Health Care - From Policy to Practice

Video: Dr. Lauwrence Baker on Drug Pricing

noreply@blogger.com (Valerie M. Russo) — Fri, 27 Jan 2012 12:00:00 +0000

I came across this video recently while perusing Khan Academy's videos on healthcare and medicine and thought this one discussing how drug prices are set would interest our readers here almost as a primer to the topic but it has some interesting commentary on U.S. drug pricing v. Europe:

Valerie M. Russo is a Senior Social Media Strategist at IIR USA with a technology, anthropology, marketing and publishing business acumen, covering the MDRP Summit beat. She is a published poet and also maintains a literary blog. She may be reached at vrusso@iirusa.com. Follow her @Literanista.

Mark McClellan on the future of the ACA & Healthcare Reform

noreply@blogger.com (Jennifer) — Thu, 26 Jan 2012 19:39:00 +0000

This week, Marc McClellan was at the Drug Delivery Partnerships Conferncee and shared a few of the insights he had into the future of healthcare with the coming changes of the 2012 Election. We'd like to share that with you.

Will it Help or Hurt? The Impact of Healthcare Reform on Drug Delivery Innovation, Reimbursement, and Patient Compliance
Mark McClellan, Engelberg Center for Healthcare Reform, Brookings Institute, Centers for Medicare and Medicaid Services

The healthcare world is anxiously awaiting the the decision from the Supreme Court as to whether or not the ACA is legal. McClellan believes that some of the Act will be overturned, but not the whole thing. No matter the individual mandate to buy healthcare insurance will be delayed or repealed entirely. A lot of the other aspects are directly impacted by the 2012 Election. Since it is unpopular, Congress will delay the implementation. McClellan believes that this whole process will take longer and won’t be implemented on schedule in 2014. What won’t change? The insurance market will change, and those with chronic conditions will be covered. Republicans can’t repeal the whole law should they win the 2012 Election. The challenge is how to figure out how to cover more and more people who aren’t covered by insurance.

Rising healthcare costs that are coupled with a lot of rules to restrict spending means it will be very difficult to find a way balance the budget.
As for FDA Drug Approvals, they are up. This includes more personalized treatments. The process of developing new treatments is very long and uncertain. So success rates are still running around 11-13% for approval. Pharma is moving towards targeting therapies and innovative develop methods require new ways for the FDA to approve them.

Quick approval methods currently from the FDA: Fast track, Priority review, Accelerated approval. There were 8 drugs over the past few years approved this way. It’s hard to set up post approval success measures to get the drugs approved as well.

In the future, McClellan believes that there will be an evidentiary standard (Progressive approval), Targeting , better regulatory guidance and premarket development science

McClellan believes that personalized medicine will have a huge impact on health care in the future, but only if the reimbursement structure is changed from its current structure.

Look who’s Attending the 2012 Medicare Congress

noreply@blogger.com (Jennifer) — Wed, 18 Jan 2012 21:08:00 +0000

We're less than 3 weeks away from the Medicare Congress in Orlando, February 6-8. We’re expecting a big turnout this year so don’t miss your opportunity to attend the largest, longest running Medicare event in the industry and network with Health Plan executives and CMS officials.

Look at the companies who are attending:
AARP, Aetna, Allergan, American Enterprise Institute, Ameri-Plus Select Services , Arcadian Health Plan & Management Services, Arkansas Blue Cross Blue Shield, BCBS of Minnesota, Bloom Marketing Group, Blue Cross Blue Shield Northern Plains Alliance, Blue Cross Blue Shield of Alabama, Blue Cross Blue Shield of Illinois, Bristol Myers Squibb, Cain Brothers, Capital District Physicians Health Plan, Care N Care Health Plan , CareFirst Blue Cross Blue Shield of Maryland, Cazma LLC, Centers for Medicare & Medicaid Services, CIGNA Healthcare, Colibrium Partners LLC, DMW Worldwide, Dynamic Healthcare Systems Inc, Endo Pharmaceuticals, Epstein Becker Green, Family Physicians Group, First Recovery Group, Forbes, Forest Laboratories, Gorman Health Group LLC, Health Alliance Plan of Michigan, Healthcare Partners, HealthPlanCRM , HealthSpring, HMS Permedion, Humana, Inter Valley Health Plan, Kaiser Family Foundation, Kaiser Permanente, Kaiser Permanente, KBM Group Health Services, LA Care Health Plan, Matrix Medical Network, Milliman USA, National Committee for Quality Assurance, Oliver Wyman Actuarial Consulting, Optum Health, OptumInsight, PharmMD, Preferred Care Partners, Silverlink Communications, Sterling Life Insurance Company, Susquehanna Research Group, SXC Health Solutions Corporation, SXC Health Solutions Corporation, The National Advisory Board on Improving Health Care Services for Seniors, The Weekly Standard, United Community Health Plans, United Health Care, Universal American Corporation, Wellpoint

The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida. If you’d like to join these companies, use priority code XP1707BLOG to receive 25% off of the standard rate! This is an exclusive discount to this blog. If you have any questions about the agenda or event, please contact Jennifer Pereira.

