Health Care Insights - From Policy to Practice

MDRP 2012 Session Spotlight: Potential Impact of the Proposed Rule and 340B Program Updates

noreply@blogger.com (Jennifer) — Wed, 23 May 2012 15:11:00 +0000

There is no pharmaceutical or generic manufacturer not impacted by the rules set forth by CMS and OPA. While the government representatives might not be able to discuss ongoing proposed rules themselves, the updates to the 340B program and the AMP Proposed Rule are still the most talked about topics this year and we have the most respected industry leaders on hand to discuss what these potential new rules mean to your company in 2013 and beyond. Join us at Medicaid Drug Rebate Program Summit 2012 for the session "Potential Impact of the Proposed Rule and 340B Program Updates" to go in-depth on this topic with expert Alice Valder Curran, Partner, Hogan Lovells US LLP.

For more information the Medicaid Drug Rebate Program Summit, download the brochure. If you'd like to join us September 10-12 in Chicago, register today! As a reader of this blog, when you mention code XP1758BLOG, you'll receive a discount of 25% off the standard rate.

Featured Session: Potential Impact of the Proposed Rule and 340B Program Updates
Featured Speaker: Alice Valder Curran, Partner, HOGAN LOVELLS US LLP
About the session: Now that you’ve heard the policy and operational updates from CMS and OPA, you will want to stay and hear how to put all of this information into practice at your company. This session will detail the hottest topics in the industry up until the last minute and how they will affect your company.

How important is the ACA to the insurance industry?

noreply@blogger.com (Jennifer) — Tue, 22 May 2012 19:17:00 +0000

According to reports at Bloomberg, healthcare reform could bring as much as $1 trillion extra to insurance company revenues. The excess revenue comes from insurance subsidies and Medicaid expansion. This massive expansion will lead hto the health insurance industry staking claim in .5% of the GDP from now through 2020. Also according to Bloomberg, 80% of all premium revenue must be put back into the healthcare system, pumping the majority of the $1 trillion revenue back into the healthcare system to doctors, hospitals and healthcare providers.

At the Medicaid Drug Rebate Program 2012, Steve Phillips, Johnson & Johnson, will present "Impact of Healthcare Reform and the Changing Healthcare Delivery System: Accountable Care Organizations and Patient Centered Medicine" looking at the goal of increased specialized care for patients balanced with coverage and reimbursement policies. This will be ever important as the number of patients flowing into the system increases. For more information on this session and the rest of the program, download the brochure here. As a reader of this blog, when you register to join us September 10-12 in Chicago, and mention code XP1758BLOG, you'll receive an exclusive discount of 25% off the standard rate!

What sector of healthcare will benefit the most from the influx of new revenue to the insurance industry from the Affordable Care Act?

How can $3,000 Save Your Company $30 Million?

noreply@blogger.com (Jennifer) — Thu, 17 May 2012 20:12:00 +0000

Government fines are no laughing matter. The latest fine that made headlines was for a staggering $1.5 BILLION. Fines like these go well beyond the cost of doing business. With company budgets shrinking, you can’t afford to make a mistake that could cost your company millions of dollars in fines.

At the Medicaid Drug Rebate Program Summit, we gather USDOJ, HHS, OIG and industry senior in-house counsel representatives to explain who is getting caught, why, and how to avoid actionable behaviors. You might think you’re prepared, but if you haven’t been through an audit, how can you know?

Given the new complexities and number of changes in government reimbursement programs, and consequences for failing to follow and correctly implement these changes, these MDRP Summit sessions will show you if your compliance program covers all the bases:

- Timely Updates from the Office of the Inspector General: Sources say the OIG will have some exciting new reports to discuss. The MDRP Summit is your opportunity to get these updates directly from OIG officials so you will know what to focus on in the coming year to ensure compliance that stands up to increasing OIG scrutiny.
- Current Criminal and Civil Enforcement Activities to Improve Corporate Compliance: Avoid getting caught in the DOJ’s crosshairs and owing them millions with an update from Marilyn May, Healthcare Fraud Coordinator and Assistant US Attorney with the USDOJ, and a panel of experts who will review lessons learned from 2011-2012 civil and criminal Medicaid investigations and new trends the DOJ is seeing in current investigations
- Industry Legal Roundtable: Current Legal Trends Affecting Pharmaceutical Manufacturers: Know how to work with your legal team on compliance issues, saving you both time and money in this first-ever session with Harvey Kaish, VP and Assistant General Counsel at BMS, Sabrina Yohai, Senior Corporate Counsel at Pfizer, and Steven Benz, Assistant General Counsel at Eli Lilly, who will identify best practices in dealing with GP-related compliance issues including changes in laws, policy documentation, and systems.

Download the brochure here to find out more about the sessions and the rest of the summit. Last year's MDRP summit sold out early. Register now for the one event that will deliver compliance initiatives you can take back to the office and potentially save millions.

As a reader of this blog, you receive an exclusive discount of 25% off of the standard price when you register to join us this September 10-12, 2012 in Chicago, IL. Simply use priority code XP1758BLOG. Do you have any questions about the event? Feel free to email Jennifer Pereira.

MDRP 2012 Session Spotlight: Annual Update on 340B Program Regulations, Processes and Enforcement Answers from PHS

noreply@blogger.com (Jennifer) — Wed, 16 May 2012 20:43:00 +0000

At the Medicaid Drug Rebate Program Summit 2012, our annual update will help you determine the 340B pricing as it relates to Medicaid rebate formulas for BP and AMP. Hear current issues and how to work collaboratively with OPA (and the Prime Vendor Program). Specific discussion include how to calculate the 340B Ceiling Price, the process for which OPA, wholesalers, and covered entities get pricing information, and understand eligibility verification.

For more information the Medicaid Drug Rebate Program Summit, download the brochure. If you'd like to join us September 10-12 in Chicago, register today! As a reader of this blog, when you mention code XP1758BLOG, you'll receive a discount of 25% off the standard rate.

Featured Session: Annual Update on 340B Program Regulations, Processes and Enforcement Answers from PHS

Featured Speakers: Krista Pedley, Director, Health Resources and Services Administration, Office of Pharmacy Affairs
Christopher Hatwig, MS, RPh, FASHP, Vice President, APEXUS/340B Prime Vendor Program
Lisa Scholz, PharmD, RPh, HRSA’s Pharmacy Services Support Center, American Pharmacists Association

About the session: This session defines the Office of Pharmacy Affairs Mission/ Functions/Administration and helps you determine the 340B pricing as it relates to Medicaid rebate formulas for BP and AMP. Hear current issues and how to work collaboratively with OPA (and the Prime Vendor Program). Specific discussion surrounds how to calculate the 340B Ceiling Price, the process for which OPA, wholesalers, and covered entities get pricing information, and understand eligibility verification. Specific discussion around:

• OPA Program Integrity Efforts
• 340B audits of covered entities
• FY 2013 user fee proposal

MDRP 2012 Session Spotlight: Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?

noreply@blogger.com (Jennifer) — Wed, 09 May 2012 20:24:00 +0000

The government has the power to completely overhaul the way the pharmaceutical industry does business. With healthcare reform, we saw a huge increase in the number of people eligible for Medicaid and the 340B program, a redefinition of pricing calculations, and the addition of Managed Medicaid to the rebate system. All of these things had a huge impact on the financials of each manufacturer. Healthcare reform is a hot button topic at every election and this year will likely be no different. The outcome of either candidate’s election could mean a slew of new laws on Medicaid or Medicare, significantly impacting the way government reimbursement programs function. These keynote speakers presenting the "Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?" session are experts in the Healthcare landscape and will give an insider’s view to how each party will approach current healthcare legislation, and potentially move forward if elected.

