note: this is an authorized excerpt from the full 2011 ...© 2011, healthcare intelligence network...

© 2011, Healthcare Intelligence Network — http://www.hin.com. Download the 2011 Healthcare Benchmarks Yearbook at http://store.hin.com/product.asp?itemid=4131

Note: This is an authorized excerpt from the full 2011 Healthcare Benchmarks Yearbook. To download the entire yearbook,

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© 2011, Healthcare Intelligence Network — http://www.hin.com


2011 Healthcare Benchmarks Yearbook:

Metrics, Measurements and Innovations

Contributing Authors

Dr. Karen Amstutz, vice president and medical director of Medicaid and senior markets, WellPointJan Berger, MD, MJ, chief medical officer for Silverlink Communications, Inc.Beth Chester, PharmD, MPH, BCPS, senior director of clinical pharmacy services and quality at Kaiser Permanente ColoradoMary Cooley, RN, BSN, MS, CCM, manager of case and disease management at Priority HealthPatricia Curtis, RN, BSN, MBA, director of operations for clinical care services for Optima HealthMichael Earley, CEO of Metcare of Florida, Inc.Joe Eppling, RN, MN, CRR, CNAA, BC, director of behavioral health services for East Jefferson General HospitalJose Guethon, M.D., president and chief operating officer of MetCare of FloridaBarsam Kasravi, MD, MPH, managing medical director for state-sponsored programs, WellPointPaul Kaye, MD, medical director at Taconic IPAAriel Linden, DrPh, MS, president of Linden Consulting Group; Diane Littlewood, RN, BSN, CDE, regional manager of case management for health services at Geisinger Health PlanYann Meunier, MD, health improvement manager at Stanford School of Medicine Health Improvement ProgramCraig Nelson, MS, DC, director of health services research with American Specialty Health; Dr. Jim Reynolds, chief medical officer, Health Fitness CorporationDr. Elizabeth Rula, principal investigator of Health Outcomes Research at Healthways Inc.Joann Sciandra, RN, BSN, CCM, regional manager of case management for health services at Geisinger Health Plan(continued)

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William Shea, partner, health industry consulting for Cognizant Business ConsultingJessica Simo, program manager with Durham Community Health Network for the Duke Division of Community HealthDexter Shurney, MD, MBA, MPH, medical director, Employee Health and Care Plan of Vanderbilt University and Medical Center; Gary Smithson, MD, MBA, clinical and business consultant for WorldDocThom Stambaugh, chief pharmacy officer and vice president of clinical programs and specialty pharmacy with CIGNA Pharmacy ManagementPaul Terry, PhD, president and CEO of StayWell Health Management Janet Tomcavage, RN, MSN, vice president of health services for Geisinger Health Plan (GHP)Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of ColoradoSteven T. Valentine, president, The Camden GroupJan Van der Mei, continuum case management director at Sutter Health Sacramento Sierra RegionMarcia Wade, MD, FCCP, MMM, senior medical director at Aetna Medicare Medical ManagementHymin Zucker, MD, chief medical officer of Metcare of Florida, Inc.

Executive EditorMelanie MatthewsHIN Executive Vice President and Chief Operating Officer

Project EditorsPatricia DonovanJessica Papay

Cover DesignJane Salmon


Table of Contents

Note from the Executive Editor ............................................................................. 19

Chapter 1: Healthcare Trends for 2011

About the Healthcare Intelligence Network .......................................................... 1-1

Executive Summary .............................................................................................. 1-1

Survey Highlights ..................................................................................................1-1

Methodology ........................................................................................................ 1-2

Respondent Demographics ................................................................................... 1-2

Respondents In Their Own Words ........................................................................ 1-2

Biggest Challenge in 2010 ....................................................................................1-2

Most Successful Programs and Services ...............................................................1-5

Best Business Decisions ........................................................................................1-7

Biggest Business Mistakes ....................................................................................1-8

Anticipated Impact of Healthcare Reform in 2011 .............................................1-10

Biggest Issue for 2011 .........................................................................................1-11

7 Macro Trends Impacting Business and Technology .......................................... 1-13

ACOs and New Models of Care Integration ......................................................... 1-17

Responses to Questions ..................................................................................... 1-19

Figure 1-1: 2010 Versus 2009 - Better Year? ...............................................1-19