How Important is Clarification On Current Government Guidance's To Your Organization?

noreply@blogger.com (Jennifer) — Mon, 16 Jan 2012 14:00:00 +0000

Post Healthcare Reform, not only are Government Programs in a seemingly constant state of flux, but many of the most complicated programs are in a regulatory vacuum period – we know something is coming down the pipe, but have no idea when and how it will affect us.

So what can we do to help? At the Government Programs Summit, we bring together both the key government officials who can offer the most clarity about what to do NOW to prepare for what may come LATER and leading pharmaceutical and generic manufacturer executives who will leave you with practical information on how they are coping with the uncertainty.

In two short days you will:

- Have unparalleled access to CMS authorities from the Policy, Technical, and Operations Departments, in the session, “CMS AMP Guidance Answers and Next Steps for Medicaid Drug Rebate Program,” as well as the opportunity for one on one, personalized attention in the CMS meeting room.
- Get an update on 340B guidance directly from HRSA officers, including definitions of “Eligible Patient” under the PHS program in the session, “340B PHS Guidance, Definitions and Oversight Update.”
- Learn to accrue for the potential 4 million new beneficiaries to Medicare Part D who may fall in to the Donut Hole in 2012 in the session, “Medicare Part D for the Donut Hole: Guidance Updates, Invoicing, Disputes and Appeals Processes.”

Staying up to date on current proposed rules, interpretations, and implementations of government programs is of paramount importance to branded and generic manufactures.

Government Programs and Pricing Compliance Summit will take place March 7-9, 2012, in Baltimore, Maryland. For more information on the program, download the brochure here.

Updates on Duals from Jennifer Coleman of CMS’s Medicare-Medicaid Coordination Office

noreply@blogger.com (Jennifer) — Fri, 13 Jan 2012 14:00:00 +0000

Your patients with chronic diseases require the greatest investment of money and time for your healthplan. And we know their treatment needs grow more complex if they are dual eligibles. Join us at the 9th annual Medicare Congress - the largest and longest-running conference devoted to the Medicare marketplace – as we have exclusive coverage on the chronically ill and dual eligibles.

Expert speakers include:

• CMS’s Senior Advisor for the Medicare-Medicaid Coordination Office, Jennifer Coleman, will detail CMS’s new demonstration program to test new financial models for integrating coverage for dual-eligibles. Learn more about their timelines, coverage areas, and best operational practices required to adapt to these new initiatives.
• Karol Attaway, VP of Operations at HealthCare Services, will detail how you can use risk assessment stratification to predict and prepare for the financial costs of your most seriously ill patients.

To learn more about the program, download the program agenda.

The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida. If you’d like to join us, use priority code XP1707BLOG to receive 25% off of the standard rate! This is an exclusive discount to this blog. We encourage you to register ASAP because the hotel block is 80% sold out and the negotiated rate expires this Sunday. If you have any questions about the agenda or event, please contact Jennifer Pereira at jpereira@iirusa.com or visit the homepage.

New Proposal for Dual Eligibles presented by GWU

noreply@blogger.com (Jennifer) — Thu, 12 Jan 2012 16:06:00 +0000

Dual eligibiles, those who receive both Medicaid and Medicare, are a relative small portion of those receiving medical coverage fromt the US government. However, according to UPI, they account for 36% of all Medicare spending and 39% of Medicaid spending. Part of the reason is the vast amount of coverage and plans they have to deal with in order to have their medical bills paid. They also often have chronic conditions or are mentally impaired and need continuous care.

Jane Hyatt Thorpe, one of the authors, stated "The new state plan option allows states to design a permanent program in partnership with federal officials that integrates financing and care across the Medicare and Medicaid programs to better meet the needs of dual eligibles."

You can read the full proposal here.