The Medicaid Drug Rebate Program Summit will take place September 10-12, 2012 in Chicago, IL. For more information on the program, download the brochure here. If you'd like to join us, register today and mention code XP1758BLOG and save 25% off the standard rate!

Featured Session: Point/Counterpoint: Impact of the Election on Healthcare Reform—What’s Coming and How Will it Affect the Pharmaceutical Industry?

Featured Speaker representing the Democrats: Paul Begala, Political Analyst & Commentator, CNN; Columnist, Newsweek & The Daily Beast
About Paul: He is a political analyst for CNN, and part of a political team that won an Emmy for its coverage of the 2006 elections and a Peabody Award for its coverage of the 2008 Presidential election. He served as counselor to President Clinton in the White House, where he helped define and defend the Administration's agenda, from the State of the Union Address to the economic, domestic and International issues the White House faces each day. He helped launch the political magazine George and is the author of several New York Times best-selling books, including Is Our Children Learning? The Case Against George W. Bush and Buck Up, Suck Up, and Come Back When You Foul Up. He is also a columnist for Newsweek and The Daily Beast.

Featured Speaker representing the Republicans: Dan Crippen, Fmr. Director, Congressional Budget Office, Executive Director, National Governor’s Association
About Dan: Dan Crippen serves as the executive director of the National Governors Association (NGA). As executive director, he works with governors to identify and prioritize the most pressing issues facing states and oversees the day-to-day operations of the association. Prior to his work at NGA, Crippen served as the director of the Congressional Budget Office from 1999 to 2002, supporting the Congressional budget process and providing expert analysis to guide and inform economic decision making. Since CBO, Crippen has worked in the private and nonprofit sectors primarily on health care—including Medicaid, health IT, and health care for elderly and complex patients.

There is Something For Everyone at the 17th Annual Medicaid Drug Rebate Program Summit!

noreply@blogger.com (Jennifer) — Mon, 07 May 2012 16:40:00 +0000

The government reimbursement landscape is constantly changing. Policy, operations, and data challenges are in constant influx, and each change affects the pharmaceutical and biotechnology professionals working in the public reimbursement space.

What has remained constant for 17 years, is that IIR's Medicaid Drug Rebate Program Summit, is the go to event for everyone in the industry. This year, it will take place September 10-12 in Chicago, IL.

Every year the audience grows and this year we’ve expanded the program to ensure that MDRP has something for everyone.

Are you NEW to MDRP?

• You will learn how to make calculations, the status of various government programs, and maintain basic compliance at your organization at the MDRP Compliance Academy.
• Don't miss a full track on Medicaid Rebate Operation Implementation for Manufacturers where industry leaders from King & Spalding, Hogan Lovells, Amgen and Johnson & Johnson will walk you through some of the biggest challenges in operations today.

Are you an experienced drug pricing executive?

• Identify new approaches to improve operations and enhance governance at the 2nd Annual Senior Leadership Forum.
• CMS representatives will clarify your pressing questions at the annual CMS Policy and Operations Update session.
• Hear from North Carolina, Illinois, Kansas, and more at the full track on State Contracts, Reporting and Operations Issues and Strategies and learn how their states are dealing with invoicing and contracting for both FFS and MMC.

Are you a financial executive?

• The Financial Implications of MDRP and other Government Pricing Programs track, is where you will hear insights from some of the leading consulting firms in the space
• The inaugural Life Science Financial Leadership Forum, where pharmaceutical finance thought leaders discuss on a macro-level how government pricing and contracting ties to the health and stability of each pharma company.

Are you a generic drug manufacturer?

• Hear from the top generic companies at the half day symposium MDRP and Other Public Sector Reimbursement Programs for Generic Drug Manufacturers as they discuss key topics including how to maintain Federal and State compliance and managing the portfolio when there are Generics and Authorized Generics at the same company.

Are you a woman working in GP?

• The Women’s Government Programs Leadership Forum is for women at all stages in their careers to meet to exchange, share and hear lessons learned from the industry’s most seasoned leaders. Keynoted by Carolyn Buck Luce, Global Pharmaceutical Sector Leader and the Healthcare Businesswoman’s Association Woman of the Year, it is an event not to be missed.

For more information on this year’s program, download the brochure.

As a reader of the Healthcare: From Policy to Practice blog, you receive an exclusive discount of 25% off of the standard price when you register to join us at the Medicaid Drug Rebate Program Summit this September 10-12, 2012 in Chicago, IL. Simply use priority code P1758BLOG. Do you have any questions about the event? Feel free to contact Jennifer Pereira.

Full Speed Ahead!

noreply@blogger.com (Millner) — Wed, 02 May 2012 12:16:00 +0000

By Richard Yadon, President and CEO, Managed Medicaid Services, Host of Medicaid Matters talk show

Yesterday I visited the Navy Memorial in Washington DC. Being a Navy veteran it has special significance to me. Being there brought back a flood of memories from my days of active duty and reserve service. Those days weren’t always easy. I can remember being on the naval gunfire line off the coast of Beirut supporting the Marines at the airport in 1983. This was just a few day after the devastating terrorist attack which killed over 200 Marines. Nobody knew if or when something bigger might be aimed at the US military. Despite the uncertainty and anxiety, our ship’s crew always operated with precision and success.

It would be easy to let the uncertainties and anxieties in Medicaid managed care get you down. There are many challenges being discussed here at the Medicaid Managed Care Congress. In the sessions I attended this morning I’ve heard from everyone from state officials to health plan presidents. Topics such as provider capacity, ambiguous exchange regulations, and the integration of behavioral care in the community have all been discussed. Each topic represents a significant operational and financial challenge.

At the back of everyone’s mind is what will happen with the Supreme Court ruling. It could mean the end of the federally mandated expansion of Medicaid. This only adds to the uncomfortable atmosphere of uncertainty. Not an easy thing to manage given the amount of money entrusted to Medicaid managed care organizations and the millions of people they serve. I can think of several industries in which similar challenges and uncertainties would cause businesses to stop in their tracks.

That is not the case here. This broad collection of Medicaid health plan and state leaders has no intention of letting the uncertainly stop them. They are all moving forward as if nothing were threatened, as if there was no uncertainty. It is clear that they intend to continue to succeed, and serve, in spite of the challenges in front of them. Listening to the speakers and the questions from the audience suggest only one thing – Full Speed Ahead.

#MMCC 2012 Live: Thurston Howell III vs. the Professor

noreply@blogger.com (Millner) — Tue, 01 May 2012 19:55:00 +0000

By Richard Yadon, President & CEO, Managed Medicaid Services and Host of Medicaid Matters talk show

Thurston Howell III vs the Professor is how political analyst and commentator Paul Begala characterized the upcoming presidential election during his comments at the Medicaid Managed Care Congress today. This was in response to a question from the audience about whether health care is a Right or a Privilege. As pointed out by Mr. Begala, it is not a constitutionally guaranteed right; however, most Americans recognize that access to health care is the right thing to provide.

