Iag newsletter july 2011 final

S u mme r 2 01 1 -Ju ly
Information Advantage Group’s Healthcare Digest is focused on the emerging delivery models and
tools for the hospital-to-consumer continuum. In a fast-read format, we provide only the vital news
that is essential to keeping you current on the latest and most notable trends, ideas, research,
results, technological developments and helpful resources.
Click on titles below for quick navigation, once there, click on abstract title to go to source.

MACRO TRENDS
• Q1 GDP A DJUSTED U P…SLIGHTLY MEDICAL HOME
• CONSUMER AND B USINESS CONFIDENCE SLIPS • FIRST ONCOLOGY MEDICAL HOME REDUCES
• BY FAR, MAJORITY OF A MERICANS ARE STILL HAPPY HOSPITALIZATIONS
• MARKETERS CAN MISS THE LARGEST P ERCENTAGE OF • ONLY 35% OF UNDER 20 PHYSICIAN PRACTICES USE

BUYERS MEDICAL HOME PROCEDURES
• A SHIFT TO THE RIGHT – THE MAJORITY (52%) OF • COORDINATION OF CARE I MPROVES WITH EHR

SOCIAL NETWORK USERS ARE 36+, YOUNGER SHOWS • NEWLY RELEASED - HELPFUL R ESOURCES:

STEEP DECLINE
HIE
HEALTHCARE MACROS • THE AMERICAN ASSOCIATION FOR FAMILY PRACTICE

• IDC STUDY: H EALTHCARE IS THE MOST ATTRACTIVE LAUNCHES LOW-COST MESSAGING SERVICE (HIE)
US MARKET • MAINE PASSES OP-OUT HIE R EQUIREMENT

• HOSPITAL SERVICES COST CONTINUES TO RISE YEAR • LESSONS LEARNED FROM CONNECTING TO

OVER YEAR THE NATIONWIDE HEALTH INFORMATION NETWORK
• $8,100 PER MAN, WOMAN AND CHILD IN 2009 (NWHIN)
• MOST HOSPITALS PREPARING FOR THINNER MARGINS • NEWLY RELEASED - HIE HELPFUL RESOURCES:

• AHIP COUNTERS AMA CHARGES

• MCKINSEY QUARTERLY: E MPLOYERS WILL PUSH TO PHYSICIAN & PROFESSIONALS
DROP TRADITIONAL COVERAGE • PATIENT EXPERIENCE – A LONG LIST OF “ROOM FOR

• EXPECT E MPLOYER-BASED R ETIREMENT PLANS TO BE IMPROVEMENT” IN THE TYPICAL OFFICE VISIT
RETOOLED • BETTER PHYSICIAN-TO-PATIENT COMMUNICATIONS IS

• HEALTH SAVINGS ACCOUNTS GROW 14% THE KEY TO IMPROVING P ERCEIVED Q UALITY
• EMPLOYERS WILL INVEST MORE IN WELLNESS/FITNESS • CANADIAN PHYSICIANS RECEPTIVE TO PHR…WITH THE

PROGRAMS USUAL CONCERNS
• THE NEXT GENERATION OF MOBILE APPS TO OFFER • VA PHYSICIANS STILL USE WORK-A-ROUNDS WITH

“VIDEO HOUSE CALLS” EHR
• WORLDWIDE MOBILE HEALTH PROJECTS – EARLY • 19% OF PHYSICIAN USING TABLETS CLINICALLY

DAYS, RELATIVELY LOW T ECH • PATIENT LIKE I PAD EDUCATION VIDEOS

• MINNESOTA PIONEERS ALLIED HEALTH WORKFORCE

EXPANSION PATIENT-CONSUMER -CAREGIVER
• PWC: CONSUMERS WILL SPEND $13.8 BILLION OF

ACO THEIR OWN MONEY
• EARLY F EDERAL ACO PILOTS FALL SHORT ON RETURN • CONSUMERS WILLING TO PAY FOR NEW GENERATION

AND COSTS OF HEALTH DEVICES
• CALIFORNIA HYBRID ACO PARTNERSHIP SHOWS $15.5 • MEDICAID PRICE CONTROLS LIMITS CHILDREN

MILLION IN SAVINGS GETTING CARE
• KPMG SURVEY: MOST P ROVIDERS A RE STILL • YOUNG CANCER PATIENTS SPEND A LMOST FOUR TIMES

THINKING ABOUT AN ACO, MOST PAYERS DON ’T HAVE AS MUCH AS THOSE WITH OTHER CHRONIC
A STANCE CONDITIONS
• HFMA: 12 ESSENTIALS FOR ACO SUCCESS REPORT • NEWLY RELEASED - PATIENT-CONSUMER-CAREGIVER

• PHYSICIAN ALIGNMENT IS THE MOST CRITICAL STEP HELPFUL RESOURCES
FOR DEVELOPING AN ACO • BOOMERS N EED E DUCATION ON HOW TO CARE FOR

• TOP FIVE: ALIGNING PHYSICIANS FOR THE ACO THEIR PARENTS
• DOJ SAYS MOST ACOS WON’T HAVE ANTITRUST

PROBLEMS OVERSIGHT -INFLUENCE -INNOVATION
• REGULATORY:
• NEWLY RELEASED - CMS ACO HELPFUL R ESOURCES

Continued

Information Advantage Group, San Francisco, IAG.co, 415.346.3860

• FDA MEDICAL DEVICE DATA SYSTEMS (MDDS) • NEW BILL EASES TELEMEDICINE REQUIREMENTS FOR
REGULATIONS TO BE U PDATED VETERANS HEALTHCARE
• FCC CALLS FOR COMMENT ON “GRANDFATHERED” • TECH & INNOVATION:
RURAL TELEMEDICINE PROVIDERS • ACO
• PATIENT-CONSUME21

MACRO TRENDS

Despite a”you’re on the bus, you’re off the bus” economy, we are remaining a
happy bunch of Americans (81%) in the face of renewed slippage in our
personal and business confidence.
What is also interesting is that the older we are the happier we seem to be
getting. With 58% of us being outside the traditional 25-54 years of age
demographic and the largest group (9%) being the 70+ and then considering
the shift to 52% of those using social networks being 36+ years (a 58%
increase since 2008), we can expect some wise rethinking about how to reach
those who buy, use and provide the most healthcare.