Figure 1-2: Three Areas Most Affected by 2010 Economy ..........................1-20

Figure 1-3: Most Critical Aspect of Healthcare Reform ...............................1-21

Figure 1-4: Respondent Demographics .......................................................1-21

Glossary ............................................................................................................. 1-22

Healthcare Trends for 2011 Survey Tool ............................................................. 1-23

About the Authors.............................................................................................. 1-25

Chapter 2: Benchmarks in Healthcare Case Management



Key Findings ......................................................................................................... 2-2

Program Prevalence, Content and Delivery ..........................................................2-2

Case Management Responsibilities, Training and Performance ...........................2-3

Impact and ROI .....................................................................................................2-3

Methodology ........................................................................................................ 2-4

Analysis of Responses .......................................................................................... 2-4

Overview of Survey ...............................................................................................2-4

Respondent Demographics ...................................................................................2-4

Program Challenges and Barriers .........................................................................2-5

The Health Plan Perspective .................................................................................2-6

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The Hospital Perspective ......................................................................................2-7

Emergence of the Embedded Case Manager .......................................................2-8

A Case Management Success Story ......................................................................2-9

Respondents in Their Own Words ...................................................................... 2-10

Key Case Manager Responsibility: Health Plans .................................................2-10

Key Case Manager Responsibility: Hospitals ......................................................2-11

Key Case Manager Responsibility: Providers ......................................................2-11

Partnerships/Collaborations with Outside Entities: Health Plans ......................2-12

Partnerships/Collaborations with Outside Entities: Hospitals ............................2-13

Key Program Success Factor: Health Plans .........................................................2-13

Key Program Success Factor: Hospitals ...............................................................2-14

Key Program Success Factor: Providers ..............................................................2-15

Conclusion .......................................................................................................... 2-16


Part I: Overall Survey Responses ........................................................................2-17

2-01: Utilizing Case Managers .....................................................................2-17

2-02: Adding Case Managers in the Next 12 Months .................................2-18

2-03: Populations Targeted by Case Managers ...........................................2-18

2-04: Case Manager Work Locations...........................................................2-19

2-05: Participant Referral Methods .............................................................2-19

2-06: Average Monthly Case Load...............................................................2-20

2-07: Case Manager Duties .........................................................................2-20

2-08: Case Manager Communication Tools .................................................2-21

2-09: Case Manager Educational Background .............................................2-21

2-10: Evaluating Case Manager Performance .............................................2-22

2-11: Diagnosis Most Impacted by Case Management ...............................2-22

2-12: Impact of Case Management .............................................................2-23

2-13: Case Management ROI ......................................................................2-23

2-14: Respondent Organization Type ..........................................................2-24

Part II: Responses from Health Plans .................................................................2-24

Part III: Responses from Hospitals ......................................................................2-30

Glossary ............................................................................................................. 2-37

Healthcare Case Management Benchmark Survey Tool ...................................... 2-38


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Chapter 3: Benchmarks in Medication Adherence



Key Findings ......................................................................................................... 3-3

Targeted Conditions and Populations ...................................................................3-3

Program Content, Delivery and Tools ..................................................................3-3

Impact and ROI .....................................................................................................3-4

Methodology ........................................................................................................ 3-4




Medication Adherence and Hospital Readmissions .............................................3-6

Tools and Technology ............................................................................................3-7

Programs in Development ....................................................................................3-7

Barriers to Adherence ...........................................................................................3-8

The Pharmacist on the Medication Adherence Team ..........................................3-9

The Health Plan Perspective ...............................................................................3-11

The Hospital Perspective ....................................................................................3-12


Role of the Pharmacist .......................................................................................3-13

Greatest Program Challenge ..............................................................................3-14

Final Comments ..................................................................................................3-16

Conclusion .......................................................................................................... 3-16



3-01: Existing Medication Adherence Programs .........................................3-17

3-02: Planning Program in the Next 12 Months .........................................3-18

3-03: Targeted Populations .........................................................................3-18

3-04: Targeted Conditions ...........................................................................3-19

3-05: Common Barriers to Medication Adherence .....................................3-19

3-06: Program Components ........................................................................3-20

3-07: Supporting Technologies ....................................................................3-20

3-08: Adherence Assessment Tools .............................................................3-21

3-09: Points in Care for Medication Adherence Efforts ..............................3-21

