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HEALTHCARE MODEL MAKING THE GRADE! Guide to Senior Care Options & Patient Care Assisted / Alzheimer’s – Home Healthcare – Hospice – Home Care Senior Living - Skilled Nursing & Rehabilitation – Rehabilitation MOBILE AND DIGITAL AVALIABLE
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DEPARTMENTS
Volume 1 Issue 2
COLORADO'EDITION' JANUARY'–'FEBUARY'2014''
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CHICAGOLAND/SUBURBS JANUARY – FEBUARY 2014
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HEALTHCARE MODEL MAKING THE GRADE!
Logon to our website for additional information on • • •
Guide to Senior Care Options & Patient Care ALZHEIMER’S 4 Assisted / Alzheimer’s – Home Healthcare – Hospice – Home Care - Skilled Nursing & Rehabilitation – Rehabilitation ProgramsSenior andLivingassistance designed with those MOBILE'AND'DIGITAL'AVALIABLE'' with memory loss; some communities will 1!! . ! provide !! specially trained security measures to ! prevent residents from wandering.
Senior Companies Newsletters Upcoming events
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ASSISTED LIVING
5 Along with assistance with daily activities, some level of healthcare services are provided. HOME HEALTHCARE 6 Allowing patients to remain at home eliminating travel for treatment; alternative to hospital stay or a skilled nursing facility. HOME CARE
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Allowing a non-medical home care assistant (caregiver) provide transportation, meals, and daily needs. HOSPICE
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In-home or facility end of life care for the terminally ill with pain management, comfort and emotional support being the primary mission for the family.
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ALZHEIMER’S
• Caregiver Support • Educational Programs
in Alzheimer’s and Dementia Care Caring for a loved one with memory loss can be a full time
job, and selecting the right health care provider can be overwhelming. At Arden Courts, we know, we understand and we can help.SM Memory care is all we do from the specialized programming and trained staff to the homelike design and family education and support. Your job is personal and ours is professional. But together we can give your loved one all the attention and care they deserve. Schedule a tour of our innovative memory care community and receive a complimentary dementia resource kit.
Elk Grove Glen Ellyn 847.534.8815 630.469.5500
Northbrook South Holland 847.795.9000 708.895.1600
Geneva Hazel Crest 630.262.3900 708.799.7099
Palos Heights 708.361.8070
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HOME HEALTHCARE
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HOME HEALTHCARE
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HOME HEALTHCARE
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HOME CARE
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HOME CARE
The Complete Continuum of Care
Free daily telephone reassurance calls
Compassionate non-medical in-home care
Save up to 65% with Free ABC Rx cards
Escorted tours of assisted living communities
Always Best Care Senior Services ®
Non-medical in-home care • Assisted living services Dedicated to exceeding your expectations ... always
Call one of our Chicago locations today!
Chicago North Chicago West Chicago Southwest
(847) 730-5930 (855) 761-9755 (708) 320-8222
Independently owned and operated offices throughout the United States
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Although reference-based pricing (RBP) has long been a tool in pharmacy benefit management, its potential in medical services is just now emerging. WellPoint has tested the model in a limited scope and will begin offering RBP on a broader scale to group employer plans in 2014. George Lenko, program director for national network management, says the RBP model builds out on price, quality and patient experience.
that aligns with a sufficient number of providers to ensure access. In other words, a particularly low reference price would exclude too many providers and limit member choice.
“It’s helping patients be consumers and use market forces to get more rational pricing and quality—things that people see in other realms,” Lenko says. “In retail and other services, this is how business is being done, but in healthcare, it’s still kind of new.”
In the CalPERS model, the reference price was set at $30,000 for knee and hip replacement. Any member choosing a facility with a higher price point would be responsible for paying the difference.
In a pilot program for the California Public Employees’ Retirement System (CalPERS), WellPoint designed a RBP model for hip and knee replacement. First, market prices were analyzed, then a reference price was determined. The key to the reference price, Lenko says, is to set a threshold
Although local facilities ranged in price from $15,000 to $110,000 per procedure, WellPoint did not see any evidence of higher quality among the higher priced providers. The $30,000 threshold allowed WellPoint to create a sufficient list of qualifying facilities for members to choose from and discourage them
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from opting for high-cost sites.
things happened in pilot: hip and Two knee replacement prices dropped by 19% in one year; and outcomes remained the same. “It’s not like the highest cost sites are the highest quality sites,” Lenko says. “And many high-quality sites are at the lower end of the threshold, so the opposite is true as well.” OTHER APPLICATIONS RBP can be used for a variety medical services. In a similar pilot among Kroger grocery store employees, imaging services were limited to a reference price. “For CAT scans and MRIs, they set a threshold of payment at $800,” he says. “At that point, there are many commonly available services so if a member goes to a higher priced site like hospital-based, outpatient imaging at twice the price, they are exposing themselves to that liability. If you talk about a difference in price that is not correlated to a difference in quality, it makes sense to buy at a lower price.” To alert members of the reference prices and their choices, WellPoint and plan sponsors used either proactive outbound calls to the ordering physician or member, or broader web-based communication. WellPoint’s online transparency tools— which have been growing since 2006— display member choices and out-of-pocket costs. Lenko says RBP models are best suited for high-cost services when the plan has advance knowledge of an upcoming PLEASE SAY, “I FOUND YOU IN CASEMANAGEMENT SOCIALWORK.”
