Happy Holidays from Health Care -- From Policty to Practice

We're taking some much needed time off from our coverage of Health Care Policy to celebrate the season with our loved ones. We want to sincerely thank you for your readership, your comments and your participation.

Here are our top posts from 2009:

• Obama to Cut Medicare Advantage
• What does the public think about the proposed healthcare coverage?
• Senate produces another healthcare plan

We'll be back in January with more coverage.

We wish you Happy Holidays!

Medicare 'buy-in': A bargain or burden?

USAToday reports that buying into Medicare at 55 — an option that may be added to the Senate's plan to revamp the health care system — might not be such a bargain. Details of the plan remain secret pending analysis by the Congressional Budget Office, which will project its cost to those who might be eligible and the federal government. People ages 55 to 64 who are uninsured or paying high premiums in the individual market likely would be eligible. Most of those with employer-provided coverage would not.

Liberal Democrats backing the plan see it as a potential salvation for people approaching retirement with chronic diseases or medical risks. Sen. Sheldon Whitehouse, D-R.I., says it would be like "finally entering safe harbor after years of stormy seas."

Moderate members of the Democratic caucus have concerns, however. Sen. Ben Nelson, D-Neb., on Sunday called it a potential forerunner of a single government insurance plan for everyone. Sen. Joe Lieberman, I-Conn., appearing on CBS' Face the Nation with Nelson, said it could add to the federal deficit.

Learn more: Medicare 'buy-in': A bargain or burden?

Pressure is Coming down on Congress to Pass Healthcare Reform

This article in the Washington Post highlights how Vice President Joe Biden has warned Congress that if they do not agree on healthcare soon the opportunity for a "sweeping overhaul of the $2.5 trillion system will be lost for a generation."

Obama's team have been long pressing lawmakers to reach an agreement and to pass the bill. The bill has been passed by the House of Representatives but has struggled to reach 60 votes that the Democrats need. With each passing day that the bill is not passed the number of uninsured Americans increase.

What does the public think about the proposed healthcare coverage?

At the Health Affairs Blog, they reveal the results of a study done by Zogby International, where the online panelists were polled about they way they feel about certain coverages on the House and Senate's current bills for the healthcare reform.

They got public opinion on:
1) Financing of the healthcare reform
2) Employer Mandate
3) Illegal immigrants
4) Abortion coverage

Read the results here. Which of the four above do you believe is the biggest concern for the public option? Which one defiantly has to be focused on by the government? Which of the four above do you see as the biggest road bump into instating public insurance?

Complimentary Webinar: Assessing the Impact of Healthcare Reform on the Business of Medicare: An Interview with Gorman Health Group

December 15, 2009

2-3PM EST

Space is limited.
Reserve your Webinar seat now at:
https://www1.gotomeeting.com/register/504426600

Mention Priority Code: P1507W1BLOG

John Gorman, CEO, Gorman Health Group, along with Jean LeMasurier, Senior Vice President, Public Policy, Gorman Health Group will examine the current state of US healthcare reform, and its short and long term impact on Medicare plans including the financial, operational and strategic implications of the proposed bills.

About the Speakers:

Jean D. LeMasurier
Senior Vice President for Public Policy
Gorman Health Group

Jean LeMasurier joined Gorman Health Group after a 30 year career with the Centers for Medicare and Medicaid Services (CMS). Jean provides strategic planning and consulting services to Medicare Advantage Health Plans, Medicare Part D Prescription Drug Plans, drug companies and employers on programs under the Medicare Modernization Act.
Her areas of focus include health policy and health care reform and advising plans and employers on retiree options. Engagements include analysis of Medicare market opportunities, strategic advice on CMS legislative and regulatory requirements, audits and gap analyses to assure implementation of regulatory compliant programs.
Jean is also engaged in policy analysis, public speaking and educational and training activities.
As a senior CMS career official, Jean was responsible for the leading the $40 billion Medicare Managed care programs for many years, including serving as the Director of Policy and the Acting Director/Deputy Director of Operations and Regulatory Oversight. Jean also served as a Senior Advisor in the Employer Operations and Policy Group which implemented the employer provisions of the Medicare Modernization Act.
Jean also worked as a professional staff member on the Senate Finance Subcommittee on Health.