3-10: Primary Patient Contact .....................................................................3-22

3-11: Pharmacist on Medication Adherence Team .....................................3-22

3-13: Program Impact .................................................................................3-23

3-12: Reimbursable Pharmacist Tasks .........................................................3-23

3-14: Program ROI .......................................................................................3-24

3-15: Respondent Demographics ................................................................3-24

Part II: Responses from Health Plans .................................................................3-25

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Part III: Responses from Hospitals ......................................................................3-31

Glossary ............................................................................................................. 3-38

2010 Medication Adherence Benchmark Survey Tool ......................................... 3-39


Chapter 4: Benchmarks in Care Transition Management



Key Findings ......................................................................................................... 4-2

Program Details ....................................................................................................4-2

Impact and ROI ....................................................................................................4-2

Methodology ........................................................................................................ 4-3




Trends in Home Visits ...........................................................................................4-5

Challenges, Benefits and ROI ................................................................................4-6

Comparison of Program Activity from 2009 to 2010 ............................................4-7

Strategies for Success ...........................................................................................4-9

The Physician Organization Perspective .............................................................4-10



Most Successful Strategy to Improve Care Transitions .......................................4-12

Greatest Challenges of Care Transition Management .......................................4-14

Conclusion .......................................................................................................... 4-16



4-01: Existing Care Transition Programs ......................................................4-17

4-02: Care Transitions Addressed by Programs ...........................................4-18

4-03: Targeted Population ...........................................................................4-18

4-04: Risk Factors ........................................................................................4-19

4-05: Critical Care Transitions ......................................................................4-19

4-06: Care Transition Program Model .........................................................4-20

4-07: Components of Care Transition Programs .........................................4-20

4-08: Care Transition Coordinator ...............................................................4-21

4-09: Required Training ..............................................................................4-21

4-10: Home Visits ........................................................................................4-22

4-11: Home Visit Frequency ........................................................................4-22

4-12: Primary Conductor of Home Visit ......................................................4-23

4-13: Home Visit Tasks ................................................................................4-23

4-14: Future Care Transitions Programs ......................................................4-24

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4-15: Program Impacts ................................................................................4-24

4-16: Measuring Success .............................................................................4-25

4-17: Program ROI .......................................................................................4-25


Part II: Responses from Physician Organizations ................................................4-27

Part III: Responses from Health Plans .................................................................4-36

Glossary ............................................................................................................. 4-45

2010 Care Transitions Benchmark Survey Tool .................................................... 4-46

About The Authors ............................................................................................. 4-50

Chapter 5: Benchmarks in Health Risk Assessment and Stratification



Key Findings ......................................................................................................... 5-2

Methodology ........................................................................................................ 5-3




Penalties and Incentives for HRAs ........................................................................5-5

Challenges, Benefits and ROI ................................................................................5-6

Summary of Sector Responses .............................................................................5-7

The Hospital/Health System Perspective ..............................................................5-8


The Employer Perspective ....................................................................................5-9

Future Programs .................................................................................................5-10


Lessons Learned from HRA Administration ........................................................5-11

Targeted Populations for Future HRAs ................................................................5-12

Conclusion .......................................................................................................... 5-13



Figure 5-01: Respondents Using HRAs ........................................................5-14

Figure 5-02: HRA Eligibility ..........................................................................5-15

Figure 5-03: Targeted Populations ..............................................................5-15

Figure 5-04: Targeted Conditions ................................................................5-16

Figure 5-05: Mandatory Completion ...........................................................5-16

Figure 5-06: Penalty for Non-Completion ...................................................5-17

Figure 5-07: Incentives for Completion .......................................................5-17

Figure 5-08: Incentives Eligibility .................................................................5-18

Figure 5-09: Incentives Offered ...................................................................5-18

Figure 5-10: HRA Delivery Format ...............................................................5-19

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Figure 5-11: HRA Data Inputs ......................................................................5-19

Figure 5-12: HRA Data Outputs ...................................................................5-20

Figure 5-13: Annual Completion Rate .........................................................5-20

Figure 5-14: Applications for HRA Data .......................................................5-21

Figure 5-15: Barriers to HRA Implementation .............................................5-21

Figure 5-16: Recipients of HRA Data ...........................................................5-22

Figure 5-17: Link to Wellness or Care Management Program ....................5-22