The real question being asked here is “What will happen with Medicaid this year?” There are two big events coming in the next several months that have potentially significant impacts on the future of Medicaid. One event is the Supreme Court’s decision in June about ACA and the second is the presidential election. Mr. Begala’s answer to this question is that no one really knows. One thing that could happen, however, is that we all lose sight as to what Medicaid is really about.

Whether it is a right or a privilege is immaterial to the Medicaid population. They are people who need help accessing and affording essential health care. The debate about how to best pay for this is a legitimate discussion. We have the means and expertise to help those who need it most. That is what everyone at this Congress is focused on. We will be hearing a lot about Block Grants, budget proposals, eligibility limits, constitutional considerations, and campaign promises for the rest of this year. Let’s not let all that talk take away from the real mission at hand.

#MMCC2012: The ACA as an Opportunity for Pharma Companies to Increase the Proper Use of Medication

noreply@blogger.com (Millner) — Tue, 01 May 2012 11:43:00 +0000

Monday at the 20th annual Medicaid Managed Care Congress, Cindy Pigg, SVP of Pharmacy at Magellan Medicaid Administration shared that the ACA is the largest opportunity for the pharmaceutical industry since Medicare Part D. By 2019, there’s expected to be more than 25 billion dollars spent on pharmaceutical drugs. This is a huge increase, especially considering during the recession, a lot less people went to the doctor’s office, and of those, a fair amount got prescriptions but never got them filled. Therefore, as a part of the ACA, pharmaceutical organizations have not only the opportunity to grow, but also to give lifechanging medical access to those who have not had access in years.

However, funding is limited, so pharma companies need to demonstrate the increase in the value of the drug (the trifecta of access, quality and cost). States are increasingly looking for comparative effectiveness studies, although at this point the data is quite limited. It doesn’t matter how your drug may hold up against the placebo, what matters is how it increases the patient’s overall health, including patient adherence. Judi Grupp, CEO of Physicians Pharmacy Alliance, suggested that PCMHs and ACOs are one way to increase the patient’s health, and ensure they’re taking the right amounts of the right prescribed medications.

What are other ways pharmaceutical organizations and MCOs can work together to increase adherence?

McKesson Pays $190mil for Claims of Defrauding the Medicaid Reimbursement Program

noreply@blogger.com (Jennifer) — Mon, 30 Apr 2012 13:00:00 +0000

McKesson, the largest US drug distributor, agreed to pay more than $190 million to resolve claims that it caused the U.S. to overpay for prescription drugs. As Bloomberg News reports, a New Jersey lawsuit claimed McKesson defrauded the Medicaid Program by falsely reporting inflated prices of drugs, which in turn caused the federal government to set higher reimbursement rates. Under the agreement, state governments can separately negotiate with McKesson, meaning more fines could be on the way.

This story isn’t new. Every year companies are fined millions of dollars for a variety of offenses, both large and small. At the 17th annual Medicaid Drug Rebate Program Summit, September 10-12, in Chicago, we do everything possible to give you the information you need to avoid audits and be compliant, to ensure the next story in the news cycle isn’t about your company’s million dollar fine. We have more CMS, OPA, OIG, and DoJ officials, as well as industry legal heads to explain who is getting caught, why, and how to avoid those actionable behaviors.

Register today to attend the nation’s longest running and most respected event in the MDRP space!

What should be the considerations for health plans in the Medicaid Space?

noreply@blogger.com (Jennifer) — Thu, 26 Apr 2012 13:00:00 +0000

Recently MMCC supporter Nathan Goldstein of the Gorman Health Group sat down with our conference director Sarah Gordon to discuss dual eligibles, and some of the unique opportunities they create for Medicaid managed care health plans.

To read Nathan's entire transcript, download it here.

At MMCC this year, we will be hosting a full day symposium Monday, April 30 called, "Cost Containment Strategies for Dual Eligibles." If you're interested in joining the full day symposium and the Medicaid Managed Care Congress this April 30-May 2, 2012 in Baltimore, mention code XP1726BLOG when you register to save 25% off the standard rate!

In this final installment, he answers the question:
If our health plan audience is looking ahead in the Medicaid space, what would you say to these plan executives who will be at our Conference in May? Are there any key planning considerations that you’d like to share with them?

Nathan: That’s a great question. There a couple of things. First of all, we’ve got to remember that these programs are going to be state-by-state. Last year, 2011, the Coordination Office awarded 15 states $1 million a piece to design person-centered approaches to coordinated care across primary, acute and behavioral health and long-term supports and services for duals. And what that means is that state-by-state you see different approaches. What I meant by the laboratory here. In Colorado, the proposal is to enroll duals into what’s called an ‘Accountable Care Collaborative’, which is sort of a hybrid medical home and ACO, which is a familiar term to our listeners I would imagine. And it would include involuntary enrollment of both Medicare Fee-for-Service and MA enrollees.

It’s different elsewhere. New York is considering a range of options. State management of delivery and financing of a combined benefit package, managed long-term care, SNPs. In Oklahoma they are considering ACOs or state-operated network, an expansion of the PACE program. Tennessee is going to do it through TennCare and expand managed care services to include Medicare Parts A and B. So, the first thing these folks need to do is bring their head of Regulatory Affairs with them to the Conference. It’s worth paying for the extra seat. They are going to get so much knowledge that they can apply to their home situation, but recognizing that the home situation is going to be unique to that state. And that’s where it begins.

The other considerations, at least where the duals are concerned, would be as follows: One is that the model of care or the service model with which you approach these beneficiaries needs to be different. In case management (traditionally in managed care), you would have a case manager assigned to that very small proportion of beneficiaries (2-5% depending on the plan and the way they approach it) to be that advocate within the plan and that navigator to help the beneficiary navigate the system. Keep in mind that dual eligibles see an average of 10-12 different physicians, 30-40 office visits a year. It’s an extraordinary volume of clinical information to coordinate. Imagine being that beneficiary. Imagine when, as inevitably happens, a couple of those doctors tell you to do different things, things that contradict each other. How do you resolve that? Many of the beneficiaries don’t. So, it’s critical that traditionally you would have a case manager watching out for those beneficiaries. They weren’t necessarily duals. They were just your most vulnerable beneficiaries. We would make the argument that you need to take almost a case management approach and apply it to customer service where the duals are concerned. We actually recommended for many of our plan clients it’s a good fit for them in serving their Medicare Advantage population more generally. It is certainly true in the duals. The challenge, of course,is that, as we’ve stated, these can be very hard beneficiaries to get in touch with. Where do you send the mail to a transient beneficiary? As I said earlier, sometimes the cell phone is the best way to get in touch with them. Maybe you should offer a cell phone as part of your plan to all of your beneficiaries. Plans need to think outside of the box here and get involved in a different way in their beneficiaries life if they have any hope of succeeding here.
The first consideration is: “What’s going on in my state?” The second consideration is: “What kind of a service model can I offer my beneficiaries that can distinguish my plan and do so, of course, in a completely compliant way to attract beneficiaries (because you are going to voluntarily enroll into my plan in some cases or make me attractive to the state to be a qualified provider).” And how do I get on top of some of these difficult service issues?

The next two things are absolute must dos. The first is to take a look at how your provider network is contracted, both the rates and the incentives, the information that you share with the network, how you share it to them, and your use of field agents (are you sending in long faxes to these offices? Well, they are getting used to line bird cages; they aren’t getting read). Are you having face-to-face interaction with the big players in your provider network and compelling them and giving them better information with which to make better clinical decisions because ultimately they are the one in contact with the beneficiary, not us the payer? We can only give them information for them to make better decisions. We can’t force them to do anything. No bonus scheme in the world is going to do that.