Q1 GDP ADJUSTED UP…SLIGHTLY
The U.S. Department of Commerce delivered a bit of
good news June 24th, announcing that real GDP growth
during the first quarter of 2011 was higher at 1.9%
(final reading) than its prior estimate of 1.8% provided a
month ago and Wall Street's estimate of 1.8%, but down from
the 3.1% of Q4, 2010. The small upward revision was due to an
increase in net exports, the changes in private inventories,
decreases in state and local government spending and
nonresidential fixed investment countered these increases.
(US Bureau of Economic Analysis, June, 2011) Top

CONSUMER AND BUSINESS CONFIDENCE SLIPS
Based on data through June 16th, 2011, the Conference
Board's Consumer Confidence 58.5 reading is lower than
the consensus estimate of 60.8 and a decline from the
May reading of 61.7 - the lowest reading since December
2010. This reflects a less favorable assessment of current
conditions and continued negativism about the short-term
outlook with fewer consumers than last month seeing
conditions improving over the next six months.

The University of Michigan Consumer Sentiment Index
for June, 2011 came in at 71.5, down from the 74.3 in
the previous month.

© Information Advantage Group, San Francisco, IAG.co, 415.346.3860 2

And finally, the NFIB Business Optimism Index of small
business sentiment falls in line with the previous
consumer confidence indices.
Doug Short sees these consumer and small business
sentiments as remaining close to levels associated with other
recent recessions. The good news is that the trend since
the Financial Crisis lows has been one of general
improvement and it is too early to call whether the
latest monthly data will subsequently be seen as a
reversal.
Given the combination of uneasiness about the economic
outlook and future earnings, consumers are likely to
continue weighing their spending decisions quite carefully.
(Advisors Perspectives, June 28, 2011) Top

BY FAR, MAJORITY OF AMERICANS ARE STILL HAPPY
81% of Americans are happy. Of those, 33% of 2,184 Americans are very happy this
year - slightly down from the 35% who were very happy in both 2008 and 2009 -
according to a May, 2011 poll by Harris Interactive. The Harris Happiness Index is calculated by
asking how Americans agree or disagree with a list of statements like: "My relationships with friends
bring me happiness", "I rarely worry about my health" and "At this time, I'm generally happy with my
life" or "I frequently worry about my financial situation" and "I rarely engage in hobbies and pastimes I
enjoy."
The poll also showed:
• Men's happiness has been trending down since 2009 - 31% are very happy in 2011,
down from 32% last year and 34% in 2009,
• Women are generally happier than men and slightly trending up (36% vs. 35%) over
2010,
• African Americans are the happiest and trending up from 40% who were very happy last year
to 44% this year, Hispanics are now less happy than they were last year (35% vs. 39%) yet
they remain happier overall than White Americans who are steady at 32%,
• No surprise - the highest income bracket, earning $100K or more per year, are the happiest
group (37%) - most interesting are the least happy who are those who earn just slightly less,
between $75K and $99.9K per year (29% very happy),
• Older Americans remain happier than those younger, as has been the case in all
previous years - 50-64 years (37%) and 65 years (42%) and older are very happy and
• Those who graduated from college are happier (35%) than those with less (32%) who have
never attended.
(Harris Interactive, June 22, 2011) Top

MARKETERS CAN MISS THE LARGEST PERCENTAGE OF BUYERS
According to US Census and Neilsen data, 58% (180 Million) of the US population is outside
the traditional 25-54 age demographic - of this the largest grouping by age is the 70+ at
9%. Also, consumers age 55 and older have nearly identical purchasing habits to those age 25-54 in
many consumer package goods product categories. Top


A SHIFT TO THE RIGHT – THE MAJORITY (52%) OF SOCIAL NETWORK USERS
ARE 36+, YOUNGER SHOWS STEEP DECLINE
The average age of social network users rose between 2008 and 2010, according to Pew Research.
Key trends include:
• The percentage of social network users age 18-22 fell 43%, from 28% to 16%,
• The percentage of social network users age 23-35 dropped 20%, from 40% to 32%,
• The percentage of users age 36-49 rose 18%, from 22% to 26% and
• Most significantly, the percentage of users age 50-65 more than doubled, from
9% to 20%.
In total, 52% of social network users in 2010 were 36 years old and up, a 58% increase
from 33% in 2008.
(Pew Research, June 16, 2011) Top

HEALTHCARE MACROS

The $2.7 trillion healthcare market has always been an attractive market
for the simple reason that it’s dependent on someone else providing and
paying for it – a natural fertilizer for runaway costs. We also know that
persistent high costs and pending thinner margins (4% down to possibly -1%)
are forcing those who pay for and provide most of our care to be a bit
more collaborative.

It’s early, but the exciting parts of the current proposition are the
incentives to get the patient on a path of self-care and monitoring that
requires them to think more about how and what they will pay and who’s
going to provide it – personal responsibility seems to be a key ingredient in
this brand of reformulation.


IDC STUDY: HEALTHCARE IS THE MOST ATTRACTIVE US MARKET
IDC States the FACTS: on a purely economic basis, the U.S. market for health care is
the most attractive single market in the U.S. because:
• $2.7 trillion spent in the U.S. is on health care, which is now 17 percent of GDP and rising,
• The total health-care IT provider spends on a global basis is $25.6 billion: a mix of hardware,
software and services - 40% of that is in the U.S. and expected to be 53 percent by 2014,
• Estimates say $700 billion in wasted time, energy and resources is poured into health care,
• The 15 US hospital systems account for 29% of the total hospitals in the country, and 27% of
the total beds,
• Because many providers have been able to recover about 30% of their overall IT budgets by
optimizing their data centers and infrastructure, they are investing this in the CPOE, EHR and
analytics systems under reform,
• 43% of providers are accelerating their investment in EMR to qualify in time for stimulus
incentives, and
• An additional 32 million Americans will in theory have health insurance by 2019, and
insurance companies are required to pay out up to 85% of the revenue they take in premiums
to actual patient care.
(CRN, June 16, 2011) Top

HOSPITAL SERVICES COST CONTINUES TO RISE YEAR OVER YEAR
The U.S. Bureau of Labor Statistics reports:
• Consumer prices for hospital services increased 0.8% in May up slightly from April’s 0.7%
climb the prior month - a year ago, the agency's index of consumer hospital prices increased
0.5%.
• The hospital index climbed 6.3% during the 12-month period ended in May
compared with an 8.1% increase a year ago.
(Modern Healthcare, June, 2011) Top