At the upcoming Medicaid Managed Care Congress, taking place April 30-May 2, 2012, there will be a full day workshop entitled "Cost Containment Strategies for Dual Eligibles." This will be a full day focusing on this aspect of the Medicare system. For more information on this workshop and the rest of the program, download the brochure. As a reader of this blog, when you mention code XP1726BLOG, you'll receive 25% off the standard rate when you register to join us in Baltimore.

How important is it to manage the care of dual eligibles? Should this be a priority to control healthcare spending in the future?

Lou Saccoccio’s Exclusive Podcast on Monitoring and Responding to Prescription Drug Abuse

noreply@blogger.com (Jennifer) — Thu, 05 Jan 2012 14:00:00 +0000

Did you know CMS can now track your healthplan’s performance on even more criteria than ever before? Which means proactive compliance is the most important aspect for survival in our world of CMS sanctions. Your compliance officer must be kept fully equipped and up-to-date, and your entire team must be ready to ensure your compliance strategies are fool-proof.

But what happens when your compliance strategies fail?
If your company was sanctioned, how would it survive? Do you have the right contingency and messaging plans in place? Ensure your compliance defense is tough as steel by attending the 9th Annual Medicare Congress. Hear from keynote speaker Robert Fahlman, CEO of Arcadian Healthplan, as he recounts how they successfully emerged from an 8-month sanction period – all while continuing to negotiate major business transactions! For more about Fahlman’s presentation and the rest of the program, visit the webpage to download the brochure.

For a sneak peek at this year's content, I invite you to download our exclusive interview with Lou Saccoccio, executive director of the National Healthcare Anti-Fraud Association, which delves into the ways that healthplans must prepare for monitoring and responding to evidence of prescription drug abuse.

Download the podcast here.

Don’t forget, as a reader of this blog you can use priority code XP1707BLOG to receive 25% off of the standard rate! If you have any questions about the agenda or event, please contact Jennifer Pereira at jpereira@iirusa.com. The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida.

Today’s Weather Watcher for the Medicare Congress

noreply@blogger.com (Jennifer) — Wed, 04 Jan 2012 16:26:00 +0000

On behalf of the 9th Annual Medicare Congress, we at the Healthcare: From Policy to Practice blog would like to wish you a very happy, healthy, and successful New Year! We are a little more than one month away from the largest and longest-running conference devoted to the Medicare marketplace, and my colleagues and I eagerly look forward to welcoming you to this event. As we get further into winter, don’t miss out on your opportunity to head to sunny Florida so you can learn from and network with the luminaries in healthplan management.

Check out this weekend's weather in Orlando:

As a reader of this blog, when you register to join us in Orlando from February 6-8, 2012, and mention code XP1706BLOG, you receive a 25% discount off the standard rate!

Ditch the winter blues and join us in sunny Florida this February!

What's the future for Medicare?

noreply@blogger.com (Jennifer) — Tue, 03 Jan 2012 19:49:00 +0000

In a recent article at Chico News, they examine what has kept the Medicare System running to this point - and what will have to happen for it to run successfully into the future. The two main problems Larry Mitchell offers are that there is a lack of proper reimbursement from Medicare to the doctors themselves, as well as fewer and fewer doctors due to many of the doctors retiring themselves. Many doctors have had the time to foster relationships with their patients and collaborate and communicate on what the patients are feeling. However, with the current process - doctors being paid on the amount of patients they see and treat - this is one of the things that is failing in the system.

At The 2012 Medicare Congress, Charles Mackay, CPHQ, Health Insurance Specialist, Centers for Medicare & Medicaid Services will be on hand to examine many of these problems in his presentation "Health Rebooted: How Taking Technology All the Way will Solve Both the Cost and Quality Problems". For more information on his presentation and the rest of the event, download the brochure here. Don't forget, as a valued reader of this blog, when you register and mention code XP1707BLOG, receive 25% off the standard rate!

Do you agree with the statements in the Chico News? How can Medicare step in and fix the issues they face? What is the best solution to have doctors spend quality time with their patients yet also treat more of them at the same time?

Our Gift to You: The Medicaid Managed Care Congress Agenda is Ready

noreply@blogger.com (Jennifer) — Fri, 23 Dec 2011 14:45:00 +0000

Happy Holiday from the Medicaid Managed Care Congress, taking place April 30-May 2, 2012 in Baltimore. We are pleased to announce that the completed brochure is now ready for review.

Download it here.

What can you look forward to from MMCC 2012?