The last consideration is really a financial one that ties back to care, which is risk adjustment. As I’ve said a number of times, these beneficiaries are terribly expensive. They are expensive because they are sick. In that they are sick they need our support, but we can’t do this purely out of the goodness of our heart without getting revenues to pay for all that care. Risk adjustment is the way the plans get the revenues to care for those beneficiaries.Your non risk-adjusted average beneficiary premium is around $800-$850 pmpm.. It’s a big range nationally, about $350 range between a high and a low. But, let’s say it’s 800 bucks. These beneficiaries can be as high as $3000 per member per month. But, if you don’t accurately report that risk score, how much money are you going to get? Well, in this example, you’ll get $800 or $850. So, you’ve got to risk adjustment right to get the payment right or else you’ll never fund those benefits that the beneficiaries are entitled to.

So, those are really the four considerations: what’s your state’s local market condition, what is your service model, what can you offer these beneficiaries that’s unique, risk adjustment. And then think about your provider network very carefully. You’re probably going to have to re-contract portions of it to make this all work.

Look Who’s Attending the Medicaid Managed Care Congress 2012

noreply@blogger.com (Jennifer) — Wed, 25 Apr 2012 13:27:00 +0000

With the ACA appearing in the news almost daily, you need to know what your company needs to do now so you can take advantage of new opportunities, such as Medicaid expansion and health insurance exchanges. There is a lot at stake and the timelines are tight. We invite you to join us at the 20th Annual Medicaid Managed Care Congress, taking place on April 30 – May 2 in Baltimore.

Don’t let your company fall behind. Join top executives from the following companies to achieve better quality and better care at lower costs. More people are registered to attend than ever before, so space is limited. Make sure you reserve your spot today!

2012 Attending Companies:

3Cinteractive * Access2Care * Aegis Sciences Corporation * Aetna Medicaid * Altegra Health * Amerigroup * AmeriHealth Mercy * Amgen * Arbor Healthcare * Association for Community Affiliated Plans * Assurance Wireless * AstraZeneca Pharmaceuticals * Bayer Healthcare Pharmaceuticals * Bio-Reference Laboratories Inc * BioRx * Blue Cross Blue Shield Northern Plains Alliance * Blue Cross Blue Shield of Tennessee * BMC Healthnet Plan * Boehringer Ingelheim * CalOptima * Cardon Outreach * Care Systems Design LLC * CareCall Inc * CareSource * CenCorp Health + Solutions * Cenpatico Behavioral Health * Central California Alliance for Health * Children's Hospital and Health System * CMS * Community Health Choice Inc * Comprehensive Behavioral Care * Connolly Healthcare * Cook Childrens Health Plan * Covidien * DC Health Care Finance * DentaQuest * DMoller Associates * DST Output * Excellus BlueCross & BlueShield * Express Scripts Inc * Fallon Community Health Plan * Forest Laboratories Inc * Geisinger Health Systems * Genentech Incorporated * Georgia Department of Community Health * Gilead Sciences Inc * Gorman Health Group * Government of the District of Columbia * Health First Health Plans * Health Management Associates * Health Partners * Health Services for Children With Special Needs Inc * HealthHelp * HealthPlus of Michigan * HealthPort * HealthSpring * Hemophilia of Georgia * Horizon NJ Health * HSMA * Hudson Health Plan * Humana Inc * InstaMed * ISG * Johns Hopkins Healthcare Inc * Krames A MultiMedia Company * Lilly USA LLC * Loving Care Agency * LVHN * MDwise Inc * Medicaid Health Plans of America * Medimpact * MedSolutions * Merck & Company Inc * Michigan Department Community Health * Molina * Monroe Plan for Medical Care * Montgomery County Government * Mostly Medicaid * Myers and Stauffer LC * National PACE Association * Navitus Health Solutions * NC Divison of Medical Assistance * Neighborhood Health Plan of Rhode Island * Network Health * Newkirk Products Inc * Novo Nordisk * Nurtur * OCCMHA * OptiCare Managed Vision * Optimetra Inc * OptumHealth * OptumInsight Life Sciences *Pfizer * Physicians Pharmaceutical Corp * Piurek & Associates * Plasma Protein Therapeutics Associates * Prestige Health Choice * Prolacta Bioscience * Purdue Pharma Minnesota * QualityMetric Inc * RI Department of Human Services * Sanofi Aventis * Schaller Anderson Inc * Senior Link * South Florida Community Care Network * Sprint * State of Maryland * State of Michigan * State of Mississippi * State of New Jersey * State of New York * State of New Hampshire * State of North Carolina * State of Pennsylvania * State of Texas * Sunovion Pharmaceuticals * SXC Health Solutions * Teva Pharmaceuticals * UCB Managed Markets * UnitedHealthCare Community Plan * US Government Accountability Office * Utah Department of Health * Varis * Vertex Pharmaceuticals Inc * Visiting Nurse Service of New York * VITAS Healthcare Corporation * VNSNY CHOICE Health Plans * Walgreens * Wellpoint * ZOLL LifeVest *

Also, as a reader of this blog, you can receive 25% off the standard registration rate with Priority Code XP1726BLOG. For more information on the Medicaid Managed Care Congress and to register, visit our webpage.

Why is it critical to identify the needs of duals now?

noreply@blogger.com (Jennifer) — Tue, 24 Apr 2012 19:58:00 +0000

To read Nathan's entire transcript, download it here.

At MMCC this year, we will be hosting a full day symposium Monday, April 30 called, "Cost Containment Strategies for Dual Eligibles." If you're interested in joining the full day symposium and the Medicaid Managed Care Congress this April 30-May 2, 2012 in Baltimore, mention code XP1726BLOG when you register to save 25% off the standard rate!

Today he answers the question:
It’s clear that dual eligibles initiatives bring a new level of complexity to the government programs marketplace. From your perspective, what makes now such a critical time for these issues? Looking ahead, what impact do you think the Medicaid expansion that you’ve talked about will have on health plans?

Well, now is the time partially because of demographics. We talked about the boomers aging. Keep in mind when the economy hit the skids as it has since the crash in 2008. You’ve got a lot of new beneficiaries that might not think of themselves as being Medicaid eligible but who may be finding under the provisions of health reform that they are. They never expected to be in this place. Nevertheless, they are. So, you’ve got the demographic reality of the boomers aging in.

Keep in mind, we’re going from 45 million Medicare beneficiaries to 80 million beneficiaries in a blink of an eye. That’s profound. We’ve seen what has happened in Japan and other industrialized nations who have been a little out in front of us in terms of that boom. It puts enormous strains on the economy and, no doubt, our listeners are aware of the challenges that it puts the federal and the state treasuries through with the entitlement programs.

And that’s worth mentioning for a second. There is a lot of reform talk here in Washington about the entitlement programs. Everyone knows that earmarks don’t actually increase spending. Actually, not everyone knows that. Earmarks don’t actually increase spending. There are designations within budget priorities that have already been made. There is really not a lot of foreign aid. When people look for things to cut, it always comes back to the entitlement programs. That means social security, Medicare and Medicaid. Well, two thirds of that Medicaid spending has been on everything but these types of beneficiaries. We are not about to cut spending to moms and kids. Frankly on a Medicaid standpoint, probably not going to cut funding to seniors, either. Typically not a good idea to do in an election year. Wouldn’t you know it, it always seems to be an election year (especially these days).