$8,100 PER MAN, WOMAN AND CHILD IN 2009
In an excellent summary, the July, 2011 National Institute for Health Care Management
Foundation’s data brief “Understanding U.S. Health Care Spending” concludes that annual
American health care spending hit $8,100 per man, woman and child in 2009, for a total
of 2.5 trillion dollars. Key points include:
• 5% of the US population is responsible for almost 50% of all
spending; conversely, 50% of the population accounts for only
3% of spending.
• Despite the growing numbers of those being treated for chronic
conditions, spending distribution remains highly concentrated.
• 50% of national and 80% of private insurance premiums were
attributed to increase spending for hospital care and physician and
clinical services during the 2005-09 period.
• Rising prices per unit of service eclipsed rising utilization rates as the
largest cause for recent expenditure growth.
• Leading drivers of rising unit prices and higher utilization rates include
advances in medical technology, higher rates of chronic diseases and
increased provider consolidation and market power.


(NIHCM, July 2011) Top

MOST HOSPITALS PREPARING FOR THINNER MARGINS
Research by a global consulting company posits that the resulting shift in the payer mix (i.e., more
government, less commercial interests) will likely cause the majority of hospitals to see
their average 4% margin sink to -1% or lower over the next decade unless they begin
pursuing major strategic changes now. This is because historically, the fiscal health of U.S.
hospitals and health systems has been precariously supported by using profits from commercial
health insurance plans to cover losses generated when caring for the uninsured, or lower reimbursed
Medi/Medi patients (Medicare currently provides approximately 30% of all reimbursements to
hospitals -- nearly five times the percentage of the American population that it insures). Trends
causing this change include:
• Companies discontinuing their employer-sponsored coverage plans,
• Companies not subsidizing employees' healthcare benefits on health insurance exchanges,
• It may be cheaper to pay government penalties than to provide employee coverage at all,
• The decrease of employer-sponsored coverage will swell the ranks of lower-reimbursement
Medicaid membership by 16-18 million individuals during the next decade, and
• The wave of "baby boomers" will continue to increase Medicare membership at roughly 3.1%
per year.
The dramatic shift to a much larger percentage of government reimbursements will
substantially reduce profitability for most hospitals and health systems (despite the
reduction in bad debt associated with fewer uninsured).
(Marketwire, June 20, 2011) Top

AHIP COUNTERS AMA CHARGES
America's Health Insurance Plans (AHIP) released research on June 8 supporting the
observation that hospital systems are growing more dominant in their markets and thus
causing cost increases. The idea is that doctors and hospitals are behind cost increases has been
a consistent theme of AHIP's public position on reform and health care public policy for years.
• According to AHIP, 80% of 335 markets studied would be considered highly concentrated by
the Dept. of Justice and the Federal Trade Commission's Herfindahl-Hirschman Index -
agencies use the index as a guide during merger review.
• AHIP-commissioned research in 2009 showed that hospital consolidation between 1997 and
2006 drove up the country's health care spending by one-half of a percentage point - $10-12
billion annually.
• Hospital consolidation is not a new problem. From the late 1990s to 2003, these
consolidations affected 90% of people in densely populated locations where the hospital
market qualified as highly concentrated.
AHIP's statements counters other, including the American Medical Association, reports
and statements arguing that increasing health plan market consolidation is the reason why
premium rates have been going up even as physicians have had to accept lower rates.
Consistent research undertakings by the American Medical Association have indicated that
the market for health insurance is highly concentrated in virtually every metropolitan area
of the country.
• AMA has reported that one insurer controlled 30% or more of nearly every
market, based on enrollment data from Jan. 1, 2008.


(Amednews, June 8, 2011) Top

MCKINSEY QUARTERLY: EMPLOYERS WILL PUSH TO DROP TRADITIONAL
COVERAGE
Although the Congressional Budget Office estimated that, under reform measure, only
about 7% of employees will have to switch to subsidized-exchange policies in 2014 from
their currently employer-sponsored insurance (ESI) programs, in a February 2011 survey
1,329 U.S. private sector employers undertaken to measure their attitudes about healthcare reform,
as well as other proprietary research, found:
• 30% of employers will definitely or probably be offering ESI after 2014 - this rises to more
than 50% and will push 60% to pursue some alternative to traditional ESI among those
considered to have high awareness of reform.
• 30% of employers would gain economically from dropping coverage even if they completely
compensated employees for the change through offering other benefits or higher salaries.
• If ESI was stopped, 85% of employees would remain at their jobs, but about 60 percent
would expect increased compensation.
(McKinsey Quarterly, June 2011) Top

EXPECT EMPLOYER-BASED RETIREMENT PLANS TO BE RETOOLED
According to the sixth annual Employer Survey on Retiree Medical Strategy by Towers Watson:
• Nearly 60 percent of the retiree medical plan sponsors cite the high cost of
providing coverage and opportunities under healthcare reform as the main reasons
for retooling retirement plans.
Among these sponsors:
• 87% are examining the new federally-subsidized insurance options under reform
for pre-age 65 coverage,
• 73% cite the “Cadillac Tax¨ for high-end plans as a concern.
So far, approximately 5% of employers have stopped group plan sponsorship entirely and
switched to helping Medicare retirees purchase higher-value medical and pharmacy insurance in the
individual market through the use of Medicare coordinators.
(International Society of Certified Employee Benefit Specialists, 2011) Top

HEALTH SAVINGS ACCOUNTS GROW 14%
The American Health Insurance Plans
(AHIP) association announced that more than 11.4
million Americans are now using Health Savings
Accounts (HSA) - a 14% increase since last
year. HSAs are tax-exempt trust accounts that are
an alternative to traditional health insurance plans
and offer employees lower insurance premiums if
they agree to place money into a special account
from which they pay for most of their lower-cost,
basic healthcare. These plans include
a “catastrophic,” high deductible insurance plan for
larger medical bills due to hospitalizations, surgeries,
or other higher cost specialized treatments.