Figure 5-18: Planning HRA in Next 12 Months ............................................5-23

Figure 5-19: Program Impact .......................................................................5-23

Figure 5-20: Program ROI ............................................................................5-24

Figure 5-21: Respondent Demographics .....................................................5-24

Part II: Responses from Hospitals .......................................................................5-25


New Frontiers in Health Risk Assessment Use .................................................... 5-44

Real ROI from Health Risk Assessments .............................................................5-44

Developments in HRA Functionality ...................................................................5-44

Assessing Health Risk in the Elderly ...................................................................5-45

Glossary ............................................................................................................. 5-47

Health Risk Assessment Benchmark Survey Tool ................................................ 5-48


Chapter 6: Benchmarks in Reducing Avoidable ER Use



Key Findings ......................................................................................................... 6-2

Top Strategies and Results .............................................................................6-2

Role of the Primary Care Physician ................................................................6-2

Promotion of Alternative Health Services ......................................................6-2

Methodology ........................................................................................................ 6-3



Handling High Utilizers ...................................................................................6-4

Alerting PCPs to ED Visits ...............................................................................6-5

24 Ways to Engage PCPs in ER Utilization Efforts ...........................................6-5

Tactics for Recently Discharged Patients ........................................................6-6

Challenges, Benefits and ROI .........................................................................6-7

Comparing Responses from Top Three Sectors ....................................................6-8

The Hospital Perspective .....................................................................................6-9


Handling Behavioral Health Cases ................................................................6-10

ED Census and Registries .............................................................................6-10

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Future Programs .................................................................................................6-11


Most Successful Strategies to Reduce Avoidable ER Visits .................................6-12

Overcoming Challenges to Reducing Avoidable ER Use .....................................6-14

Conclusion .......................................................................................................... 6-15



Figure 6-01: Organizations Affected by Avoidable ER Use ..........................6-16

Figure 6-02: Programs to Reduce Avoidable ER Use ...................................6-17

Figure 6-03: Populations Linked to Avoidable ER Use .................................6-17

Figure 6-04: Conditions Linked to Frequent Flyers .....................................6-18

Figure 6-05: Tactics to Discourage Inappropriate ER Use............................6-18

Figure 6-06: Interventions for Recently Discharged Patients ......................6-19

Figure 6-07: Staffing Models to Reduce Avoidable ER Use .........................6-19

Figure 6-08: Program Promotion Methods .................................................6-20

Figure 6-09: Reduction in Avoidable ER Visits .............................................6-20

Figure 6-10: Program ROI ............................................................................6-21

Figure 6-11: Program Implementation Barriers ..........................................6-21

Figure 6-12: Respondent Demographics .....................................................6-22

Part II: Responses from Hospitals .......................................................................6-22

Part III: Responses from Health Plans ................................................................6-28

New Frontiers in Reducing Avoidable ER Use ..................................................... 6-34

Glossary ............................................................................................................. 6-38

Reducing Avoidable ER Use Benchmark Survey Tool ........................................... 6-39


Chapter 7: Benchmarks in Health and Wellness Incentives



Key Findings ......................................................................................................... 7-2

Comparison of 2009 Data to 2010 Data ................................................................ 7-4

Methodology ........................................................................................................ 7-6


Overview of Survey Results ..................................................................................7-6

Respondent Demographics ...................................................................................7-7

Program Prevalence and Barriers .........................................................................7-7

The Employer Perspective ....................................................................................7-8


The Role of the Health Risk Assessment ............................................................7-11


Health Plans: Biggest Challenge in Program Development ................................7-12


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Health Plans: Additional Feedback .....................................................................7-12

Employers: Biggest Challenge in Program Development ....................................7-12

Employers: Additional Feedback ........................................................................7-13

Other Respondents: Biggest Challenge in Program Development .....................7-14

Other Respondents: Additional Feedback ..........................................................7-15

Conclusion .......................................................................................................... 7-15



7-01: Offering Incentives Program ..............................................................7-17

7-02: Economic Incentives...........................................................................7-18

7-03: Benefit-Based Incentives ....................................................................7-18

7-04: Top Three Incentives (Overall Ranking)..............................................7-19

7-05: Incentivized Health Improvement Programs .....................................7-19

7-06: Incentives for Behavior Change Achievement ...................................7-20