So, you’ve got this demographic issue that’s staring us down in the face. Then you’ve got health reform essentially saying: ‘You know what? We’re going to increase eligibility for this program, not decrease it because it’s the way we’re going to try to get the lower, lower middle class (which some call the working poor) with some coverage here, particularly as so many more of themare finding themselves in a position of need that they maybe didn’t expect to be five years ago.’ They weren’t going to be living high on the hog in retirement, but they had savings. Well, those savings are wiped out now. If they had a little 401K, it’s probably hurting. Most Americans don’t have the benefit of those retirement vehicles.

So, you’ve got a number of forces here conspiring to make us confront this issue. The issue we’re confronting is how we finance care for everyone in a way that doesn’t bankrupt either the federal government or the traditional provider of coverage, which is the employer. Something that is lost in this debate too often is that the cost of care increases as the rate of medical inflation increases. All the payers are in the same boat. Whether it’s Medicare or the employer Boeing, they are paying more and more money every year to provide coverage for those people. Whether it’s the State of California or Medicare Fee-for-Service. We are all in the same boat as payers here. So, while in the short term it’s pretty incredible to think about adding 30 million more people into managed care through the exchanges and millions more through these dual eligibles programs (just a million more this year alone), we’re going to find ourselves in a position where we’ve got a significantly larger amount of people with coverage in this country and we will be forced by the cost of that coverage to reform how we purchase services. Coverage will be something different. Benefits will look something different. We are ending up with this patchwork of coverage here and we are going to be compelled to fix the way that we finance underneath that coverage. There’s no way we can continue on the path we’re on and just add more people to the federal government’s tab. And that’s really what’s happening here.

So, the challenge with the duals, again, everything that’s hard about health care, even harder and with even higher stakes because these are beneficiaries who are tremendously vulnerable. A $2 co-pay or a $5 co-pay is out of reach to these beneficiaries, which is why they receive such heavy subsidies now. They are on the most fixed incomes. They sometimes lack family or community support. We know sociologically speaking how isolating it is to be elderly in this country. So, we need to be cognizant that as we do this reform, we have to hold the beneficiaries harmless. We have to protect them from feeling what is, quite frankly, a great deal of volatility in the structure and the financing of care. They should never feel it. They should never feel the difference. They should instead feel higher levels of service. Our work on the dual eligibles through the Special Needs Program tells us that it is absolutely possible.

It may sound like an impossible issue when you begin to describe the demographic factors and the challenge in providing a good model of care and the challenge of finance, but it can work. There are plans out there that are doing exceptional work in this space. But, every single one of them has something in common, which is that they knew they had to approach their business fundamentally different in order to make this dual eligibles program work. My counsel to the listeners of this podcast is that it is absolutely worth going into this program and serving this population. In fact, it’s a strategic imperative for most plans. But, you’ve got to go in with eyes wide open, as I said earlier, or you will find yourself upside down from a financial standpoint very, very quickly. Again, these members are $30,000 a year or more to care for. Think about that number. It’s extraordinary. It’s as high as an entry-level salary into this economy; $30,000 a year to care for these beneficiaries under the current system. That payment from the federal government is risk adjusted and plans have shown that they are incredibly unsophisticated over the years in managing that risk adjustment score. So, they’ve got to get that right or they will be in a world of hurt a couple of years into the benefit when they start seeing some volume of members being attracted to the plan.

The other interesting thing where at least the Dual Eligibles SNPs are concerned is that they are voluntary enrollments traditionally into these programs and under some of the projects that are being contemplated by CMS now, there may be the auto-assignment of beneficiaries into qualifying plans in those states on a state-by-state basis. Plans obviously will be applying to be qualified here. It’s not going to be random. But, it will be a specific number of plans and they will get these beneficiaries auto-assigned, just as they did with Part D. And that voluntary assignment is, again, a movement of an entire industry towards a retail sales model that is, frankly, alien to most health plans who are operating in this space today. But, one place where they’ve had significant experience in the retail model is Medicare Advantage. So, very interesting times for our payers. Extraordinary opportunities to improve care for these beneficiaries.

Healthcare Reform and how dual eligibles are impacted

noreply@blogger.com (Jennifer) — Thu, 19 Apr 2012 13:00:00 +0000

To read Nathan's entire transcript, download it here.

At MMCC this year, we will be hosting a full day symposium Monday, April 30 called, "Cost Containment Strategies for Dual Eligibles." If you're interested in joining the full day symposium and the Medicaid Managed Care Congress this April 30-May 2, 2012 in Baltimore, mention code XP1726BLOG when you register to save 25% off the standard rate!

Today he answers the question:
We hear a lot these days about health care reform. In what ways has health care reform impacted the duals population?

Nathan: That’s a great question. We talked a little bit about the expansion of eligibility. That’s probably the single biggest immediate change in this program. We also see a number of Dual Eligibles Coordination Demonstration Programs. For those who may not be familiar, Demonstration Programs are designed and initiated by CMS itself. Take us back to high school Civics class for a second here. When a law gets passed by the legislature, by our Congress, it then gets handed to the executive branch to execute. In this case it gets handed to CMS. We all know that moment when that law passes (Obama Care, as some people call it), it gets passed and it gets handed to the agency and then they write regulations. You could take a 1,000-page law and turn it into hundreds of thousands of pages of regulations, rules and guidance as it actually gets implemented.

But, CMS also has the authority to conduct experiments. They are given a rather broad purview in doing this. Some of these are called ‘demonstrations’ where they also do them under a different designation called an ‘authority’. There are some technical details between

the two. But in this case, they have a number of Dual Eligibles Coordination Demonstration projects that they run out of the MMCO, which is that Medicare/Medicaid Coordination Office that I mentioned before. They’ve got CMS sponsored Medicare/Medicaid integration waivers in the states of Massachusetts and Minnesota and Wisconsin. They’ve got 29 states that our audience is probably aware of that operate what are called: ‘PACE programs’, which is an older program. The program of All-Inclusive Care for the Elderly. Those provide a full range of medical and long-term services for duals over 65 who qualify for nursing home care. The most vulnerable of the vulnerable. And they get a capitated payment to cover Medicare and Medicaid services at those pay sites.

And then we also see Dual Eligibles enrolling in Medicare Advantage plans through that program I mentioned a moment ago called: ‘The Special Needs Plan Program’. They are allowed to have different benefit sets that are tailored around the needs of this population.There were major changes that came though. The most important change (other than the eligibility requirements changing) really was that creation of this Office to handle integration because what they are doing is creating a structure and a mechanism for continued experimentation around these programs.

At the risk of getting political about any of this, one thing that we see is that although the government is marching into the health care sector with an energy it never has seen before (remember 2012 is the first year that government spending is going to exceed private spending in the health care space), it’s sort of a milestone. That typically doesn’t retrench; it doesn’t typically go in the other direction. But, far from a one-size-fits-all approach to this, they are giving a wide range of latitude to the states to waiver out of certain programs, to waiver out of certain requirements. They are creating an Office that’s really dedicated to experimentation. I can’t remember the Supreme Court Justice who called the states the ‘laboratory for democracy’. Well, to some extent the CMS is using the states as a laboratory for creating best practices around care.
We are moving, one way or another, into something like government-financed care for all US citizens, but it’s not single payer. It’s going to be a patchwork. Now, that might sound like a pejorative term, so a better term might be a ‘sewn together system of best practices that are locally tailored’. They are not imposing one coordination-of- care system on the nation. They are allowing for many, many different types of systems to be created here. I think that CMS (although I certainly can’t speak for them) would acknowledge that they are making this kind of experiment.

