national population health management initiatives

Verisk Health announced that CHE Trinity Health has selected the company’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives. CHE Trinity Health is the second-largest Catholic healthcare delivery system in the nation, serving people and communities in 20 states from coast to coast with 86 hospitals, 109 continuing care facilities, and home health and hospice programs that provide more than 2.8 million visits annually. Verisk Health is a subsidiary of Verisk Analytics.

“We reviewed many potential tools that could support our population health initiatives, and we ultimately chose Verisk Health because of its alignment with the Centers for Medicare and Medicaid Services (CMS), experience in the payer space, and its reputation,” said Ted Makowiec, VP, Medical Economics, Payer Strategy and Product Development for CHE Trinity Health. “We expect the solution will help us reduce risk and increase the value of the care we deliver.”

CHE Trinity Health will implement Verisk Health’s DxCG platform, the industry standard for risk adjustment and predictive modeling, for pre-risk contract evaluations with prospective employers and payers. In addition, CHE Trinity Health will leverage Verisk Health’s Provider Intelligence to manage risk-based contracts. Provider Intelligence uncovers opportunities for optimizing clinical value and enables medical cost management in and out of network by giving providers another means to identify the patients and health issues that require added care and attention. Addressing experience, health, and cost, Provider Intelligence gives providers tools to address CMS’s “triple aim.”

Read the full press release here  

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IBM expands U.S. federal healthcare practice

IBM announced that its U.S. Federal Healthcare Practice will be applying its Watson cognitive computing technology to help solve health care problems.

IBM has made new investments in its health care organization to address the rapidly growing technology needs of public-sector health institutions. Big Blue added big data solutions for advanced clinical care from its IBM Watson Group, new collaborations with IBM Research focused on data management and an expansion of the team with the naming of a chief medical information officer for IBM's U.S. health care practice.

"IBM has a proven track record in delivering transformational, value-based health care solutions that can increase the quality of care and lower costs in both the public and private sectors," Anne Altman, general manager of IBM US Federal, said in a statement. "Government leaders recognize that there is a tremendous opportunity to combine new and existing data sources with advancements in technology to find innovative ways to build a sustainable and affordable health care system."

IBM said it will be employing Watson cloud-delivered solutions to the federal health care practice, including the IBM Watson Engagement Advisor to transform interactions and experiences with patients; the IBM Watson Discovery Advisor to uncover insights into diseases and innovative therapies and speed medical research; and the IBM Watson Explorer designed to consolidate and visualize information and help users uncover and share data-driven insights more easily.

IBM's big data and cognitive computing solutions will help federal health care customers aggregate and analyze clinical information to improve care and reduce costs. Improving health outcomes, controlling costs and achieving a value-based, affordable and sustainable health care system have become economic and social imperatives for governments around the world.

According to the Congressional Budget Office, the U.S. government is expected to spend $13.95 trillion on major health care-related operations and programs through 2024. To address rising rates of chronic disease and reduce spending, health systems today face greater expectations for improved health outcomes and higher quality care.

Read the full article from here  

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Medicare patients are first casualty in emerging healthcare revenue battles

Whatever else you may need financially after age 65 as a patient, you will likely need a special Medicare calculator that includes a timer. Turns out that how patients are technically admitted to a hospital and how many “midnight’s” they stay both play a critical role in what Medicare will cover and what out-of-pocket costs will be. As the revenue battles heat up the rules governing Medicare coverage and payment are becoming increasingly complex and litigious.

The first question is how a Medicare patient is admitted. Was it officially as “inpatient” or did the hospital elect to admit the patient under “observation status?” Beyond that was the stay for 3 consecutive midnight’s or was it under the terms of the new “two-midnight” rule (pending in March, 2015).

Many patients either don’t know or incorrectly assume that because they stayed in a hospital room they were admitted as “inpatient” and therefore qualify for the more complete Medicare coverage. The resulting bills are a new kind of patient “shock and awe.”