John K. Gorman
Chief Executive Officer

John Gorman is CEO of Gorman Health Group, a company he founded in 1996 (under its predecessor name, Managed Care Compliance Solutions) to provide Medicare regulatory compliance advisory services to healthcare payers. Under John’s leadership, Gorman Health Group has since emerged to beco

After registering you will receive a confirmation email containing information about joining the Webinar.

System Requirements
PC-based attendees
Required: Windows® 2000, XP Home, XP Pro, 2003 Server, Vista

Macintosh®-based attendees
Required: Mac OS® X 10.4 (Tiger®) or newer

Kansas citizens see cuts to Medicaid customer service

According to the Topeka Capitol Journal, the The Kansas Health Policy Authority has slashed $233,000. This accounts for almost 240,000 calls dealing with Medicaid for low income families and children. The Medicaid customer service call center will also be eliminated for providers as of February 1, 2010. All inquires will be fielded by email and mail

Do you find these kinds of cuts problematic to provider care? What other impacts will closing call centers for Medicare have?

‘Medicare Advantage’ at Issue in Senate

David M. Herszenhorn of The New York Times discusses the focus of today's senate debate with healthcare. He writes, the focus Friday will be on proposed reductions to Medicare Advantage, the privately administered plans that provide enhanced benefits but now typically cost the federal government more than traditional Medicare.

Further, "the Democrats, in the health care legislation, essentially seek to end subsidies for Medicare Advantage plans that cannot match or beat the cost of traditional Medicare."


Learn more: ‘Medicare Advantage’ at Issue in Senate

Aventis to pay N.C. $2.2 million as part of Medicaid settlement

Triangle Business Journal reports that Drug-maker Aventis Pharmaceuticals Inc. has agreed to pay $2.2 million to North Carolina for underpaying rebates to Medicaid for allergy medications.

The payment is part of $95.5 million settlement the company has reached with states and the federal government, according to North Carolina Attorney General Roy Cooper.

Learn more: Aventis to pay N.C. $2.2 million as part of Medicaid settlement

I Deserve Health Care Ad

After many submissions OFA and a panel of experts have finally chosen a winner for the Health Reform Video Challenge. If you haven't seen it yet make sure to check it out below. What are your thoughts on health reform?

Women's Insurance Amendment Set For Senate's First Health Bill Vote

As the Senate debates the health reform legislation, amendments are being advanced and Senators are reacting to the bill. Kaiserhealthnews.org reports that, "A bipartisan amendment to increase insurance benefits for women ... gets the first Senate vote Tuesday on health care overhaul legislation." The provision, co-sponsored by Sens. Barbara Mikulski, D-Md., and Olympia Snowe, R-Maine, "would require policies to include a variety of yearly screenings and was inspired in part by controversial recommendations last month that women undergo fewer mammograms and Pap smears to test for cancer." Mikulski said the amendment does not "mandate that you have a mammogram at age 40. What we say is discuss this with your doctor, but if your doctor says you need one, my amendment says you are going to get one." According to the AP, "The Congressional Budget office said the amendment would cost $940 million over a decade."

Learn more: Women's Insurance Amendment Set For Senate's First Health Bill Vote

Senate produces another healthcare plan

The Democrats have introduced their proposal for the new healthcare system that would be available to all Americans. Their proposed plan would insure 31 million more Americans while reducing the budget. The total cost for the overhaul would be $848 billion, but also decrease the deficit by $130 billion.

The goals they've outlined for the plan would:
-Impose new regulations on insurers
-Cover 31 million extra Americans
-Introduce new benefits for Medicare

Republicans are opposed to the idea and see it as a way to increase taxes and insurance costs. Read the full New York Times article here.

Senate Dem leader bringing out new health bill

The Associated Press reports that the Senate's top Democrat is poised to outline a new health care bill designed to meet President Barack Obama's goal of expanding coverage without adding to the deficit.

Majority Leader Harry Reid of Nevada met Wednesday morning at the Capitol with Vice President Joe Biden to go over the game plan on health care. Crucial to the White House and Reid is winning over reluctant moderate Democrats.

Reid wants to bring his roughly $900 billion, 10-year health care remake to the floor in the next few days. The Democratic leader has spent weeks melding bills from the Senate health committee and the Finance panel. Democrats plan to meet behind closed doors to discuss the bill in late afternoon Wednesday.