7-07: Rewarding Repeat or Long-Term Participation ..................................7-20

7-08: Penalties for Health Risks ...................................................................7-21

7-09: Program Promotion Methods ............................................................7-21

7-10: Participant Identification Methods ....................................................7-22

7-11: Program Eligibility ..............................................................................7-22

7-12: Future Programs ................................................................................7-23

7-13: Program Success Measurement ........................................................7-23

7-14: Most Positive Response .....................................................................7-24

7-15: Program Impact .................................................................................7-24

7-16: Program ROI .......................................................................................7-25

7-17: Organization Type ..............................................................................7-25

Part II: Responses from Health Plans ..................................................................7-26

Part III: Responses from Employers ....................................................................7-34

New Perspectives in Health & Wellness Incentives ............................................. 7-42

Incentive Ideas ....................................................................................................7-42

Tying Incentives to Participation .........................................................................7-42

Validity of Self-Reported Data.............................................................................7-43

Using Incentives to Boost Patient Engagement and Activation ..........................7-44

Best Practices in Incentives.................................................................................7-45

Structuring Physician and Member Incentives ...................................................7-45

How Incentives Can Improve Outcomes ............................................................7-46

Structuring an Incentives Program ....................................................................7-46

Sweet Spot for ROI from Incentives ....................................................................7-46

The Challenges of Incentives ..............................................................................7-47

The Most Effective Incentives .............................................................................7-47

Health & Wellness Incentives Benchmark Survey Tool ........................................ 7-48



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Chapter 8: Benchmarks in the Patient-Centered Medical Home



Key Findings ......................................................................................................... 8-2

Trends, Tools and Teams .......................................................................................8-2

PCMH Impacts ......................................................................................................8-3

Methodology ........................................................................................................ 8-3



Comparison of Medical Home Activity in 2009 and 2010 ....................................8-4

Overall Trends .......................................................................................................8-6

Program Challenges and Barriers .........................................................................8-9

Medical Home Cost and ROI .................................................................................8-9



The Physician Perspective ...................................................................................8-13

The Co-Located Case Manager in the Medical Home ........................................8-13


Advice and Comments on PCMH Adoption ........................................................8-14

Conclusion .......................................................................................................... 8-16



8-01: Familiar with Term “Medical Home”..................................................8-17

8-02: Established Medical Homes ...............................................................8-18

8-03: Percentage of Population in Medical Homes .....................................8-18

8-04: Targeted Populations of Program ......................................................8-19

8-05: Lives Covered by Program ..................................................................8-19

8-06: Participating Physicians ......................................................................8-20

8-07: Time Required for Medical Home Conversion ...................................8-20

8-08: Tech Tools Used in Medical Homes ....................................................8-21

8-09: Medical Home Education and Engagement .......................................8-21

8-10: Professionals on the PCMH Team ......................................................8-22

8-11: Embedded Case Manager ..................................................................8-22

8-12: Medical Home Adoption Challenges ..................................................8-23

8-13: Reimbursement Model ......................................................................8-23

8-14: PCMH Participation Incentives ..........................................................8-24

8-15: Measuring Medical Home Effectiveness ...........................................8-24

8-16: ROI Achieved .....................................................................................8-25

8-17: Impact on Care Delivery .....................................................................8-25

8-18: Impact on Utilization ........................................................................8-26

8-19: Future Medical Home Establishment ................................................8-26


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8-20: Respondent Organization Type ..........................................................8-27

Part II: Responses from Hospitals ......................................................................8-27

8-21: Hospitals: Familiar with Term “Medical Home” .................................8-27

8-22: Hospitals: Established Medical Homes ..............................................8-28

8-23: Hospitals - Percentage of Population in Medical Homes ...................8-28

8-24: Hospitals - Targeted Populations of Program .....................................8-29

8-25: Hospitals - Lives Covered by Program ................................................8-29

8-26: Hospitals - Participating Physicians ....................................................8-30

8-27: Hospitals - Time Required for Medical Home Conversion .................8-30

8-28: Hospitals - Tech Tools Used in Medical Homes .................................8-31

8-29: Hospitals - Medical Home Education and Engagement ....................8-31

8-30: Hospitals - Professionals on the PCMH Team ...................................8-32

8-31: Hospitals - Embedded Case Manager ................................................8-32