So, it is a time of great experimentation. It’s a time of great opportunity for payers that have experience with either the Medicare or Medicaid population. They just need to go in eyes wide open to this program because the needs of this beneficiary population are just so different than your average Medicare beneficiary or the moms and kids of so many that our Medicaid providers currently care for.

Why are the dual beneficiaries unique to healthcare coverage?

noreply@blogger.com (Jennifer) — Tue, 17 Apr 2012 13:00:00 +0000

To read Nathan's entire transcript, download it here.

At MMCC this year, we will be hosting a full day symposium Monday, April 30 called, "Cost Containment Strategies for Dual Eligibles." If you're interested in joining the full day symposium and the Medicaid Managed Care Congress this April 30-May 2, 2012 in Baltimore, mention code XP1726BLOG when you register to save 25% off the standard rate!

Today he answers the question:
You mentioned this special population of beneficiaries that are both Medicare and Medicaid programs and have a great deal of impact on today’s healthcare system. What makes this member population so unique?

Nathan's Answer:

Well, there are a number of things. First of all, there is a direct correlation between income and health status in this country. It’s an issue of profound moral importance, I think, when we’re talking about health care. We can’t lose that dimension. The further down you are on the socioeconomic ladder, typically the more ill you are. Remember, of course, the important thing (and our audience surely knows this) is that the driver of costs in our health care system isn’t so much the funding of acute episodes of care (although it is important), but it is the management of chronic illness over a long horizon. By the time a Dual enters into the system and becomes Medicare eligible and, in some cases has perhaps not had Medicaid coverage over their life because they’ve had a lower middle class income and they haven’t qualified for their Medicaid benefit, they may not also have had consistent health coverage. So, by the time they come into the system they often have multiple chronic illnesses or co-morbidities that have a very complicated clinical interaction.

You remember back a moment ago to your first question. Everything we know about the health care system is compounded with the duals. So, one of these is the duals who receive fragmented care because they’ve got multiple complex conditions. They can have clinical recommendations or pharmacy therapies that are at a cross purpose. So, it is a challenging population to manage because of the way they enter into the system. But, there are other challenges, as well.

It seems like we see every extreme when you’re talking about the duals. In our practice at GHG, we work with quite a few Dual Eligible Special Needs Plans, which is a designation created by CMS. In the previous major health reform in the MMA, it grew out of a pilot that was created there. The Special Needs Plans that we work with, you see populations that are either virtually housebound, often in neighborhoods that don’t have a grocery store. The food comes from a corner bodega or they have, on the other extreme, extremely transient lifestyles. The most consistent thing about these beneficiaries is a cell phone, if they have one.

So, they are incredibly difficult beneficiaries to manage from a model-of-care standpoint. They are in many cases (but certainly not always) at the lower end of the educational scale. So, communicating with them can be difficult. You think about what it’s like to come out of a hospital stay and have complicated discharge instructions. We know that hospitals and clinics are struggling to really get on top of the importance of discharge planning. We know it, but we don’t do a terribly good job of it. So, again, all of those things are compounded when you’re talking about serving this population.

Whether it’s a plan or a state, historically as you’re trying to reach out to these folks you’ve got to do so in ways that can be profoundly different from how you manage the rest of your population. The average Medicare plan that got into a dual SNP was accustomed to a certain model of care for caring for these beneficiaries and it doesn’t quite apply or it certainly needs to be changed for the duals. They require from a regulatory standpoint, an independent model of care from the plan.

And then your average Medicaid provider or payer, rather, is accustomed to perhaps moms and kids, blind and disabled, different populations. So, plans need to come into managing the duals with an expectation that everything from the operational model to

Who are the dual eligables for Medicaid?

noreply@blogger.com (Jennifer) — Fri, 13 Apr 2012 19:34:00 +0000

To read Nathan's entire transcript, download it here.

At MMCC this year, we will be hosting a full day symposium Monday, April 30 called, "Cost Containment Strategies for Dual Eligibles." If you're interested in joining the full day symposium and the Medicaid Managed Care Congress this April 30-May 2, 2012 in Baltimore, mention code XP1726BLOG when you register to save 25% off the standard rate!

Today he answers the question:
To start off our conversation with the upcoming Medicaid Managed Care Congress in mind, when we talk about dual eligibles and the Medicaid’s programs role for the low-income Medicare beneficiaries, who are we talking about here? Who are the duals?

Nathan's Answer:

Right. It’s an important question, especially these days. The duals are low-income individuals who are entitled to benefits from both Medicare and Medicaid. There are roughly 9 million elderly and disabled duals in the system. These are the most vulnerable patients in the healthcare system. They are also among the most expensive patients in the system. To an average managed care plan they will generate almost $3000 per member per month in costs. That translates to a little more than $300 billion in annual health care spending.

The challenge here is that the Medicare program, which is financed and administered by the Federal government and the Medicaid program which, as our audience knows, is partially financed by the Feds but managed by the states, are generally not coordinated. There has been a fragmentation of care with respect to the Duals which really is an amplification of everything we see in the system. Anything we know about a beneficiary--whether they are a healthy 35 year-old commercial beneficiary or a 70 year-old Medicare beneficiary--everything we know that’s wrong with the system is doubled in the case of the Duals. They experience the fragmentation of the system more acutely. They suffer from the lack of coordination because their needs are greater and the lack of financial integration between Medicare and Medicaid is only the tip of the iceberg. More importantly with Duals, as for everybody, the much bigger deal is the lack of clinical integration. What we are seeing in the policy landscape is tinkering with the finances in order to get clinical things aligned and tinkering with the way we do clinical alignment and integrated care in trying to influence the way the program is financed. So, everything we know about the health care system really comes home to roost with the Duals.

CMS, the agency that has oversight of the Medicare and Medicaid programs, the federal level has known this for some time. So, in 2010 they actually created a new Medicare-Medicaid Coordination Office. That Office is dedicated to trying to coordinate not just the finances, but the clinical infrastructure and the data flow and what have you around the Dual Eligibles. So, they’ve set a goal of enrolling one million Duals in coordinated care programs by the end of this year, 2012. That came out of a result of what was in the ACA.

The Health Reform Act, which is now nearly two years old (hard to believe; it passed on March 23, 2010) is known in some quarters as ‘Obama Care’. From a policy standpoint, though, it is known as the ‘Affordable Care Act’. The ACA mandated better coordination and established a structure to accomplish that mandate. The other thing that the ACA did, though, which is of great importance to our audience is that it expanded the eligibility criteria for Medicaid. That meant that more beneficiaries were eligible for Medicaid and, therefore, more beneficiaries became duals.

So, you have this double whammy demographically, one of which is just the overall aging of the population, right? You’ve got the Medicare beneficiaries increasing by 30,000 Baby Boomers a month to become Medicare eligible. It’s a big, big number. But now you’ve also got expanded eligibility on the Medicaid side. So, those two things have created an environment where the number of Duals is just absolutely exploding.