Based on their annual census, AHIPS January 2010 to January 2011 finds enrollment breaking out
as:
• 2.4 million lives for the individual market, 2.8 million lives for small-group market and over 6.3
million lives were covered in the large-group market.
• 26% growth for large-group coverage, making it the fastest growing, with the individual
market coverage coming in second at 15%
• The leading states include: California (1,073,319 enrollees), Texas (844,832 enrollees), Ohio
(728,868 enrollees), Illinois (690,509 enrollees), Florida (656,243 enrollees) and Minnesota
(507,307 enrollees).
(AHIP, June 14, 2011) Top

EMPLOYERS WILL INVEST MORE IN WELLNESS/FITNESS PROGRAMS
A provision in the ACA law earmarks $200 million for grants to help small businesses set
up wellness programs between 2011 and 2015. Some recent findings include:
• 86% of employers plan to significantly increase wellness and health promotion
programs over the next three years and
• 56 % improving employee health and 49% lowering healthcare costs topped the lists
of Hewitt’s 2011 Health Care Survey of 1,028 employers.
(Boston.com, May 31, 2011) Top

THE NEXT GENERATION OF MOBILE APPS TO OFFER “VIDEO HOUSE CALLS”
Increasingly over the last year, insurers have begun offering mobile apps, largely for
administrative functions, aimed at patients. Payers like United Healthcare and HealthNet
already provide mobile access to coverage and benefits information, physician directories, health
savings account balance totals and even out-of-pocket drug cost data. More inventive companies
have expanded to mobile apps for fitness and wellness tracking, localized allergy alerts
and game-based social media apps for fitness challenges.
What is on the horizon includes health apps that engage the patient with games that are
instructional, challenging and also have the addictive component of video games. Microsoft's
Kinect is one of these systems that are just now being explored for exercise and fitness.
For the physician, we can expect the current shift of mobile apps from consumer
to biomedical measurement to continue. We can also expect payers to be looking to build
"collaboration" apps that allow network physicians to communicate via Smartphone with patients,
send secure messages to other providers, and receive alerts, results and "video house calls."
( FierceMobileHealthcare, June 17, 2011) Top

WORLDWIDE MOBILE HEALTH PROJECTS – EARLY DAYS, RELATIVELY LOW
TECH
A recent World Health Organization study on mobile healthcare (mHealth) states:
• Nearly 50 percent of the mHealth projects underway around the world involve
telemedicine,
• Although worldwide mHealth is growing exponentially, there's no organization to it,
• The biggest problem with this growth is that, while 83% of the 112 countries
studied have mHealth projects ongoing, most are pilot projects with only 12% of
these evaluating the success of their mHealth programs,


• Europe (and the U.K., specifically), are the leading mobile-enabled countries when it comes
to healthcare; Africa has the least mHealth involvement, and
• Appointment reminder (71%) is the most common use for mobile devices in high-income
countries; in low income countries the two mHealth applications are lower-tech health call
centers (59%) and emergency phone services (54%).
(FierceMobileHealth, June 10, 2011) Top

MINNESOTA PIONEERS ALLIED HEALTH WORKFORCE EXPANSION
Minnesota's lack of rural physicians has opened the door for mid-level practitioners to
take on a greater role in providing health care. Called community paramedics, this new
category of healthcare personnel targets underserved rural areas. Most of us accept nurse
practitioners and specially-trained nurses to perform physical exams and prescribe medications.
What's new is the idea of using mid-level practitioners to fill health care gaps. An example is
Minnesota being the first state in the nation to license "dental therapists," who perform duties that fall
between those of a dental assistant or hygienist and those of a full-fledged dentist - they can fill
cavities and other simple procedures, under the supervision of a licensed dentist. Or, it is also the
first state to pass a law establishing certification for community paramedics who might suture a
wound, adjust a medication, or address an asthma attack or allergic reaction.
(MPRNews, June 20, 2011) Top

ACO

Objections on the proposed rules for ACOs (“…as they are written…”) are
often seeded with the less than glowing results from federal ACO pilots
where only 40% of physicians got a shared savings bonus. The truth is, - the
pilot did slow Medicare spending across the board. Other refined “ACO-like”
pilots have been turning in good results. This has most looking for the best
way to structure and align with the developing ACO model.

EARLY FEDERAL ACO PILOTS FALL SHORT ON
RETURN AND COSTS
A key government five-year test of the ACO concept
enlisted 10 leading health systems around the country and
offered financial bonuses if they could save enough by
treating older patients more efficiently while providing
high-quality care:
• By the last year of the study, 2010, only 40% of
the long-established groups run by doctors, slowed their Medicare spending enough
to qualify for a bonus.
• Two sites saved enough to get bonuses in all five years; three did not succeed
even once.
Other work has shown that the financial investments for infrastructure and re-
engineering have been higher than the government has predicted, causing it to lose money
for at least the first few years. The ACO rules will be final in December and much more
research is needed on these cost and return issues.
(NCPA, June 8, 2011) Top


CALIFORNIA HYBRID ACO PARTNERSHIP SHOWS $15.5 MILLION IN SAVINGS
Four years ago, Blue Shield of California, Catholic Healthcare West and Hill Physicians
Medical Group partnered to form their version of an ACO in response to concerns about
rising health care costs and their effect on policyholders. Now in 2011, the partnership said for
CalPERS 41,500 members have seen:
• Health care spending was reduced by $15.5 million in 2010,
• Premiums did not rise between 2009 and 2010 and
• There was a 15% reduction in the average length of hospital stays and readmissions.
The partnership stated that much of the savings were created by eliminating duplicative positions
and jointly funding new positions to make care more efficient. They also indicated that it didn't
require a significant amount of capital to start their partnership.
Headquartered in San Francisco Catholic Healthcare West (CHW) is the fifth largest hospital
provider in the nation and the largest hospital system in California. It has stated that it does not
intend to participate in the federal government's ACO efforts because as the rules are
written, the bar is currently set too high for the incentives offered.
(California Healthline, June 27, 2011) Top

KPMG SURVEY: MOST PROVIDERS ARE STILL THINKING ABOUT AN ACO,
MOST PAYERS DON’T HAVE A STANCE
In April, KPMG polled leaders of healthcare systems, hospitals and healthcare payers about their
participation in the Centers for Medicare and Medicaid Services’ shared savings program (MSSP) –
the Medicare ACO program and found that most are still thinking about it.
• 64% of hospital and health system executives either didn’t know their
organization’s position (39%) or were in a wait-and-see mode (25%) about
participating in the MSSP - either position wouldn’t allow them to be ready for the
launch of the program, planned for January 1, 2012.
• 61% of payers said they didn’t know what their organization’s stance (50%) was or
were in a wait-and-see mode (21%) on the MSSP.
(Healthcare Financial News, June 30, 2011) Top