Reid's office alerted health care allies that Senate Democratic leaders planned to unveil the bill at a Capitol Hill event at 12 noon Thursday.

Senate Dem leader bringing out new health bill

Former Senator Tom Daschle's Keynote Speech at MDRP

Tom Daschle, Former Senator, recently spoke at MDRP. As Senate majority and minority leader from 1994 to 2005 and the architect of President Obama's healthcare plan, he is an outspoken advocate for reform, and a well-connected voice between the healthcare industry and Washington policy-makers. His recent book, Critical: What We Can Do About the Healthcare Crisis, offers exciting new solutions on changing America's healthcare system providing the framework for Obama's plan. Watch Part 1 of his keynote speech below!

Government healthcare versus current state's laws

In an interesting article at the LA Times, they look at how the proposed bill for healthcare reform could actually harm some of the consumer rights states have put in place to protect them when it comes to insurance. For instance, in California, they require that insurance companies cover second surgical opinions, and breast reconstruction surgeries for breast cancer patients. This could affect consumers when insurance companies are allowed to sell insurance policies across borders.

According to the article, said Kris Haltmeyer, Blue Cross Blue Shield policy director, believes that establishing a minimum level of benefits at the federal level could mitigate some states receiving health insurance plans that aren't completely up to par.

What do you think about this? Will insurance companies being allowed to sell policies across state borders affect the quality in some places? What does this mean for the consumer?

Forbes: Medicare Part D: A Health Care Success Story

Mary Grealy writes that among the pitfalls America has seen with Medicare, there may be one beacon of hope with Medicare Part D. Grealy says, the landmark legislation that created Part D was passed by Congress in 2003 with bipartisan support. It was the first major overhaul of Medicare in 35 years, and it offered a much-needed benefit to seniors struggling to pay for their prescriptions...Far from leaving seniors with limited options, Part D allows Medicare enrollees to choose the prescription plan that most closely aligns with their needs. In the Medicare Today survey, 80% of participants say their plan covers all the medicines their doctor prescribes. The numbers were even higher in New York and Florida.

To read more about the success of Medicaid Part D, please visit Grealy's article.

Medicare Part D: A Health Care Success Story

Healthcare reform and abortion

Now that healthcare reform is in full swing, we're sure to see several issues that votes and opinions collide on when it comes to coverage. Currently the House and the Senate are looking at if and how abortion should be covered. Should this be dropped from the health bill, it may leave many women with private insurance at risk for their insurers to drop abortion coverage as well.

Stupak’s amendment prohibits any public health insurance option from offering abortion coverage except for cases of rape, incest and the life of the mother. It also prohibits individuals from using tax credits and subsidies to buy private insurance with abortion coverage from companies taking part in new health insurance exchanges.

Read more about the debate about including health care in the healthcare reform bill here. What do you think? When and how should the government choose to cover abortions? What impact will this have on the ruling of Rowe vs. Wade?

Obama's Health Care Bill Narrowly Passes in House

President Obama praised the House yesterday for narrowly passing his healthcare bill. The count was extremely close - 220 to 215 with only one Republican voting yes. The $1.2 trillion bill is aimed at expanding coverage to 36 million uninsured Americans and the plan will also cut spending by $400 billion over the course of a decade. Take a couple of minutes to view the coverage by CBS News below.

WSJ: How would you recommend we improve the health care system?

The Wall Street Journal asks, "How would you recommend we improve the health care system?" to their Health Care Analysis group.

Given that health costs are constantly increasing, we definitely need to reform the health care system -- but if we are not careful how we fix it, we could end up with a lot of unintended consequences. Current projections show that the reform bill in its current state would increase costs to many people who have insurance now.

The main reason is the current bill only spreads costs around. We need an effective means to lower costs.

How would you recommend we improve the system? How will you get Congress to implement your recommendations?

NYTimes: Costs at Urban Hospitals May Get Extra Scrutiny in Health Care Overhaul

Anemona Hartocollis of The New York Times writes today that a provision in the House health care bill, included over the objections of hospitals from New York and other cities, would order a neutral group, the Institute of Medicine, to conduct a two-year study of regional variations in Medicare spending. The bill requires the institute to recommend changes that would reward “quality and value,” and those changes would take effect automatically unless Congress objected by May 31, 2012.