Now, of those Duals about three quarters of them are what are known as ‘full benefit duals’ who qualify for full Medicaid benefits in addition to Medicare. And then the remaining quarter are partial duals. Partial duals qualify to have Medicaid subsidize their Medicare Part B premiums and the cost sharing, but they don’t receive the full spectrum of Medicaid benefits.

Getting back to your question of who they are, there is a broad range of duals state by state. Eleven states have 25% or more of the Medicare beneficiaries also receiving Medicaid benefits. And these are highly populated states – California, New York, Massachusetts (a very sophisticated state from the standpoint of clinical infrastructure and, of course, a state that already has a mandate for coverage) and Wisconsin. The actual state with the highest proportion of duals (and this surprises many people) is Maine. And then you’ve got the deep South states of Louisiana, Mississippi, Alabama, Tennessee and then up into Kentucky. Very high proportions of duals. That’s over 25% of Medicare beneficiaries.

The lowest state, by the way, is Montana. And you look out to those mountain states (Colorado, Utah, Wyoming, and Nevada). These are all states of generally low proportions of dual eligibles.So, it’s a national issue. The states are going to deal with this in different ways. CMS has shown itself open to experimentation on a number of different levels.

Subscribe to Receive News from the Medicaid Drug Rebate Program Summit

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

As a valued reader of our Healthcare From Policy to Practice blog, we invite and encourage you to subscribe to receive exclusive VIP discount offers, notification of private industry events, and access to proprietary content and pre-press industry news relating to MDRP. We assure you that our sophisticated segmentation strategies guarantee you receive only those notifications that are relevant to you.

Now in its 17th year, the Medicaid Drug Rebate Program Summit is the must-attend meeting for pharmaceutical and generic manufacturers’ contracting, compliance and pricing executives. With over $3 billion in fines paid by pharma manufacturers in 2011 alone, compliance remains the #1 priority to avoid these fines. At MDRP, we gather OIG and USDOJ officials, along with industry legal heads to explain who is getting caught, why, and how to avoid actionable behaviors. MRDP will take place September 10-12, 2012.

And 2012 has proved to be a pivotal year for government rebates with the release of the long-awaited AMP Proposed Rule. Industry experts will be on hand to interpret these rules and discuss proposals for operationalization.

And don’t forget that with more CMS officials than any other MDRP event, you will get the most up to date information on MDRP operations, policies and data systems.

This event attracts the most industry, state and federal government professionals providing you unparalleled access to the government regulators creating the rules, and the pharmaceutical executives implementing them so that you have the most current updates and industry practices to navigate the regulatory hurdles and optimize your budget.

To join our mailing list, click here.

MMCC Session Spotlight: CMS Joins MMCC!

noreply@blogger.com (Jennifer) — Thu, 12 Apr 2012 13:00:00 +0000

In today's session spotlights, we look at the newly confirmed sessions in which the CMS will be joining the Medicaid Manged Care Congress. Steve Larson will be on hand to look at the current state of healthcare reform and how the CMS is working with the upcoming transitions. Patrick Conway will also be on hand to look at what strategies are in place in order to serve the Medicaid population with a higher quality of care.

For more information on these presentations and the Medicaid Managed Care Congress, download the brochure here. MMCC will take place April 30-May 2, 2012. As a reader of this blog, when you register today and mention code XP1726BLOG, you'll receive 25% off the standard rate.

Featured Session: Health Care Reform: A Federal Perspective
Featured Speaker: Steve Larsen, Deputy Administrator & Director of the Center for Consumer Information and Insurance Oversight (CCIIO), CMS
About the Session: The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with implementing the private market provisions of the Affordable Care Act. During this keynote address, Steve will focus on areas of the ACA of interest to Medicaid managed care.

• Learn what CCIIO is doing to help states and plans prepare for health insurance exchange implementation
• Understand some of the implications of Medicaid Expansion
• Discuss insurance market reforms

Featured Session: CMS’ Strategies to Increase Quality
Featured Speaker: Patrick H. Conway, M.D., MSc, Chief Medical Officer, CMS; Director, Office of Clinical Standards and Quality
About the session: At CMS, the Office of Clinical Standards and Quality identifies best practices and techniques to improve quality, then implement them across all states.

• Learn about the demonstration projects the Office of Clinical Standards and Quality supports
• Hear the best practices they have currently identified

Have Lunch with your State Medicaid Representative at the Medicaid Managed Care Congress!

noreply@blogger.com (Jennifer) — Wed, 11 Apr 2012 16:43:00 +0000

The 20th Annual Medicaid Managed Care Congress is just around the corner, taking place April 30-May 2, and you’re invited to an exclusive luncheon discussion with a State Representative. This is your opportunity to ask state government officials questions and converse with other attendees about Medicaid Expansion, Health Insurance Exchanges, and Dual Eligibles. Don’t miss this amazing opportunity to speak with key stakeholders and walk away with exclusive information about your state.

To reserve your seat at the table, please use the specific state Priority Codes when registering:

Lunch on Tuesday, May 1:

- Michael Norton, Senior Program Manager, Massachusetts Health Connector

◈Register with Priority Code BLOGMA

- Deborah Florio, Administrator, Center for Child & Family Health, Rhode Island Department of Human Services

◈ Register with Priority Code BLOGRI

- Joe Vesowate, Deputy Director, Managed Care Operations for Medicaid and CHIP Texas Department of Health & Human Services

◈ Register with Priority Code BLOGTX

- Amy Allen, Healthcare Reform Planning Director, Department of Community Health, Michigan

◈ Register with Priority Code BLOGMI

Lunch on Wednesday, May 2:

- Valerie Harr, Director, Division of Medical Assistance & Health Services, State of New Jersey.

◈ Register with Priority Code BLOGNJ

For more information on The Medicaid Manged Care Congress, including the complete program, visit the webpage to download the brochure.

Also, don’t forget as a reader of this blog, you can receive 25% off the standard registration rate with the above Priority Codes. For more information on the Medicaid Managed Care Congress and to register to have lunch with your Medicaid Representative, visit our webpage. If you have any questions about the event, feel free to email Jennifer Pereira.

Download the New 2012 Medicaid Drug Rebate Program (MDRP) Summit Brochure

noreply@blogger.com (Valerie M. Russo) — Thu, 05 Apr 2012 10:00:00 +0000

2012 is a pivotal year for government rebate executives.

First and foremost, compliance is king, and with pharmaceutical manufacturers continuing to see fines in the hundreds of millions of dollars, you want face-to-face interaction with the government watchdogs who will direct you towards improved compliance initiatives.

With the January release of the long-awaited AMP Proposed rule, you have had several months to interpret what the rule could mean, and now you must begin to develop internal strategies to implement those pieces that make it to the Final Rule in 2013.

No other event has these government and industry leaders at a time you need them most.

Download the 2012 Medicaid Drug Rebate Program Summit Agenda and join the one event where you will navigate regulatory hurdles, maximize limited resources and limit company liability and risk with the most current government updates and industry practices.

At MDRP 2012:

Access to more CMS, OPA, DOJ and VA officials who provide regulatory updates to clear up uncertainty and ensure compliance

More states confirmed than ever before, providing insight into state operations and enabling dispute resolution

Over 45 branded and generic manufacturer executives share best practices to inform successful rebate operations

Access to more leading industry expert opinions sharing information that would otherwise cost thousands in fees

Don’t miss out on the leading Medicaid Drug Rebate Program event of the year!