- The largest and longest running event that gives you the tools to improve quality care and comply with the ACA and protect profitability
- Over 50 sessions including over 20 case studies in three all new tracks designed to meet the needs of every stakeholder in your organization
- The right mix of States and Plans with more and more States attending every year as Managed Medicaid continues to expand
- All new State Snapshots from the States everyone is talking about—Texas, DC, PA, and NJ
- The 2nd Annual Medicaid Managed Care Innovation Awards to recognize the exceptional work you do every day
- 20 years of experience bringing you the most visionary speakers and actionable content to improve clinical and financial outcomes

As a reader of the Healthcare: From Policy to Practice Blog, you can use priority code XP1726BLOG to receive 25% off of the standard rate! If you have any questions or need any further information, feel free to email jpereira@iirusa.com.

Season's Greetings from the Medicare Congress Group

noreply@blogger.com (Jennifer) — Wed, 21 Dec 2011 14:00:00 +0000

Happy Holidays to you and your family. As a gift to you, receive 25% off the standard registration rate for the Medicare Congress with Priority Code XP1707BLOG. Register online to reserve your spot!

Cheers to a happy, health New Year! See you in 2012!

- The Medicare Congress Team

Could a bipartisan plan lead to a breakthrough in Medicare sustainability?

noreply@blogger.com (Jennifer) — Tue, 20 Dec 2011 17:02:00 +0000

Last week, Democratic senator, Ron Wyden of Oregon, and a Republican member of the House, Paul D. Ryan of Wisconsin, proposed a new plan for Medicare that could help solve the problem of the system that is unsustainable for the US Government as it stands.

In the new plan, specifically created by members from both parties, this new plan looks to implement significant structural changes and limit the current open-ended commitment to sustaining the system from the government. A health insurance exchange would b created for the beneficiaries, and growth would be capped. The governmental would not be required to pay more the rate of the economy plus 1%. The government would also cut payments to those beneficiaries who typically overspend. For a more in-depth look at the proposed changes, visit the New York Times article.

At The Medicare Congress 2012, Fred Barnes, Executive Editor, The Weekly Standard and Commentator, FOX News will be on hand to present 2012 Election Outlook – Examine Today’s Headlines to
Find the Real Signals and Implications for ACA. In addition to uncertainty of the unsustainability of the system, elections take place next year, leading to more uncertainty of who will be in power to make the decisions to make the changes needed to fix the Medicare system. As a reader of this blog, when you register to join us in Orlando from February 6-8, 2012, and mention code XP1706BLOG, you receive a 25% discount off the standard rate!

Do you see this as a plan that could lead to the sustainability of the Medicare System? What would hold back from Congress members?

The Medicare Congress Keynote Spotlight: Crisis Into Opportunity: Keeping your Business Going (and Growing) While Sanctioned

noreply@blogger.com (Jennifer) — Mon, 19 Dec 2011 16:53:00 +0000

While it is obviously business-crucial to avoid CMS sanctions, it is just as crucial to make sure the entire team at your healthplan, from the highest levels, know how to face this emergency and keep it from dealing permanent damage to your company and brand. In this week's The Medicare Congress Session Spotlight, we spotlight the session from Robert Fahlman, Chairman & CEO, Arcadian Health Plan who will examine this topic. For more information on The Medicare Congress, taking place February 6-8, 2012; in Orlando, Florida, download the brochure now. If you register and mention code XP1707Blog, you will receive a discount of 25% off the standard rate!

Featured Session: Crisis Into Opportunity: Keeping your Business Going (and Growing) While Sanctioned

Featured Speaker: Robert Fahlman, Chairman & CEO, Arcadian Health Plan

About the session:
In July, Arcadian Health came out of an 8-month-long CMS-issued sanction. Learn the key methods they used to emerge from the sanction period without any contingencies while meeting (or exceeding) CMS expectations. Toward the end of the sanction period, Arcadian was also involved in an orderly process to evaluate options with a number of interested parties including a merger with a much larger health plan. Strategies from the top helped the organization work closely with CMS, and develop and execute a sanction remediation plan that meet expectations of benefi ciaries,members, and regulators – all without derailing the negotiation process during a major transaction! Take-away messages will be of tremendous value to corporate leaders responsible for crisis management.

• Identify strategies to manage negatives
• Correct non-compliant aspects of your plan
• Implement necessary changes as quickly as possible
• Sharing vital knowledge with prospective partners,shareholders, and regulators

See who is attending The Medicare Congress 2012!

noreply@blogger.com (Jennifer) — Wed, 14 Dec 2011 15:08:00 +0000

With the 2011 Open Enrollment period complete, registrations are pouring in for the 9th Annual Medicare Congress. DON’T GET LEFT OUT IN THE COLD. We encourage early registration before the event sells out. The 2012 Medicare Congress will be our biggest year yet with over 300 attendees! The Medicare Congress is this February 6-8, 2012 in Orlando, Florida.