8-32: Hospitals - Medical Home Adoption Challenges ................................8-33

8-33: Hospitals - Reimbursement Model ...................................................8-33

8-34: Hospitals - PCMH Participation Incentives ........................................8-34

8-35: Hospitals - Measuring Medical Home Effectiveness .........................8-34

8-36: Hospitals - ROI Achieved ....................................................................8-35

8-37: Hospitals - Impact on Care Delivery ...................................................8-35

8-38: Hospitals - Impact on Utilization .......................................................8-36


Part IV: Responses from Physicians ....................................................................8-45

Glossary ............................................................................................................. 8-55

2010 Medical Homes Benchmark Survey Tool..................................................... 8-56


Chapter 9: Benchmarks in Telehealth and Telemedicine



Key Findings ......................................................................................................... 9-2

Telehealth Applications ..................................................................................9-2

Remote Monitoring ........................................................................................9-2

Impacts and Challenges of Telehealth ............................................................9-3

Methodology ........................................................................................................ 9-3



Trends in Remote Monitoring ........................................................................9-5

Emergence of Telephonic Advice Lines ..........................................................9-6

Funding and Health Reform Incentives ..........................................................9-8

Challenges, Impact, ROI and Successes ..........................................................9-8

Comparing Telehealth Trends from 2009 and 2010 ...........................................9-10


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The Health Plan Perspective ..............................................................................9-11


Future Programs .................................................................................................9-13


Taking Advantage of PPACA Telehealth Provisions ............................................9-14

Most Successful Applications of Telehealth ........................................................9-14

Conclusion .......................................................................................................... 9-16


9-1: Using Telehealth for Clinical or Non-Clinical Applications ...................9-17

9-2: Populations Targeted by Telehealth .....................................................9-17

9-3: Health Conditions Targeted by Telehealth ...........................................9-18

9-4: Technologies Utilized in Telehealth Programs ......................................9-18

9-5: Devices Utilized in Telehealth Programs ..............................................9-19

9-6: Non-Clinical Applications for Telehealth ..............................................9-19

9-7: Clinical Applications for Telehealth ......................................................9-20

9-8: Telehealth Opportunities for Patients ..................................................9-20

9-9: Using Telehealth for Remote Monitoring ............................................9-21

9-10: Remote Monitoring — Targeted Conditions ......................................9-21

9-11: Remote Monitoring — Targeted Activities.........................................9-22

9-12: Funding Supporting Telehealth ..........................................................9-22

9-13: Legislation Supporting Telehealth ......................................................9-23

9-14: Impact on Clinical Metrics .................................................................9-24

9-15: Impact on Utilization Metrics ............................................................9-24

9-16: ROI from Telehealth ...........................................................................9-25

9-17: Barriers to Telehealth .........................................................................9-25


Part II: Responses from Health Plans ..................................................................9-26

Part III: Responses from Hospitals .....................................................................9-35

Glossary ............................................................................................................. 9-44

2010 Telehealth and Telemedicine Survey Tool ................................................... 9-45


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Note from the Executive Editor

Welcome to the 2011 Healthcare Benchmarks Yearbook, the Healthcare Intelligence Network’s second annual review of the year in healthcare. Over the last 12 months, healthcare reform moved from rhetoric to reality. The Patient Protection and Affordable Care Act (PPACA) mandates a range of patient-centered and accountable care models that seek to improve healthcare quality, safety and efficiency while reducing resource consumption and spend.

PPACA will reward organizations that reduce hospital readmissions, curb avoidable emergency room visits, manage health risk, improve care coordination, demonstrate quality and deploy health IT. The 2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations delivers all-new actionable data compiled in 2010 on nine key areas of healthcare activity and growth:

Healthcare Trends for 2011

Healthcare Case Management

Medication Adherence

Care Transitions Management

Health Risk Assessment & Stratification Reducing Avoidable ER Use

Health & Wellness Incentives

Patient-Centered Medical Home

Telehealth and Telemedicine

Each set of benchmarks is supplemented with relevant advice from healthcare thought leaders from Geisinger Health Plan, Kaiser Permanente, Priority Health, Taconic IPA and many other organizations.

All in all, the yearbook contains more than 400 charts, tables and graphs. And at more than 400 pages, we hope it will prove to be an essential planning and reference tool that you’ll use to navigate PPACA rollout.