To register today, please visit the www.medicaiddrugrebates.com, call (888)670-8200, or email register@iirusa.com.

The 17th Annual Summit on the Medicaid Drug Rebate Program is taking place September 10-12, 2012 in Chicago, Illinois. As a valued reader of the Health Care Insights - From Policy to Practice blog, you can use priority code XP1758BLOG to receive 25% off of the standard and onsite rate!

* Group Discounts Available:
Send your entire team to MDRP 12! For information on group discounts, please contact Millison Thenor at (646) 616-7625.

A Message from the Medicaid Chairperson Vern Smith: Update on the Supreme Court Hearings

noreply@blogger.com (Jennifer) — Fri, 30 Mar 2012 13:56:00 +0000

Medicaid Chairperson Vern Smith comments on this week’s Supreme Court Hearings:

The Supreme Court arguments on Medicaid, and recent new rules on Medicaid eligibility, have highlighted both the complexity and the significance of the changes coming for Medicaid, and their implications for states and health plans.

A lot is at stake, the risks are high, and there is hardly enough time to prepare for the opportunities immediately ahead.

Across all states and Medicaid managed care plans, the keywords now are innovation, coordination, collaboration, quality improvement and performance. It is an exciting time to be involved with serving the health care needs of this population.

That is why I invite you to attend IIR’s 20th Annual Medicaid Managed Care Congress, April 30 – May 2 in Baltimore. I’ve had the privilege to chair this event for the past few years, and have seen it consistently bring together health plan leaders, state and federal officials, to share how they are addressing the most significant challenges in Medicaid.

When you download the agenda, you’ll see more than 45 exceptional speakers. There is plenty of time to interact with speakers and with more than 350 fellow participants with their own expertise in the world of Medicaid managed care.

This year I will moderate the annual State Medicaid Directors Panel, always a highlight of the conference, where we’ll focus on the top challenges state leaders are facing, and their strategies for addressing them.

Thank you very much, and I look forward to seeing you in Baltimore!

Sincerely,
Vern

Vernon K. Smith, Ph.D.
Managing Principal
HEALTH MANAGEMENT ASSOCIATES

** ** **
Don’t forget, as a reader of this blog, when you register to join us at MMCC in Baltimore this April, 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 Jennifer Pereira.

Affordable Care Act : Day 3

noreply@blogger.com (Kate) — Thu, 29 Mar 2012 13:28:00 +0000

After three separate sessions this week, the decision concerning whether the Affordable Care Act is constitutional still remains, if congress proceeds with the individual mandate, and it’s found unconstitutional, where do the rest of the laws stand? Deputy Attorney General Edwin S. Kneedler argued, “if it were to fall only two other provisions of the law should follow suit and fall, as well.” Risk factors of insurance companies, and the effects of if the mandate did indeed fall were discussed at great length. All information has been submitted to the justices’ and they will come to a decision by June.

A second meeting was held during the afternoon to discuss the expansion of Medicaid. The matter of whether or not the states will be coerced to comply with the mandate was a concern because they will be relying on the government for initial funding when their program expands in 2014. By 2017 the state will be covering up to 5 percent of the cost of care. Expanding the bracket for both age, and income will make it possible for millions of Americans to receive coverage.

What are your thoughts? Do you think the affordable care act is constitutional? How do you think it will impact the Medicaid expansion in 2014?

Listen to all hearings from Day 3 here.

View transcript from Day 3 here.

Affordable Care Act : Day 2

noreply@blogger.com (Kate) — Tue, 27 Mar 2012 21:25:00 +0000

Today the Supreme court met for the second time this week, regarding the issue of whether the Affordable Care Act is Constitutional. The arguments focused on the issue of regulating commerce. Justice Anthony Kennedy questioned whether this mandate would, “change the relationships status between the Government and U.S. Citizens.”

Many of the statements circling around the same subject matter of if the government can require us to purchase healthcare, what else can they require us to buy? The cost of healthcare was also a concern. Justice Ruth Bader Ginsburg also discussed,” the people who don't participate in this market are making it more expensive for those who do.” The third hearing will resume tomorrow morning, with a 90 minute debate in the morning regarding how effective the law will be and an hour in the afternoon discussing the expansion of Medicaid.

Should Americans be required to purchase health care or face a penalty? Do you believe Congress is out of its jurisdiction? Review today's hearing below and check back here for the latest news from Washington on this matter.

Listen to all hearings from Day 2 here.

Read transcript from Day 2 here.

Is the Affordable Care Act Constitutional? Supreme Court began hearings today

noreply@blogger.com (Jennifer) — Mon, 26 Mar 2012 21:22:00 +0000

Today he Supreme Court heard the preliminary arguments for 90 minutes today on the whether or not the Affordable Care Act is constitutional. Most of the arguments focused on the Anti-Injunction Act of 1867. This looks as to whether or not the US government can collect a penalty, forcing people to pay for insurance they don't necessarily want. So, is this new provision a tax or a mandate?

CNN points out that pointed out that Justice Ginsburg commented on the constitutionality of the provision to require the purchase of health insurance, "This is a suit that is challenging the 'must-buy' provision, and the argument is made that, if, indeed, 'must-buy' is constitutional, then these complainants will not resist the penalty. So what they're seeking is a determination that ... 'must-buy' is unconstitutional, and, if that's so, that's the end of the case. If it's not so, they are not resisting the penalty."

Read the full transcript of today's hearings here.
Listen to all of today's hearings here.

After looking over today's hearings, what do you think? Is the ACA a tax or a mandate?

So what does this mean for Medicaid Managed Care? Should the court decide that the ACA cannot be challenged, some states and plans may have to hurry to prepare for various ACA upcoming deadlines, most notably Medicaid expansion going into effect in 2014. Other states and plans that have already started to prepare for Medicaid expansion will be in better shape, and will continue business as usual.

Tomorrow the court will look at whether or not the law’s health-insurance mandate fall outside the Constitution’s limit of congressional regulatory power to matters of interstate commerce? Check back here for the latest news from Washington on this matter.

Illinois planning big budget cuts to Medicaid

noreply@blogger.com (Jennifer) — Mon, 26 Mar 2012 16:51:00 +0000

In what many states are trying to do in two years, Illinois is trying to do in one. They goal is to cut $2.7 billion from their Medicaid spending budget next year. The State Journal Register states that their initial plan is determine eligibility of participants, and remove those who don't qualify; rescind services that aren't required by the law and reduce the rates of doctors who service Medicaid. The is acknowledgement form the government that cutting spending by that much in one year will be difficult, but they will proceed with their plan.

Illinois Governor Pat Quinn released in a statement:
"But we’ve gotten to the point where, despite the difficulty, we must try to make the program sustainable in order to keep providing other government services that are just as essential."

At the Medicaid Managed Care Congress this April 30-May 2, 2012, Pennsylvania, Nebraska, Georgia and Texas will be participating in the State Medicaid Directors Panel: Overcome State Budget Crises addressing the same issues that Illinois and many other states are missing. As a reader of this blog, when you register to join us and mention code XP1725BLOG, you'll receive 25% off the standard rate.

What do you think? What will be the biggest challenges to Illinois for cutting $2.7 billion from their Medicaid budget in one year?