Don’t miss your chance to network with Medicare execs from these companies:

AARP * Aetna * American Enterprise Institute * Ameri-Plus Select Services * Arcadian Health Plan * Arkansas Blue Cross Blue Shield * Arnold & Porter * BCBS of Minnesota * Bloom Marketing Group * Blue Cross Blue Shield Northern Plains Alliance * Blue Cross Blue Shield of Illinois * Bristol Myers Squibb * Cain Brothers * Capital District Physicians Health Plan * Care N Care Health Plan * Care First Blue Cross Blue Shield * Celgene * Centers for Medicare & Medicaid Services * CIGNA Healthcare * DMW Worldwide * Dynamic Healthcare Systems Inc * Endo Pharmaceuticals * Geisinger Health Systems * Gorman Health Group LLC * Healthcare Partners * HealthplanCRM * HealthSpring * Humana * Inter Valley Health Plan * Kaiser Family Foundation * Kaiser Permanente * KBM Group Health Services * LA Care Health Plan * Matrix Medical Network * National Committee for Quality Assurance * Optum Health * PharmMD * Preferred Care Partners * Sterling Life Insurance Company * Susquehanna Research Group * The National Advisory Board on Improving Health Care Services for Seniors * The Weekly Standard * United Community Health Plans * United Health Care * Universal American Corporation * Wellpoint*

Download the agenda to find out more about this year's speakers and presentations.

As a reader of this blog, mention code XP1707BLOG to receive a discount of 25% when you register to join us this February in Orlando!

We hope to see you in sunny Orlando!

How can hospitals decrease readmission for Medicare patients?

noreply@blogger.com (Jennifer) — Mon, 12 Dec 2011 20:07:00 +0000

One of the goals of the new Affordable Care Act is for hospitals to decrease the number of patients that are readmitted into the hospital after they've been discharged. Studies show that currently, one out of five Medicare patients are readmitted in 30 days while 35% are readmitted within 90 days. This costs the government $17 billion. So as incentive to change this the Affordable Care Act is tying reimbursement to how many patients are re-admitted into the hospital. One of the key reasons for this is patients aren't aware of how to properly care for themselves after they leave the hospital, often due to miscommunication in the discharge process.

In this article from the Washington Post, they share that researchers from Northeastern University have developed an avatar that patients can watch from their hospital beds on TV that go over their care instructions after they're discharged from the hospital. This is called "Project Red", and has shown that readmission for patients have dropped by 30% in use during clinical trials.

At the 9th Annual Medicare Congress, Charles Mackay, CPHQ, Health Insurance Specialist, Centers for Medicare & Medicaid Services will be keynoting a speech entitled "Health Rebooted: How Taking Technology All the Way will Solve Both the Cost and Quality Problems" which will look at technologies like this and others that can improve the care of Medicare patients and efficiency of hospitals. For more information on this presentation and the rest of the program, download the brochure here. Don't forget, as a reader of this blog, mention code XP1707BLOG to receive a discount of 25% when you register to join us this February in Orlando!

Do you believe a process like this can help both hospitals and patients?

The Medicare Congress Keynote Spotlight: 2012 Election Outlook – Examine Today’s Headlines to Find the Real Signals and Implications for ACA

noreply@blogger.com (Jennifer) — Fri, 09 Dec 2011 17:05:00 +0000

Medicare spending levels will be more relevant than ever to the 2012 presidential and Congressional elections—and the outcome of those elections could result in significant changes for Medicare benefit coverage and the entire healthcare marketplace. In this week's The Medicare Congress Session Spotlight, we spotlight the session from Fred Barnes of Fox News that will examine this topic. For more information on The Medicare Congress, taking place February 6-8, 2012; in Orlando, Florida, download the brochure now. If you register and mention code XP1707Blog, you will receive a discount of 25% off the standard rate!

Featured Session: 2012 Election Outlook – Examine Today’s Headlines to Find the Real Signals and Implications for ACA

Featured Speaker: Fred Barnes, Executive Editor, The Weekly Standard and Commentator, FOX News

About the session:
Taking audiences beneath the surface of headline events, Fred Barnes uses his skills as a journalist to map the political landscape and chart a course for the future. In presentations that cut through the spin and uncover the truth, Barnes reveals the stories that lie beyond the headlines and details how those stories will define the future. Fred Barnes’ presentation offers an insider’s look at the presidency and Congress. With over 25 years of reporting on Washington politics, his analysis and predictions are among the most on-target of anyone covering Washington. Barnes takes a hard look at how a divided Congress will effect the Obama agenda, which candidate to watch in the 2012 Republican Presidential field, and what issues are front on mind for the American electorate.