HFMA: 12 ESSENTIALS FOR ACO SUCCESS REPORT
HFMA 2011 Leadership report describes Baylor Health Care System 12 ACO essentials for
success that focus on people, quality, and finance and include:
1. Effective and Shared Governance
2. Aligned and Efficient Clinical Workforce
3. Informed and Skilled Participants/Workforce
4. Interoperable, Data-Enabled Environment
5. Quality
6. Attribution, Assignment, and Capacity Management
7. Anchored Patient-Centered Medical Home
8. Care Coordination and Patient Compliance
9. Risk Assessment and Acceptance
10. Cost Monitoring and Reduction
11. Provider Reward Methods/Incentive Design


12. Sustainable Business Structure
(HFMA, 2011) Top

PHYSICIAN ALIGNMENT IS THE MOST CRITICAL STEP FOR DEVELOPING AN
ACO
A recent survey of 882 administrators and physicians highlighted that, while capital,
infrastructure and data analytics are key structural components regarding both ACO
formation and the industry-wide effort to enhance quality of care and reduce costs,
physician alignment was most pivotal:
• 58% stated they are either in the process of forming ACOs or are thinking about
it - of these, 42% said physician alignment is the most serious obstacle to their
efforts, followed by lack of capital (38%), lack of integrated IT systems (31%), and lack of
evidence-based treatment protocol data (25%).
• 42% will not form ACOs in the near future - of these, 40% cited physician
alignment as a reason they are not, followed by lack of capital (31%), lack of integrated
IT systems (26%), and lack of evidence-based treatment protocol data (23%).
(MarketWatch, June 20, 2011) Top

TOP FIVE: ALIGNING PHYSICIANS FOR THE ACO
Peggy Naas, MD, MBA, vice president of physician strategies at VHA, Dallas, TX has one of the
better “lists” for developing strategies for successfully aligning physicians with a hospital
during the creation of an ACO:
1. Focus on clinical outcomes being delivered efficiently and in a way that benefits the entire
organization.
2. Choose a specific model suited to the culture of the enterprise:
• Employment -Hospitals can employ or contract physicians as a step on the way to align them
with the organization.
• Co-management - Physicians are employed or otherwise paid for administrative roles or
clinical leadership tasks and other administrative leaders would have or preferably share
outcome-based incentives.
• Clinical integration - Health systems and hospitals partner with health system-employed and
self-employed physicians on specific performance metrics.
3. Foster physician leaders who can participate in committees; listen to them and start nurturing their
understanding of the broader organization's work and the perspective of the board," she says.
4. Be visible in the enterprise and transparent about the health system's or hospital's performance
and outcomes, no matter what the outcome - positive or negative.
5. Create a culture conducive to alignment and experiences involving collaboration.
(Becker Hospital Review, June 27, 2011) Top

DOJ SAYS MOST ACOS WON’T HAVE ANTITRUST PROBLEMS
At the Second National Accountable Care Organization Summit in Washington June 27th, deputy
chief of the legal policy section/antitrust division of the Department of Justice Gail
Kursh, JD, stated:


• An ACO will be considered legitimate if it is a clinically integrated collaboration of
otherwise independent providers and not a vehicle for competitors simply to raise
prices and
• Most ACOs would not have problems with their legality under antitrust provisions
on the proposed rules.
Under current proposed rules, to participate in the Medicare Shared Savings Program, would-be
ACO collaborations that have more than a 50% market share of a primary service area (PSA) would
need to demonstrate that their percentage of the market does not create market power or
anticompetitive behavior. However, what constitutes a clinically integrated collaboration remains to
be figured out.
(FierceHealth, June 27th, 2011) Top

NEWLY RELEASED - CMS ACO HELPFUL RESOURCES
CMS Proposed Rule establishing ACO Program Details
Request for Information Regarding Accountable Care Organizations and the Medicare Shared
Savings Program
IRS Request for Comments Regarding the Need for Guidance on Participation by Tax-Exempt
Organizations in the Shared Savings Program through ACOs
Implications Regarding Antitrust, Physician Self-Referral, Anti-Kickback, and Civil Monetary Penalty
Laws
Proposed Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations
Participating in the Medicare Shared Savings Program

MEDICAL HOME

Objections about the proposed rules for ACOs (“…as they are written…”) are
often seeded with the less than glowing results from federal ACO pilots
where only 40% of physicians got a shared savings bonus. The truth is, - the
pilot did slow Medicare spending across the board. Other refined “ACO-like”
pilots have been turning in good results. This has most looking for the best
way to structure and align with the developing ACO model.

FIRST ONCOLOGY MEDICAL HOME REDUCES HOSPITALIZATIONS
Consultants in Medical Oncology and Hematology, PC (CMOH), a private practice in southeastern
Pennsylvania, has become the first oncology practice in the nation to achieve level III recognition
from the National Committee for Quality Assurance as an oncology patient-centered medical home
(OPCHM) with results that include:
• CMOH chemotherapy patients ER visits are half the rate reported in another large
commercially insured population and 65% lower than their practice's own 2006 rate
in 2006.
• CMOH's rate of hospitalizations per chemotherapy patient per year has dropped
by 43% since 2007.
(Fierce Health, June 14, 2011) Top


ONLY 35% OF UNDER 20 PHYSICIAN PRACTICES USE MEDICAL HOME
PROCEDURES
A just released study in Health Affairs offer the first
national data on to what degree 1,344 medical
practices with fewer than 20 doctors had adopted the
seven fundamental principles of medical home
processes showed:
• Across all entities, only 35% used medical
home processes, and overall earned only
21% of the medical home points,
• Adoption was greatest for the largest
medical groups (>140 physicians) and
those owned by large entities like
hospitals and
• Contrary to the studies assumption, practices serving a high percentage of minority
or poor patients were not less likely to be using medical home practices.
With 35% of visits to US office-based physicians are to solo practitioners, and 88% are to practices
with nine or fewer physicians, the study offers several strategies to raise these scores.
(Health Affairs, June 28, 2011) Top