The recommendation that New York hospitals fear most is that Medicare should reduce payments to areas where costs grow fastest and increase payments to those who are best at controlling them. They argue that some of the most efficient hospitals are in affluent and rural areas that do not face the same challenges, including higher poverty and cost of living, as New York.

As more urban hospitals undergo the "knife" moreso than their rural counterparts, do you think this move is fair?

Costs at Urban Hospitals May Get Extra Scrutiny in Health Care Overhaul

House unveils healthcare bill

The New York Times recently took a look at the bill Nancy Pelosi and the House. Their package includes a $894 billion package that will not add to the national debt. It will cover an additional 36 million by expanding Medicaid. The House had previously worked on three bills this summer, and this is a combination. Now it is up to Senator Harry Reid to combine the bills set out by the two parties. Read more here.

Republicans Take Aim at AARP

This article in The Wall Street Journal blog discusses how Republicans are taking aim at AARP by saying that they want an overhaul because its business arm would benefit from legislation in both the House and the Senate. Republicans mentioned in a recent hearing that support for the proposed cuts would lead to benefit cuts for seniors.

AARP membership has both fallen and risen in the past year so it is hard to see if more people are being turned away or drawn to it over this period.

Senate introduces opt-out bill for state healthcare

According to Salon.com, the Harry Reid announced today that the Senate's bill for healthcare reform includes the option for states to opt out of public insurance. Many believe this is one of the keys for the healthcare reform to survive the legislative process. The House still has to introduce their bill, is still weighing their options, which includes one that pays doctors and hospitals on a fee schedule based on Medicare rates, or one that negotiates directly to set its own prices, much like private insurers do. Read more about the current healthcare reform situation here.

Medicare changes coming into focus as health care overhaul moves forward

The Chicago Tribune reports there's growing agreement among policy experts about how Medicare will be affected.

The 10.4 million beneficiaries with private insurers' Medicare Advantage plans will still get coverage at least comparable to regular Medicare, but some will see fewer extra benefits or higher out-of-pocket costs.

For most of Medicare's 45 million beneficiaries, an overhaul will improve coverage by beefing up drug benefits, preserving access to physicians, paying for more preventive care and putting Medicare on firmer financial footing.

For more information about the Medicare policies, please visit the original article here.

Medicaid, Medicare Make Easy Marks for Fraud

Greg Burns of the Chicago Tribune writes that in a troubled economy, cheating Medicare and Medicaid just might be the easiest money anywhere. Recent reports about violent criminals and organized-crime figures putting aside their drug-running enterprises to pose as health care providers only scratch the surface.

Burns continues, some health care fraud is sophisticated and subtle. Some results in bloody crime scenes as hardened criminals enter the racket.

"If you're going to defraud somebody, the government is a reliable payer," said John Blum, a law professor at Loyola University Chicago who specializes in health matters. "Eventually, people like me catch up to you."

Read more about Burns' thoughts on Medicaid and Medicare fraud on his original post here.

Barack Obama's health care plan could get support from second Republican senator

All eyes on a possible second Republican senator who may cast her vote in support of President Obama's healthcare plan. Susan Collins joined fellow moderate Republican senator Olympia Snowe, in endorsing the goal of far-reaching changes in the US health care system. Collins said, "My hope is that we can fix the flaws in the bill and come together with a truly bipartisan bill that could garner widespread support."

The bill will be melded with a Senate Health Committee version before being debated in the full 100-member Senate, where Democrats will need all of their 60 votes to prevent a Republican filibuster.


Barack Obama's health care plan could get support from second Republican senator

Complimentary Webinar Today: Overcoming the Challenges of Government Pricing, Compliance Reporting and Medicaid Rebate Processing

Thursday, October 15
2-3PM EST
Space is limited.

Reserve your Webinar seat now at:

https://www1.gotomeeting.com/register/286708561

Priority Code: P1458W1BLOG/TWITTER

About the web seminar:
All pharmaceutical product manufacturers who sell to various agencies of the federal government and/or who participate in Medicaid, 340B, Medicare or other public sector reimbursement programs face significant requirements and challenges with respect to their government-mandated pricing calculations and compliance reporting processes. Huge penalties and fines can be levied for miscalculating or incorrectly applying the various government price types to government-contracted sales and/or for compliance reporting mistakes.