We wish you a prosperous and innovative year in healthcare.

Melanie Matthews, HIN executive vice president and chief operating officer


xiv

Executive Summary

Healthcare Trends in 2011: Most Critical Areas of Healthcare Reform

In response to the Healthcare Intelligence Network’s sixth annual survey on

Healthcare Trends for the Year Ahead conducted in October 2010, PPACA’s prevention and health promotion mandates are the chief concern of 16 percent of the survey’s 73 respondents, followed by cost containment, Medicaid expansion and reimbursement (each reported as a chief concern by 14 percent of respondents).


xv

Source: HIN Healthcare Trends SurveyOctober, 2010

1:07: Critical Areas of Healthcare Reform

©2010


xvi

Healthcare Case Management in 2010: Key Case Manager Duties

The Healthcare Intelligence Network December 2009 Healthcare Case Management e-survey captured the expanding focus, responsibilities and impact of case management. Eighty-four percent of 187 responding healthcare organizations have healthcare case management programs. Here are the top ways that case managers spend their time:

Managing care continuity and transitions: 87.6 percent Patient/family advocacy and education: 68.2 percent Utilization management: 60.5 percent Complex patient care: 59.7 percent Patient/family counseling: 50.4 percent Psychosocial management: 42.6 percent Quality improvement: 39.5 percent Crisis intervention: 28.7 percent Research and practice development: 6.2 percent

Source: HIN Case Management SurveyDecember, 2009

2:07: Key Case Manager Duties

©2010


xvii

Patient-Centered Medical Home in 2010: Who’s On the Medical Home Team

The Healthcare Intelligence Network Medical Homes in 2010 e-survey captured the dynamics of the PCMH experience for more than 156 healthcare responding organizations, who reported the presence of the following non-physician professionals on their PCMH care teams:

Physician assistant (PA): 57.8 percent Medical assistant (MA): 64.4 percent Nurse practitioner (NP): 68.9 percent Registered nurse (RN): 73.3 percent Licensed practical nurse (LPN): 48.9 percent Dietitian: 35.6 percent Case manager: 64.4 percent Social worker: 46.7 percent Pharmacist: 35.6 percent Health educator: 33.3 percent Respiratory therapist: 4.4 percent Coder: 17.8 percent Other: 11.1 percent

Source: HIN Medical Homes SurveyMarch, 2010

8:10: Professionals on the PCMH Team

©2010


xviii

Reducing Avoidable ER Use in 2010: Staffing Models That Reduce Preventable Utilization

The Healthcare Intelligence Network’s July 2010 Reducing Avoidable ER Use e-survey captured the steps that 90 healthcare organizations are taking to reduce avoidable use of the hospital ER, including the most effective staffing models to prevent inappropriate use:

Community collaborations: 36 percent Nurse advice line: 31 percent Disease care coordinators: 31 percent Case manager in ED: 28 percent Other: 28 percentMD triage of high-acuity calls: 10 percentNurse/MD advice line: 5 percent

Source: HIN Reducing Avoidable ER Use Survey, July 2010

Figure 6:7: Staffing Models to Reduce Avoidable ER Use

©2010

Order Your Copy Today! Fax Form to: 732-449-4463

The Patient Protection and Affordable Care Act (PPACA) mandates a range of patient-centered and accountable care models that seek to improve healthcare quality, safety and efficiency while reducing resource consumption and spend.

PPACA will reward organizations that reduce hospital readmissions, curb avoidable emergency room visits, manage health risk, improve care coordination, demonstrate quality and deploy health IT.

The 2011 Healthcare Benchmarks Yearbook delivers more than 23,000 data points on adoption, activity and ROI on nine trend-bending PPACA initiatives:

Healthcare Trends for 2011 Healthcare Case ManagementMedication AdherenceCare Transitions ManagementHealth Risk Assessment & StratificationReducing Avoidable ER UseHealth & Wellness Incentives Patient-Centered Medical Home Model Telehealth & Telemedicine

Yes, I need these healthcare industry metrics and measurements to help me evaluate and plan programs and budgets and compare performance and utilization data PPACA’s initial rollout proceeds. Please reserve my copy of 2011 Healthcare Benchmarks Yearbook: Metrics, Measurements and Innovations, today for $497 (Print and PDF).

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