Pioneer ACOs: Quantifying Risks & Identifying Opportunities

By Claire Thayer, March 5, 2012

MCOL’s Healthcare Web Summit announces Pioneer ACOs: Quantifying Risks & Identifying Opportunities, scheduled for Wednesday, May 23, 2012 at 1PM Eastern.  This session discusses the elements of risk associated with Pioneer ACOs as well as potential strategies for controlling costs and identifying opportunities for savings. Organizations not participating in the Pioneer ACO program but either wishing to monitor Pioneer ACO issues and activities, or wishing to adapt applicable risk and cost control strategies discussed to other populations, can also benefit from this session.

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Improving Chronic Care Outcomes: Depression Management Coaching

By Claire Thayer, March 3, 2012

MCOL’s Healthcare Web Summit announces Improving Chronic Care Outcomes: Depression Management Coaching, scheduled for Thursday, April 12, 2012 at 1PM Eastern.  This event is co-sponsored by the Center for Health Value Innovation.  Hear from leaders in the Center, Chief Medical Officer Jack Mahoney MD, and President Cyndy Nayer, along with Fred Newman, Founder and CEO of Interface EAP Coordinated Health Solutions. There are real-world outcomes to be shared, and questions that attendees will want to ask about outcomes-based contracting for emerging services.

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Midwest Business Group on Health’s Quest to Reduce Elective Preterm Deliveries

By Clive Riddle, March 2, 2012

Last week,  Larry S. Boress, President & CEO of the Midwest Business Group on Health was one of three featured speakers in the HealthcareWebSummit event: Managing an Increasing Trend of Elective Preterm Deliveries.

MBGH has taken a keen interest in facilitating a reduction in elective preterm deliveries, and Larry shared why purchasers have gotten involved, and what they are doing about it.

Larry’s opening arguments were:

  • Maternity care is the number one reason for hospitalization among employee populations
  • The highest cost for maternity care is when underdeveloped infants are treated in the neonatal intensive care units of hospitals
  • Preterm infants are less likely to survive to their first birthday than infants delivered at full term
  • Those preterm babies who do survive are more likely to suffer long-term costly disabilities than infants born at term

He shared 2009 Data compiled by Thomson Reuters for the March of Dimes, which compared average expenditures for newborn care yielding $4,551 for uncomplicated cases vs. $49,033  for premature/ low birth weight cases.

So what exactly is an early elective delivery. Larry offered these characteristics:

  • The newborns delivered with a gestational age between the 37th and 39thcompleted week, that were delivered electively
  • Early elective deliveries are performed on women of all backgrounds and incomes.
  • These are distinct from early deliveries performed due to clinically-appropriate reasons to avoid health problems facing the mother or the infant

And what is the scope of early elective deliveries? We learned that the national average is up to a rate of 17% of deliveries, while the Leapfrog group has set a current target at 12%. Minnesota, South Carolina, Indiana and Arizona all have rates above 25%. Virginia, Florida, and New York exceed 20%. While 53% of hospitals are at or below the Leapfrog target of 12%, 33% of hospitals have rates of 20% or higher (6% of hospitals have rates of 45% or higher.)

What are the motivations to have an elective preterm delivery, despite the dangers and costs? Larry cites these delivering physician convenience factors: (A) Guarantee attendance at birth;  (B) Avoid potential scheduling conflicts; (C)  Reduce being woken at night; and (D) the NICU can handle it. Furthermore, Larry offered these motivations for the mothers:

  • Prior bad pregnancy
  • Desire to deliver on special date or holiday
  • Special circumstances
  • Cultural factors
  • Ability to  plan in advance for birth
  •  Convenience
  • Ability to be delivered by her doctor
  • Maternal intolerance to late pregnancy
  • Excess edema, backache, indigestion, insomnia

But there are serious quality implications of non-medically indicated early deliveries beyond cost that Larry cited:

  • Increased NICU admissions (and separation from mother)
  • Increased respiratory illness
  • Increased jaundice and readmissions
  • Increased suspected or proven sepsis
  • Increased newborn feeding problems and other transition issues
  • Under developed brain and lungs
  • Potential development of cerebral palsy

The good news is this is now a national quality measure for the National Quality Forum (NQF); Leapfrog Group; The Joint Commission; and AMA Physician Performance Consortium Measure.

Larry closed by noting that in the twelve months since MBGH made its initial Call to Action to reduce elective preterm deliveries, over 70% of hospitals reduced their early elective delivery rates below previous levels, and many have set 5% as their goal.


The Business of Clinical Integration: Payment Models, Structures, Governance, Strategic Issues and More

By Claire Thayer, March 2, 2012

MCOL’s Healthcare Web Summit announces The Business of Clinical Integration: Payment Models, Structures, Governance, Strategic Issues and More, scheduled for Wednesday, April 18, 2012 at 1PM Eastern.  Join nationally renowned experts Doug Hastings, Chairman of Epstein, Becker & Green, and Dr. Mark Browne, Principal of Pershing Yoakley & Associates, as they construct the foundation of business considerations for health care organizations in pursuit of clinical integration. This session will address payment models, structures, governance, strategic issues and more, for organizations seeking: to manage populations and patients based on a culture of patient focused “Clinical Teaming”; utilizing systems and data which enable seamless coordination and continuity-of-care; and optimization of applicable incentives.

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Medicare: Predictive Analytics, MSSP & Star – Hidden Compliance & Enrollment Patterns

By  Claire Thayer, March 1, 2012

MCOL’s Healthcare Web Summit announces Medicare: Predictive Analytics, MSSP & Star – Hidden Compliance & Enrollment Patterns, scheduled for Thursday, April 5, 2012 at 1PM Eastern.  The Medicare Shared Savings Program and the Medicare Advantage Part C "Star" rating program both provide significant potential financial rewards if participating organizations meet applicable criteria. Join Milliman's Rong Yi and Bruce Pyenson as they explore how the two sets of quality measures relate to each other, and discuss what types of these Medicare members are less likely to be compliant and therefore require more targeted communication or intervention.

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