Medicare claims database to open up for examination

noreply@blogger.com (Jennifer) — Tue, 06 Dec 2011 20:22:00 +0000

For the first time, the Medicare claims can now be accessed by providers, employers, insurance companies and consumer groups in order to make more educated choices when it comes to choosing their doctors for Medicare. After analyization, this will allow consumers to see which doctors have preformed these procedures with ease as well as preventable complications that have arisen in the past and how they can be prevented.

According to the San Francisco Gate, this is a huge step forward for the Medicare system, as it allows as the system becomes more transparent while increasing competition and accountability while lowering costs.

At the The Medicare Congress this February in Orlando,Karol Attaway, Vice President of Operations, HealthCare Partners, to present "Stratify Risk by Predicting the Financial Cost of Seriously Ill Patients". This situation could benefit from an open database which asses the care coming from doctors.

What do you think of this new Medicare option? Will it help patients in the future?

The Medicare Congress Keynote Spotlight: Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries

noreply@blogger.com (Jennifer) — Fri, 02 Dec 2011 17:33:00 +0000

Leading up to The Medicare Congress 2012, we'll profile the keynotes, tracks and themes at the 9th annual event. For more information on The Medicare Congress, taking place February 6-8, 2012; in Orlando, Florida, download the brochure now. If you register and mention code XP1707Blog, you will receive a discount of 25% off the standard rate!

Featured Session: Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries
Featured Speaker: Don Berwick, Administrator, Centers for Medicare & Medicaid Services (invited)
About the session:
Medicare is tasked with encouraging more efficient, better coordinated care in Fee for Service at the same time that it is implementing payment reductions for Medicare Advantage. CMS will review updates to Medicare programs and policies and discuss:

• Changes or trends in the health care industry, program objectives, and the needs of Medicare beneficiaries
• Update on regulatory policy and reform implementation timelines 2012-2014
• Oversight, budget, and performance issues relating to Medicare Advantage and prescription drug plans, Medicare fee-for-service providers, and contractors
• Interactions and collaboration with key stakeholders relating to Medicare
• Identification of program vulnerabilities and strategies to eliminate fraud, waste, and abuse
• Initiatives for greater role of preventative care

Nominate a Medicaid Managed Care Superstar fot the Medicaid Managed Care Awards!

noreply@blogger.com (Jennifer) — Wed, 30 Nov 2011 20:40:00 +0000

The 20th Annual Medicaid Managed Care Congress is once again hosting the Medicaid Managed Care Awards. We’re looking to honor the year’s top innovators in the Medicaid managed care sector. We’d like to hear who you think has been especially innovative in the past year in the following categories:

- State Medicaid Innovation Award: This award recognizes the state official or state Medicaid office that has been the most innovative in the past year while controlling costs, driving quality improvements and expanding access. Last year’s winner was Massachusetts!
- Medicaid Health Plan Innovation Award: This award recognizes the health plan that has been the most innovative in the past year while controlling costs, driving quality improvements and expanding access. Last year’s winner was WellPoint!
- Lifetime Medicaid Innovation Award: This award recognizes the individual that has been the most innovative in the past year while controlling costs, driving quality improvements and expanding access. Last year’s winner was Vern Smith, our event chairman!

Submit your nominations online. The deadline for submission is Friday, April 6. Voting will be onsite at the 20th Annual Medicaid Managed Care Congress, taking place April 30-May 2 in Baltimore, MD. The awards will be presented on the final day of the event.

Register by February 6 and receive up to $600 off the standard registration rate when you mention code XP1726Blog. Don’t miss this one-of-a-kind event. With 19 successful years, our experience proves we are the experts. If you have any questions about this event, feel free to email Jennifer Pereira at jpereira@iirusa.com.

The failure of the congressional super committee

noreply@blogger.com (Jennifer) — Tue, 29 Nov 2011 19:43:00 +0000

One of the biggest stories in Washington is the failure of the Congressional “super committee” to agree on a unified plan to cut spending levels and shrink the deficit. This super committee was convened in the first place due to this past summer’s dispute over raising the ceiling on the national debt, of which Medicare expenditure is a major component. The failure of the super committee will now result in the triggering of automatic cuts to Medicare and other services, to take effect in early 2013. This will make Medicare compliance, reporting, and coverage issues even more prominent players in the 2012 presidential and Congressional elections than ever before.