COORDINATION OF CARE IMPROVES WITH EHR
A 12 month study of 119 patients, about half at Taconic Independent Practice Association in New
York State and the rest at eHealth Initiative, Sanofi-Aventis and Health & Technology Vector, a
Hartford, Conn.-based health IT and care redesign firm, the study found many process
improvements in the care with the inclusion of an EHR in the workflow that included:
• More information being transmitted to patients during each clinic visit, more
frequent setting of goals, and more complete summaries being transmitted from
primary care physicians to cardiologists,
• Electronic communication between cardiologist’s practices was problematic due
to processes not being in place, the communities did not have the tools for
electronic data exchange, and the providers did not have compatible EHR
systems. However, researchers also reported that some cardiologists were
interested in expanded exchange of electronic clinical data.
Researchers concluded that to be sustainable and successful, care coordination requires ongoing
and explicit three-way communication between patient, primary care physician, and specialist.
(Information Week, June 23, 2011) Top

NEWLY RELEASED - HELPFUL RESOURCES:
American Academy of Pediatrics: From pediatric to adult medical homes • Joint report outlines how
to plan, execute better health care transitions for all patients
The Joint Commission has developed Primary Care Medical Home which enables the potential for
increased reimbursement when the additional requirements of a Primary Care


HIE

We’re beginning to see more growth in privately offered HIEs verses public to
help physicians qualify under meaningful use rules. Part of this shift is driven
by a physician’s affinity to local affiliations, like hospitals and IPAs, and
trade associations way before governmental…healthcare happens locally not
regionally or nationally.

THE AMERICAN ASSOCIATION FOR FAMILY PRACTICE LAUNCHES LOW-COST
MESSAGING SERVICE (HIE)
The American Association for Family Practice Physicians Direct is now available to its
members for $90 a year. The service is intended to assist members meet meaningful use
requirements and is a secure clinical messaging system allowing the sending of unlimited number of
messages and data files to their clinical colleagues and other trading partners. The system is a
collaboration with Surescripts, one of the largest electronic prescription networks in the US.
(AAFP, June 22, 2011) Top

MAINE PASSES OP-OUT HIE REQUIREMENT
Maine has passed legislation requiring healthcare providers participating in the state’s HIE to provide
informative pieces that describes risks and benefits and how to opt-out. This action is the results
of a public hearing that illuminated that a proposed op-in model had not garnered support
from major stakeholders. The proposed legislation also requires the HIE to offer online and offline
access to who, when and where has accessed their records by patients. Top

LESSONS LEARNED FROM CONNECTING TO THE NATIONWIDE HEALTH
INFORMATION NETWORK (NWHIN)
Lessons shared about connecting to the NwHIN were offered by the North Carolina Healthcare
Information & Communications Alliance Organizations during a recent webinar:
• Be prepared for an abundance of interoperability testing and review before any information
can be exchanged,
• Be ready for the intensity of developing and proving conformance and interoperability
through partner testing that all has to take,
• Governance must be in place and must have the technical requirements installed first and
then the network's governing body must approve the entities for interoperability and partner
testing, and
• The cost of this is more on the enterprise and community HIE side than it is on the gateway
connection to the NwHIN.
Currently, those connecting to the NwHIN must be federal agencies or have a contract with a federal
agency that covers these types of activities.
(CMIO, June 20, 2011) Top

NEWLY RELEASED - HIE HELPFUL RESOURCES:
HIMSS Electronic Health Record Association, a vendor trade group, has developed a white paper
that lays out a framework for health information exchange by connecting EHRs more rapidly.


The eHealth Initiative has the second phase of its updated HIE Toolkit that addresses creating a
sustainable model, technical consideration of connectivity, marketing your HIE, auditing and value-
add services and working examples of documents and other helpful materials. Top

PHYSICIAN & PROFESSIONALS

The attention directed toward the physician-to-consumer market under all of
the new rules and models for healthcare have providers thinking hard about
how to gain efficiencies and improver the consumer experience. Improved
communication and patient participation and collaboration through the use of
technology are proving itself again.

PATIENT EXPERIENCE – A LONG LIST OF “ROOM FOR IMPROVEMENT” IN THE
TYPICAL OFFICE VISIT
Intuit's April 2011 Health Patient Engagement Study survey of 556 U.S. physician practices about the
patient's experience in their office found:
• Almost 25% of providers who are not online think it is hard for patients to reach
them to ask questions, make appointments or receive lab results,
• Almost 50% of physicians said their practices are typically running 30-60 minutes behind
schedule,
• 33% of a providers office staff spend three or more hours per day trying to get follow-up
information to patients,
• 83% of doctors say it takes more than one reminder before a patient pays their bill,
• 45% say phone interruptions happen so frequently they impact office efficiency.
• 72% say patients complain about having to repeatedly fill out the same paper forms, and
• 50% say their patients complain about spending too much time in the waiting room.
To improve on these inefficiencies:
• 95% of doctors want their patients to fill out necessary forms online before their appointment,
81% of patient agreed,
• 67% percent of providers are planning to build add a patient portal, communication
or EHR solutions in the next 12 months under ARRA to provide patients with
access to health records and clinical information, appointment scheduling and
prescription refills.
(HealthcareITNews, June 14, 2011) Top

BETTER PHYSICIAN-TO-PATIENT COMMUNICATIONS IS THE KEY TO
IMPROVING PERCEIVED QUALITY
Communication between patients and clinicians still follows in one-
way direction from doctor-to-patient. However, The New England
Healthcare Institute’s (NEHI) recent teleconference took a hard look at this
communication channel and produced some valuable information and
conclusions:
• The ACA of 2010 includes a number of provisions that
encourage the development and use of shared decision-making and improved
patient-clinician communication.