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event, such as a planned imaging scan or joint replacement. Even more so, RBP aligns ideally with bundled payment arrangements. “Where all services are bundled into one price, you can be sure all services are covered and that also includes the ‘warranty’ work,” he says.
However, Lenko cautions that medical homes and accountable care organizations have a different take on how members relate to providers, and it makes more sense to interact with the provider than the member to drive value in pricing.
on. The potential for RBP is increasing as more prices are being made public. Lesko says it’s a good alternative to narrow-network models because it maintains broader access and more consumer choice.
“The ACO will do what it can to keep care in their system, and that discourages choice,” he says.
And member engagement is paramount for plans that are implementing the RBP model.
PROVIDERS ALERT
“As long as you have good transparency, good information, good navigation and high engagement, it’s doable,” he says. “If you don’t have those things, you run the risk of member abrasion. Members need to they have limitations and have to be able to find care alternatives." - Julie Miller
RBP has potential to bring prevailing market prices down as well. The transparency data can cue high-end providers to reduce their prices not just to draw in more business but also to maintain favorable reputations. “As we started down the path of more transparency, in some instances there was wariness from high-cost providers that we were exposing them as high-cost,” Lenko says. “There’s always been that potential that transparency would yield market power to drive down prices. We only had anecdotal evidence it was working, but it was not as powerful as we thought it would be. As we ramped up transparency, we saw the effect more and more.” He says some California providers did bring their joint replacement prices down to stay under the $30,000 target. CalPERS is a large book of business that most hospitals wouldn’t want to loss out
ACMA National Conference April 10-13,2014 Hyatt Regency McCormick Place ________________________________
Re-engineering Case Management Departments: Successful Department Redesign Strategies for Transitioning Patients Across the Continuum of Care
For more information www.acmaweb.org/il 13
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HOSPICE
Is persistent overcrowding a problem for your ED?
VITAS breaks the cycle
A recent survey by the American Hospital Association reveals more than 50 percent of surveyed urban and teaching hospitals had EDs that were at or over capacity.1 VITAS care transition support services can help keep your beds turning. • We offer clinical staff trained to discuss goals of care and hospice benefits. • The VITAS admission team is available 24/7. • We can alleviate congestion in EDs by transitioning end-of-life patients to home. • VITAS can provide 24-hour nursing care (continuous care) in the patient’s home, nursing home or assisted living community, when appropriate, to control symptoms • VITAS after hours program provides direct, 24-hour access to clinical experts who have patient information and can dispatch a team member to the bedside any hour of the day or night, even on holidays. A referral to VITAS expands alternatives for transitioning your end-of-life patients.
1.800.93.VITAS • VITAS.com/Illinois 1
American Hospital Association “Taking the Pulse: The State of America’s Hospitals.” Results of AHA Survey of Hospital Leaders, March/April 2010-May 24, 2010.
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February 2014 Dinner Meeting
Welcome to the Chicago Chapter of Case Management Society of America! We are a non-profit, multidisciplinary "Overactive Bladder: Clinical Treatment and Protocols" group of healthcare professionals working together in case February 11, 2014 with the management. Tuesday, CMSA Chicago has been affiliated National Chapter of CMSA since 1993.
Maggiano's
We host MonthlyCenter (September - May) Educational 240 seven Oak Brook - Oak Brook, IL 60523 Meetings and one Annual Conference (April). The location of the events is rotated throughout the communities we serve. Presenter Our membership strives to collaborate with the patient, Susanne RN MS the family, healthcare provider and Michalic, employer to provide highest possible standard of professional healthcare. Please join us to collaborative efforts through networking Sponsors and educational efforts. Our mission Uroplasty is to encourage standards of excellence throughout the case management process by providing opportunities for education and Members: Non members: networking with other $20 case managers and health$30 care Registerthat nowould laterimprove than February 7, 2014! professionals healthcare outcomes.
at 12pm under Event Registration ***** 2 RN & 2 CCM Credits Awarded CMSA Chicago Please note this event features a CASH bar. The CMSA Chicago Chapter PO Box 726 Oak Park, IL 60303-******* !
0726 Telephone: (630) 415-2203 530 pm Networking/ E-Mail: info@cmsa-chicago.org
Registration 600 pm Business Meeting 630 pm Presentations
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www.cmsa-chicago.org
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The Complete Continuum of Care
Free daily telephone reassurance calls
Compassionate non-medical in-home care
Save up to 65% with Free ABC Rx cards
Escorted tours of assisted living communities
Always Best Care Senior Services ®
Non-medical in-home care • Assisted living services Dedicated to exceeding your expectations ... always
Call one of our Chicago locations today!
Chicago North Chicago West Chicago Southwest
(847) 730-5930 (855) 761-9755 (708) 320-8222
Independently owned and operated offices throughout the United States
PLEASE SAY, “I FOUND YOU IN CASEMANAGEMENT SOCIALWORK.”
16 www.alwaysbestcare.com