In the News: September 1-7, 2016

Sg2 is dedicated to helping our clients interpret the latest news and trends in health care. Below you’ll find our analysis of this week’s key industry headlines, along with links to related Sg2 resources.

Improve Care and Decrease Costs With Integrated, Team-Based Care

JAMA recently published a study conducted by Intermountain Healthcare that demonstrated the benefits of integrating mental and physical health through team-based models. The extensive 10-year study of over 100,000 adults showed lower utilization and costs and improved quality and outcomes for patients receiving team-based care. Embedding mental health screening and treatment within primary care offices led to 46% of patients in team-based practices being diagnosed with active depression, compared to 24% in traditional practices. Also, the improved care coordination led to a decrease in ED usage, as ED visits were 23% lower for patients in team-based care vs those in traditional practices.

Sg2 sees the value in executing integrated delivery models to ensure high-quality, patient-centered care. To learn more about integrating behavioral health and primary care, see the Sg2 report Reconsidering Behavioral Health.

CMS Releases Proposals to Stabilize Health Insurance Marketplace

CMS released its proposed 2018 Notice of Benefit and Payment Parameters on August 29. This notice of payment is the administration’s annual means of updating standards for insurers and a means to implement changes to the federally facilitated exchange, the Health Insurance Marketplace. It represents the administration’s first largescale effort to stabilize the Marketplace in response to major moves from insurers such as Aetna and UnitedHealthcare to minimize their footprint due to mounting financial losses (among other reasons). The 300-page proposed rule outlines many provisions focused on incentivizing insurer participation. Among the proposals are updates to the risk-adjustment criteria and the removal of obstacles for insurer growth and reentry to the marketplace.

As the insurance marketplace continues to experience volatility, payers and patients will be increasingly cost-conscious when engaging provider systems. Sg2’s Pricing Strategy Report outlines steps system leadership can take to recalibrate their pricing approaches to appeal to payers and patients and secure market share.

New Study Finds Higher Readmission Rates Linked to Lower Mortality Rates

In recent years, health care providers have been impacted by CMS’s association of hospital quality with mortality and readmission rates. A recently published article in the Journal of Hospital Medicine by Johns Hopkins researchers has called into question whether hospital-wide readmissions should be a measure of quality. Researchers examined hospital-wide readmission rates and mortality rates in 6 areas used by CMS: chronic obstructive pulmonary disease (COPD), coronary artery bypass, heart attack, heart failure, pneumonia and stroke. Their findings suggest that hospitals with the highest readmission rates were actually associated with lower mortality rates for patients with COPD, heart failure and stroke. It was noted that this association may result from the legitimate need to care for patients with chronic conditions in high-intensity settings.

In response to the 2013 launch of CMS’s phased program of increasing penalties for excess readmissions, health systems have been strengthening alignment with post-acute services in their markets. To learn more about key strategies for success in continuing care, read the Sg2 report Continuing Care—Remapping the Post-Acute Path.

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As of February 11, 2016, Vizient, Inc. has completed its purchase of MedAssets Sg2 and spend and clinical resource management segments from Pamplona Capital Management, LLC. MedAssets revenue cycle business will continue to operate as a wholly-owned subsidiary of Pamplona Capital Management LLP.

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