• The law also calls for the measurement of communications quality and the
information provided to and used by patients, caregivers, and authorized
representatives to inform decision-making.
• Providers will increasingly be held accountable for their communication with
patients, as exampled by the current use of patient satisfaction surveys (the Hospital
Consumer Assessment of Healthcare Providers and Systems survey), which are currently
part of Medicare’s Hospital Inpatient Quality Reporting program and included under the
measures for the first year of the Value-Based Purchasing Program set to begin in October
2012 (FY 2013).
• As a guide for better patient-to-physician communications, two work groups (the Evidence
Communication Innovation Collaborative and the Best Practices Innovation Collaborative)
under the Institute of Medicine Roundtable on Value and Science-Driven Healthcare have
developed a set of core principles and expectations to communication.
• Early demonstration results show that because patients are getting exactly what they want,
providers save time because patients come to appointments more prepared and have
greater risk perception.
(NEHI, June, 2011) Top

CANADIAN PHYSICIANS RECEPTIVE TO PHR…WITH THE USUAL CONCERNS
A new study of Canadian physician attitudes toward personal health records (PHRs) discovered:
• Physicians generally saw PHR adoption as an inevitable and positive step forward,
• Portability and potential to engage patients especially appealed to the docs.
Common concerns included:
• Concerns about how PHRs could affect data management, patient-physician relationships
and practice management issues,
• Security and privacy were top concerns,
• Unnecessary anxiety as patients struggle to make sense of the complex information, if
information is shared without the conventional framing by a physician,
One conclusion by a physician about a patient’s use of PHRs, “If you’re going to make (PHRs)
worthwhile, you need to ensure patients are able to interpret the information they are receiving, able
to interpret it properly, and able to do something useful with it; otherwise, you are going to create
chaos.”
(iHealthBeat, June 14, 2011) Top

VA PHYSICIANS STILL USE WORK-A-ROUNDS WITH EHR
A new study by the Veterans Administration showed that, even among practices with advanced
electronic health record (EHR) systems, physician workarounds persisted. Results included:
• Physicians used 11 types of workarounds that included: printing out copies of instead of
viewing them on the screen, writing notes to help them remember things, and building
computer spreadsheets to keep track of referrals.
• Communication breakdowns and some computerized consult management redundancies
were also discovered.
(International Journal of Medical Informatics, July, 2011) Top

19% OF PHYSICIAN USING TABLETS CLINICALLY
According to a survey of 3,800 physicians, use of mobile devices is growing rapidly:


• 83% of respondents own at least one mobile device,
• 25% think of themselves as “Super Mobile" who use a smart phone and tablet device,
• 30% of respondent are using a tablet, 19% clinically,
• The most common professional uses of mobile devices are: look up drug and treatment
reference material, learn about new treatments and research, and search for information on
diagnoses, treatment paths, and educating patients.
• No age barrier to tablet adoption, and a slight to moderate age barrier for smart phone
adoption,
• The iPhone (60%) was the most popular smart phone, and the iPad was essentially alone in
the tablet space, and
• Android tablets were used by only a few.
(QuantiaMD, June 15, 2011) Top

PATIENT LIKE IPAD EDUCATION VIDEOS
Patients using education videos on iPads at
moments of “natural downtime” during their physician
visits for 3 to 5 minutes and covering their disease
topics are being received well. Although it’s early,
results show that the modules have improved
patient knowledge and generated positive feedback without placing additional demands on
physicians or staff. The videos were developed by Wake Forest Baptist Health and Wake Forest
University School of Medicine.
(AHRQ, June 2011) Top

PATIENT-CONSUMER -CAREGIVER

The “Consumer Miracle” in healthcare requires the patient-consumer to invest
more of themselves and their money in seeking a healthy life - another round
of studies are showing the patient’s willingness to do so and the consequences
on not.

PWC: CONSUMERS WILL SPEND $13.8 BILLION OF THEIR OWN MONEY
A new report by PwC concludes that consumers would be willing to spend approximately
$13.6 billion a year of their own money on healthcare services:
• Included in the $13.8 Billion is $4 billion on health-related video games, $8.9
billion on consumer rating of physicians and hospitals, and $700 million on mobile
health applications.
• Younger consumers (18 to 24) are twice as interested in mobile health applications or
programs and three times more interested in health-related video games than those 65+.
• Demand for convenience and transparency in services and pricing is spurring alternative
sources of healthcare services like retail health clinics which grew from 10% to 17% over the
2007-10 period.
(PwC, June 2011) Top


CONSUMERS WILLING TO PAY FOR NEW GENERATION OF HEALTH DEVICES
A survey of 1300 consumers currently using wellness and health devices and conducted by the IBM
Institute for Business Value showed that consumers are demanding a new generation of health
devices, greater simplicity and better information sharing. Leading reasons driving the buy
are:
• 96% - ease of use is the key factor in selecting one device over another,
• 75% - consider price well ahead of features, customer support, warranty or stylish design and
• 86% - want real-time, easy-to-understand feedback from their devices.
Moreover, the study finds, they're willing to pay for devices especially with $100 or below
price point; and over 33% of current device users expect to pay for part of the cost of
new health devices over the next two years and 35% also expect monthly service fees.
The report goes on to present a vision of key areas of growth that include dieting, eldercare, blood
monitoring, mobility and communication. Here too the theme of collaboration rings for vendors and
content providers to work together to amplify the utility of each device.
(HealthcareITNews June 23, 2011) Top

MEDICAID PRICE CONTROLS LIMITS CHILDREN GETTING CARE
A University Of Pennsylvania, School of Medicine study found that children on Medicaid were
refused appointments by 66% of specialists and had to wait 22 days longer for an
appointment than kids with private insurance. The primary cause was seen as Medicaid’s price
controls, which one survey reports 24 states plan to ratchet down even further.
(NEJM, June 16, 2011; National Governors Association Survey, spring, 2011) Top

YOUNG CANCER PATIENTS SPEND ALMOST FOUR TIMES AS MUCH AS THOSE
WITH OTHER CHRONIC CONDITIONS
A recent study in the Journal of Clinical Oncology found that 13% of non-elderly cancer patients
in the U.S. spend more than 20% of their income on healthcare, including health insurance
premiums. This compares to almost 10% of non-elderly adults with chronic conditions other than
cancer and only 4.4 percent of non-elderly adults without any chronic condition. Top

NEWLY RELEASED - PATIENT-CONSUMER-CAREGIVER
HELPFUL RESOURCES
The National Prevention Strategy is a comprehensive plan that will help
increase the number of Americans who are healthy at every stage of life. Top

BOOMERS NEED EDUCATION ON HOW TO CARE FOR THEIR
PARENTS
A survey of 600 Boomers aged 45-65 say they’re likely to become caregivers for their parents, but...:
• Only 51% can name any medications their parents take,
• 31% don’t know how many medications their parents are on,
• 34% don’t know if their parents have a safe-deposit box or where the key is, and
• 36% don’t know where their parents’ financial information is located.
(Sun Times June 21, 2011) Top


OVERSIGHT -INFLUENCE -INNOVATION

There continues to be any number of consumer health apps and devices
entering the market weekly…with few showing a sustainable business model.
This has hidden a shift away from pure consumer plays toward tools to
improve communication and care across the provider-consumer continuum. The
VA continues to promote telehealth while the commercial and federal markets
ask for more data – the VA must know something.