The Seminar will address the complexities and challenges associated with automating Government Pricing and Medicaid Rebate system(s) as well as the pros and cons of using a packaged-software approach versus a custom-development approach. An overview of a leading-edge enterprise solution, developed as a fully-integrated component of the SAP® Enterprise Resource Planning (ERP) System, will be presented, accompanied by a live software demonstration and followed by a Question & Answer discussion of the issues.

What you will learn:
• An appreciation of the historical and legal background and context for the government-mandated price calculations and compliance reporting requirements;
• An understanding of the various price types that must be calculated, used in sales transaction processing and reported under each corresponding government program;
• Why automating and managing these processes using a packaged solution, based upon a fully-integrated enterprise architecture, is the lowest risk and lowest Total Cost of Ownership (TCO) approach;

About the speaker:

Sanjay Shah, C.P.A., is the President/CEO and Chief Solution Architect of Vistex, Inc., a global SAP Software Solution Partner.

Prior to founding Vistex, Mr. Shah spent several years as a Platinum Consultant in SAP America’s Professional Services Organization and in SAP AG’s Product Development Organization. That experience provided him with a comprehensive and unique understanding of the functionality gaps in SAP’s “core” offering as well as SAP’s product development strategy. Mr. Shah also worked in finance/accounting management at a major global manufacturing company.

Obama Calls for Bipartisan Support for Healthcare Reform

Obama recently stated in his weekly video address that we are seeing "unprecedented consensus" from doctors, nurses, hospitals, and drug manufactures that healthcare reform is no longer a Democrat issue or Republican issue but an American issue that requires an immediate solution. In the address he mentions several new politicians who have his support for the new healthcare reform like Mayor Michael Bloomberg and California State Governor Arnold Schwarzenegger. Take at the video below provided by the Associated Press. What's your take on it?

Vote expected today for the Senate Financial Committee

Today is the day that the Senate Financial Committee is expected to vote and pass on bill that will overhaul the current American health care system. After the Senate Financial Committee has passed the bill, then it will be in the hands of the Senate Majority Leader Harry Reid to combine the bill passed by the Senate Financial Committee and the bill already approved by the Senate Committee on Health, Education, Labor and Pensions.

If the revised bill then picks up 60 Democratic votes in the Senate, Reid needs 60 votes to overcome a possible Republican filibuster. Read more about the vote here. Follow the vote via Live Blogging at the New York Times.

Where does your state fall in healthcare rank?

This post in the LA Times highlights a healthcare quality rank conducted by the Commonwealth Fund. The results of the new ranking shows that these states are doing a decent job in terms of the cost of healthcare, quality of healthcare, access to healthcare and overall outcomes related to healthcare: Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire. California which ranked 40th a couple years back now moved up to 31, quite a move. Take a look at the ranks here and let us know if anything surprises you.

Cost of healthcare package expected to be released today

According to Fox News, the Senate Finance Committee is waiting on a cost projection from Congressional Budget Office for the official numbers on how much the current health care package awaiting vote in the Senate would cost. Tax experts believe the bill will cost $121 billion over the next few years, which is $29 billion more than originally thought. Read the full article here.

Doctors In Agreeance with Obama's Health Care Pitch

This post on NBC New York discusses how President Obama made his healthcare pitch today in front of doctors and nurses that he believes understands firsthand the need for a major overhaul of the current healthcare system.

Obama mentioned to the 150 doctors wearing white lab coats at the Rose Garden:

"Nobody has more credibility with the American people on this issue than you do."

Obama's healthcare reform plan has been hugely unpopular among many people. He has also denied that his plan will call for taxes to be raised on the middle class.

Convene at the health plan industry’s first congress of 2010

Join us at the start of the New Year for the health plan industry’s first congress of 2010. From operations and revenue drivers to marketing and competitive benchmarks, the 7th Annual Medicare Advantage Congress is your blueprint for optimizing the performance of your health plan. It’s a golden opportunity to interact with your colleagues, get insight into what your competitors are doing, and walk away with executable strategies for protecting profitability and driving growth.