What changes will these triggers have on your business model?

What is the likelihood that Congress will alter or even repeal the automatic Medicare cuts before they go into effect?

And what—if anything—can you do about it?

The 9th year of our Medicare Congress is going to be the most topical and pertinent one yet from a policy perspective. Don’t miss these time-critical sessions:

- “2012 Election Outlook: Examine Today’s Headlines to Find the Real Signals and Implications for ACA”

Presented by:

- “Politics as Usual: Debate the 2012 Election’s Impact on Healthcare, Medicare, and ACA”

Presented by:

- “What Does It All Mean for Main Street?”

Presented by:

- “Annual Wall Street Report: Economic Outlook for Medicare Advantage Health Plans”

Presented by:

- “Health Rebooted: How Taking Technology All the Way will Solve Both the Cost and Quality Problems”

Presented by:

The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida. For more information on these sessions and the rest of the program, download the brochure here. As a reader of the Healthcare: From Policy to Practice blog, don't forget to use code XP1707BLOG for a discount of 25% off the standard rate.

States looking to Medicaid Managed Care plans to control costs

noreply@blogger.com (Jennifer) — Mon, 28 Nov 2011 16:20:00 +0000

California is just one of the states looking to Managed Care to better care for the high risk beneficiaries in their state. By partnering with a Managed Care plan instead of paying fee for service, they'll be able to better care for the at risk patients. The team taking over the care, Molina Healthcare of California, will work with the beneficiaries to provide better care from the beginning, and avoiding the high cost of emergency care that can be prevented. This arrangement also allows for education and recognition of which populations need education. According to Manged Care Mag, by providing the education to these individuals, they can also minimize high cost of future care that can be avoided.

With Medicaid accounting for anywhere from 1/4th to 1/3rd if annual budgets are spent on Medicaid. By shifting to the manged care model, states can also care for more people. Many are looking to expand to new populations, new geographies and new services, provided by a pre-arranged network arranged by the Manged Care program.

The Medicaid Managed Care Congress will take place this May and bring together states and health plans to discuss the current state of the program, and promote collaboration and innovation to help the states and managed care programs achieve the new goals of the programs in this current challenging economic state. For more information on the event, visit the webpage.

While cost savings is a major goal of states turning to Medicaid Manged Care plans, what are some of the other benefits that the beneficiaries will see?

Save the Date for the 20th Medicaid Managed Care Congress

noreply@blogger.com (Jennifer) — Mon, 28 Nov 2011 14:39:00 +0000

Save the Date and join over 300 Medicaid managed care peers at the 20th Annual Medicaid Managed Care Congress, taking place April 30 - May 2 at the Hilton Baltimore. The longest running, premiere Medicaid managed care event brings together health plan leaders and state regulators to discuss the latest policy changes and best strategies to overcome your most pressing challenges. This year we are adding critical information on the specifics of PPACA, including up-to-date information from CMS.

At the 2012 Conference, we will discuss:

• Tactics to treat dual eligibles more cost efficiently
• Utilizing health homes to drive down costs for expensive members
• What the Basic Health Plan would mean for Medicaid Managed Care plans
• New technologies that reduce churn and increase member adherence
• Strategies to effectively manage high cost populations, such as ABD populations

Additionally, if you are interested in speaking about one of these topics, or if you are interested in speaking about another relevant topic, please email conference director Sarah Gordon at sgordon@iirusa.com.

Register by February 6 and receive up to $600 off the standard registration rate when you mention code XP1726BLOG. Don’t miss this one-of-a-kind event. With 19 successful years, our experience proves we are the experts.

The Cost of Medicare: Not sustainable at it's current growth

noreply@blogger.com (Jennifer) — Mon, 21 Nov 2011 16:07:00 +0000

Today, Medicare supports 49 million people by providing quality health care to older and disabled Americans. Currently, it accounts for 13% of all the government's spending at $477 billion in the 2011 Fiscal Year, but is projected to grow to $864 billion, or 16% of all spending, by 2021. This is not sustainable for the US tax payers. According to the article, there are three main drivers driving the cost of Medicare: the spiraling cost of all health care as new technologies and treatments are developed; much greater use of medical services by the typical beneficiary; and an aging population. The New York Times recently looked at several things that could change in order to make it a more sustainable system for the American Tax Payers:

- Near Term Costs. Over the past few years, Medicare spending has actually decreased, which may be a sign of hospitals cutting excess and better spending their money. Washington has it's eye on cutting spending now, but what will that do in the long term for those covered by Medicare?
-Long Term Health Savings. The government can find a way to let Medicare grow at the rate of the economy. The article cites several things that can help do this: Higher premiums, Older ages to qualify for coverage, and a set amount of money for the beneficiaries to buy their coverage.
-Fee for service. Currently, doctors are paid per service they perform. Could paying them one grand sum for all their services cut out the services they do that are unnecessary?
-Benefits. Solving the current gaps in the coverage could also be a way to save on costs.