Why bother with a separate admission status at all? As with all of our more complex healthcare issues there’s a simple one word answer. Money. As usual lots of it.

Without all the history, in order to curtail potential hospital overcharging to Medicare, the Recovery Audit Contractor (RAC) program was born.

Read the full article from Forbes here  

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How did America end up with this healthcare system?

Pennsylvania in the late 1800s and early 1900s was an unsafe place to work, with a quarter-million recorded industrial calamities a year. So dangerous were the trades, and so gruesome were the accidents, that the chronicling of injuries suffered by workers became its own muckraking genre. A short-lived publication of the Inter­national Association of Factory Inspectors got some its best stories from the steel industry: In one nightmare narrative, an explosion at a Butler County steel mill forced “streams of hot metal [down] on the workmen, engulfing and literally cooking some of them.” Some accounts weren’t as spectacular, but merely ghastly — arms jerked from sockets, regular decapitations, and sawmill accidents with all of the attendant gore and sinew you would expect.

In 1907, writer William B. Hard turned his attention to U.S. Steel Corp. in an article called “Making Steel and Killing Men.” Steel is war, he said, and the workers were losing: Men were being “roasted alive by molten slag.” In a given year, according to his own estimate (gleaned from a U.S. Steel plant in Chicago), more than 10 percent of the steel workforce was injured or killed on the job.

In the same year, the Russell Sage Foundation began its massive survey of working conditions in Pittsburgh. That survey spawned a 1910 book that found that among those who were lucky enough to survive their workplace accidents, “53 percent received $100 or less from the employer. ... In over one-half of the deaths and injuries [employers] assumed absolutely no share of the inevitable income loss,” the book, written by Crystal Eastman, a lawyer and co-founder of the American Civil Liberties Union, said.

“A special cloud always threatens the home of the worker in dangerous trades,” Eastman wrote. “It is not just that those whose lot falls in this part of the work should endure not only all the physical torture that comes with injury, but also almost the entire economic loss which inevitably follows it.”

Read the full article from the Pittsburg Post-Gazette here  

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Grant to support Indiana healthcare provider

Congressman Pete Visclosky announced that Valparaiso-based HealthLinc will receive $1,330,537 from the U.S. Department of Health and Human Services as a continuing grant under the Health Resources and Services Administration (HRSA) Fiscal Year 2014 Service Area Competition. This federal funding will allow HealthLinc, to continue providing affordable primary care to their patients, including medical, dental, behavioral health, and optometry services, regardless of patients' level of health insurance coverage.

"HealthLinc, Inc. continues to demonstrate their commitment to serving the uninsured and underinsured populations of Northwest Indiana," said Congressman Visclosky. "This award will be instrumental to HealthLinc as it continues to provide a wide-range of high-quality health care services to the people of Northwest Indiana. I commend the HealthLinc staff for their tireless work to improve the health disparities of our region."

Read the full article from here  

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Merck in final talks to sell consumer unit for near $14 billion

Merck & Co Inc is in the final stages of selling its consumer healthcare unit for close to $14 billion, with Bayer AG and Reckitt Benckiser Group Plc among final contenders to clinch a deal as soon as next week, people familiar with the matter said.

Germany's Bayer and British consumer products giant Reckitt have emerged as frontrunners to win the auction after each offering roughly $13.5 billion for the Merck consumer unit, best known for Coppertone sunscreen and Claritin allergy medicine, the sources said.

Both bidders are very keen to buy the asset and the price tag could go higher in the final days, one person added. All the people asked not to be named because the matter is not public.

Representatives for U.S. drugmaker Merck, as well as Bayer and Reckitt, declined to comment.

The sale would be the latest in a wave of healthcare deals in recent days, including Zimmer Holdings Inc's $13.35 billion acquisition of orthopaedics rival Biomet Inc and the agreement between Novartis AG and GlaxoSmithKline Plc to trade more than $20 billion worth of assets, with Eli Lilly and Co buying Novartis' animal health business for $5.4 billion.

Read the full article from Reuters here  

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