REGULATORY:

FDA MEDICAL DEVICE DATA SYSTEMS (MDDS) REGULATIONS
TO BE UPDATED
There's a shift from mobile health apps and devices being primarily consumer
products to becoming useful tools to connect patients and caregivers to
clinicians. These “tools” are expected to fall under FDA 501 (k) rules for medical devices when the
FDA begins regulating mobile health apps. Currently, the FDA defines medical device data systems
(MDDS) as hardware or software products that transfer, store, convert formats, and display medical
device data – it does not control the device or modify the data or it’s display.
(Information Week, June 7, 2011) Top

FCC CALLS FOR COMMENT ON “GRANDFATHERED” RURAL
TELEMEDICINE PROVIDERS
The Federal Communications Commission has adopted an interim final rule to
enable providers, who were "grandfathered" after the FCC changed its definition
for a "rural area" on July 1, 2005, to continue to participate in rural telemedicine
programs that receive subsidized telecommunications rates. The FCC is
currently seeking comment on whether to make these grandfathered providers
permanently eligible for discounted telecommunication services.
(Health Data Management, June 27, 2011) Top

NEW BILL EASES TELEMEDICINE REQUIREMENTS FOR VETERANS HEALTHCARE
The Service Members Telemedicine and E-Health Portability Act, also known as the STEP Act, was
added to the recently passed $690 billion Defense authorization bill. . Although the legislation was
designed for mental health services, it will help expand access to other types of medical care besides
telehealth services to veterans across the U.S. In addition to making it easier for providers to use
telehealth tools including video links, cell phones and Skype, the bill would exempt care providers
from having to obtain a medical license in the patient’s state. Providers still need to be licensed by
the Department of Defense.
(iHealthBeat, May 31, 2011) Top

TECH & INNOVATION:
Smartphone and tablet users still using the desktop or laptop to access the Internet:
• 56.4% - Desktop
• 39.6% - Smartphone
• 4.0% - Tablet


Rock Health, a seed accelerator for Web and mobile health applications,
has chosen ten start-ups from more than 350 entries as part of its inaugural
program. The chosen reflect trends that are shaping the next generation of
health-related applications. The ten are:
1. BrainBot – technology to improve mental performance;
2. CellScope – at-home disease diagnosis;
3. Genomera – personal health collaboration;
4. Health In Reach – medical procedure marketplace;
5. Omada Health – clinical treatment social networking application;
6. Pipette – patient monitoring and education;
7. Skimble – mobile fitness application;
8. WeSprout – connecting health data and community; and
9. Three additional start-ups in stealth mode.
The start-ups now enter a 5-month program with funding in the form of a $20,000 grant;
infrastructure; strategic medical, branding, communications and legal support; and mentoring from
experts.
(Healthcare ITNews, June 2, 2011) Top

The U.S. Department of Health and Human Services (HHS) and
the Institute of Medicine (IoM) co-hosted their second annual
event June 9th focusing on innovative applications and services
that harness the power of open data from HHS and other
sources to help improve health and health care. Some notable
applications included:
• iTriage - An iPhone app that allows users to select their symptoms, severity, etc., and then
the app guides the user to a nearby clinic, physician’s office, or hospital based on his or her
selections.
• Ozioma - A community-based app that aggregates data from HHS, CDC, NIH, and other
sources (65 sources and 300 data sets in total). The app is for use by the press, writers, and
communications groups.
• Healthline - SPG (surgical procedure guide) is a Web-based patient education application.
Users can learn about their procedure, view hospital-compare data and costs and choose
their doctor.
• Asthmapolis - Tracks where and when people use their asthma inhalers. Shows on a map
where and when people have attacks - the app also improved asthma control from 25% of
the time to 62% of the time.
• CommunityCommons.org - Connects individuals who are involved in the community health
movement.
(HHS Live, HHS, June 9, 2011) Top

The Aetna Foundation, the philanthropic arm of healthcare
insurer Aetna, has partnered with the Health 2.0 Conference in
San Francisco on September 25-27, 2011 to issue a developer
challenge. The idea is to spur new interactive browser-based
applications designed to make data about obesity more
accessible and usable. The prize for the best application will be $25,000 and two free passes to the
conference. Second prize will be $15,000, and third prize will be $10,000.


(Healthcare ITNews, June 10, 2011) Top

ACO
Health information technology company McKesson Corp's health
information technology group announced that it has signed a deal to
acquire Portico Systems. The acquisition will boost McKesson's
offerings as a provider of financial management tools for the ACO
market which calls for new products that support value-based
reimbursement incentives to align payers and providers on controlling cost and optimizing health
outcomes. Top

PATIENT-CONSUMER
A new translation app for mobile devices helps the hearing
impaired by enabling the user to speak into a device and
have the translated text appear; type-to-type translations
also are available for situations that require quiet or for those
who have trouble speaking. The application can support up
to 1,000 voice recognition-based transcriptions; text-to-text and text-to-speech transcriptions are
unlimited. $99. Top

With trend toward off-the-shelf computers increasingly being
able to replace proprietary devices, Care Innovations is a joint
venture between GE and Intel with its first product to be “The
Guide,” a table vital sign monitor and two-way telehealth
communication device. This is the first step in a transition
away from ‘purpose-built’ devices and toward device-agnostic
medical apps. It will run on any Win7 platform and they wioll recruit other vendors to offer devices
that best fit each patient’s needs. Top

The No. 1 paid medical app in the U.S. Apple App store is called “Pill Identifier” and
works by communicating with a searchable database of pill images of more than
14,000 prescription and over-the-counter medications found in the U.S. 99 cents for
the lite version $39.95 for the premium. Top

There has been an avalanche of mobile applications both for the consumer and
professional – see slide show:

® Information Advantage Group prepared this report as a general informative and educational guide and
basis for further discussions and diligence. This report includes qualitative and quantitative statements that
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