At the the The Medicare Congress 2012, Fred Barnes Executive Editor, The Weekly Standard and Commentator, FOX News will be joining us for the keynote presentation "2012 Election Outlook – Examine Today’s Headlines to Find the Real Signals and Implications for ACA" by going beneath the headlines of the news and the current happenings in Congress to identify the possibilities for the future. As a reader of the blog, when you register to join us in February 2012 using code XP1707Blog, you receive a discount of 25% off the standard rate!

What do you think about the article's suggestions to save on costs for Medicare? What other things could be done to help the unsustainable rise in cost of health care?

You’re Invited: Best Case Studies and Market Success Strategies at the Medicare Congress

noreply@blogger.com (Jennifer) — Thu, 17 Nov 2011 20:57:00 +0000

A note from 9th Annual Medicare Congress Conference Chair, Kevin Mowll, Vice President, Medicare Products – Capital District Physicians Health Plan:

Medicare Advantage plans are scrambling to develop new strategies to combat recent changes including competition from ACOs, the Star Ratings system, and an earlier enrollment period. Along with these new challenges, plans face the ongoing headaches of acquiring new members, identifying fraud and waste, ensuring audit-readiness, and controlling costs while boosting revenue. But the most attention-worthy news for 2012 is the presidential election - What happens next November will surely influence our healthcare system.

That is why I would like to invite you to attend IIR’s 9th Annual Medicare Congress, February 6-8 at the Loews Portofino Hotel in Orlando, Florida. Attending this event will give you access to over 40 top-notch industry speakers while networking with over 50 experts in the Medicare marketplace. This is an event you cannot afford to miss. To learn more, I invite you to download the Event Brochure.

Topics covered include:

• Case Study - Crisis into Opportunity: Keeping your Business Going (and Growing) while Sanctioned
• Top Rated: Medical Homes, ACOs, and Other Tools that can Improve your Star Rating
• Politics as Usual: Debate on the 2012 Election’s Impact on Healthcare, Medicare, and the ACA
• Stratify Risk by Predicting the Financial Cost of Seriously Ill Patients
• Prepare for and Survive RADV Audits
• Build a Cost-Efficient Part D Formulary
• Value-Based Payment Models: What Works, what Doesn’t, and Why

For more information about this conference including its latest up-to-date agenda, and to register, please visit our webpage. Be sure to mention priority code XP1707BLOG for a chance to receive 25% off the standard rate.

Thank you very much, and I look forward to seeing you this winter in sunny Florida!

The Medicare Congress Brochure is Ready for Download!

noreply@blogger.com (Jennifer) — Thu, 10 Nov 2011 17:32:00 +0000

The 9th Annual Medicare Congress brochure is now available for download. Join us February 6-8, 2012, in Orlando, at the largest and most sought after conference solely focused on Medicare Advantage. Health plan providers need the crucial knowledge-sharing provided at this conference in order to stay competitive with ACOs, optimize their Star Ratings, withstand potential audits and sanctions, and shape their business plans in light of the uncertain outcome of the 2012 elections. Join 150+ industry luminaries and Medicare Plan executives as they share their best practices for tackling these and other challenges to improve the quality of care for today’s seniors.

Download the brochure to find out more about their presentations and the rest of the program.

The key takeaways for 2012:
• Educate your team and partners on how to remain in compliance and audit-ready at all times
• Build on successful marketing case studies to prospective new members while maximizing retention
• Identify the most chronically ill and expensive patients while improving your coverage capabilities for dual-eligibles
• Strategize the must-have elements for establishing an ACO and making sure it operates according to recently-published regulatory guidelines
• Target the most cost-efficient means of creating a successful Medicare Part D formulary
• Predict and prepare for the impacts of the volatile 2012 election season on Medicare benefits and PPACA

As a reader of the Healthcare From Policy to Practice blog, you can use priority code XP1707BLOG to receive 25% off of the standard rate! If you have any questions about the agenda or event, please contact Jennifer Pereira.