This year’s program includes provocative Keynote Sessions delivered by the industry’s finest leaders:

Health Care Reform: Perspectives and Insights from Senator Tom Daschle and Dr. Mark McClellan:
• Tom Daschle, Former Senate Majority and Minority Leader
• Dr. Mark B. McClellan, Director of the Engelberg Center for Health Care Reform, BROOKINGS INSTITUTION

Creating an Accountable Medicare Managed Health Care System:
• Robert Berenson, MD, Institute Fellow, Urban Institute

Come together at The Medicare Congress to share the tools needed to improve quality, maximize revenue, ensure compliance, and improve operational efficiency in order to attract and retain members, protect and grow your organization’s Medicare market share, and improve clinical outcomes. With all the uncertainties coming our way, now is the time to prepare for what the future holds.

We look forward to seeing you in Washington, D.C. next January.

States Report Sharp Increase in Medicaid Enrollment and Spending Amid Worst Recession in Decades

The Kaiser Family Foundation reports that the number of people on Medicaid and state spending on the program are climbing sharply as a result of the recession, straining state budgets and pressuring officials to curb costs despite increased financial help from the federal government, according to a survey released today by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured.

The annual 50-state survey of state Medicaid officials finds that these trends are expected to continue well into the 2010 fiscal year, with the slumping economy contributing to the loss of jobs, private health coverage and state tax revenue at a time when more people are seeking help from public programs.

Across the country, states estimate Medicaid enrollment grew by an average of 5.4 percent in state fiscal 2009, the highest rate in six years, surpassing the projected 3.6 percent increase at the start of the year. Similarly, total Medicaid spending growth averaged 7.9 percent in FY 2009, the highest rate in five years, well above the 5.8 percent projected growth. For FY 2010, states estimate Medicaid enrollment will grow by 6.6 percent over FY 2009 levels.

The survey finds that, based on initial legislative appropriations, Medicaid spending across states is expected to grow by an average of at least 6.3 percent in fiscal 2010. But officials in three-fourths of the states are concerned that those appropriations will not be enough, leading to more budget shortfalls and more pressures to trim services and spending.

“The recession has shown the importance of Medicaid as a safety net for millions of Americans who have lost health coverage when they have lost their jobs,” said Diane Rowland, executive vice president of the Kaiser Family Foundation and executive director of the Kaiser Commission on Medicaid and the Uninsured. “But it also has shown the challenges for states of maintaining coverage when state revenues drop during times of economic crisis.”

American Recovery and Reinvestment Act (ARRA) Provides Some Fiscal Relief

The fiscal picture would have been much worse if not for the availability of increased federal Medicaid funding through the American Recovery and Reinvestment Act (ARRA).

The federal money, which will provide an estimated $87 billion to states through enhanced federal matching funds through December 31, 2010, helped all states, many of which are facing significant state budget shortfalls. States used the funds to address overall budget and Medicaid budget shortfalls, avoid cuts to providers, benefits and eligibility and address the recession-driven growth in enrollment.

ARRA also helped protect Medicaid eligibility. In order to qualify for the money, states had to ensure that their Medicaid eligibility standards, methodologies and procedures were no more restrictive than they had been on July 1, 2008, seven months before the enactment of the stimulus law. That requirement prompted 14 states to reverse new eligibility restrictions and five states to abandon planned new restrictions.

Nearly Every State Implemented Measures To Control Medicaid Spending

Even with federal relief, nearly every state implemented at least one new Medicaid policy to control spending in fiscal 2009 and 2010, the survey finds.

More than any other policy area, provider payment rate changes serve as a barometer of state fiscal conditions. Thirty-three states cut or froze provider rates in fiscal 2009, well above the 22 that had been expected to do so. Even more states (39) are slated to cut or freeze rates for FY 2010. And several others are considering it.

Rate cuts can jeopardize provider participation and inhibit Medicaid enrollees’ access to needed care. They bite particularly hard because some states have not fully restored provider rates to levels seen before the round of cuts in the last economic downturn from 2001 to 2004.

Several states also cut covered benefits or imposed new utilization controls for existing benefits, most commonly targeting dental and vision services for adults. Ten states reported benefits restrictions for fiscal 2009 and 15 reported them for fiscal 2010. California, Michigan and Utah instituted multiple benefit cuts.

Pressures Illustrate Challenges And Opportunities For Medicaid As A Cornerstone Of Health Reform

The reliance on Medicaid during times of economic crisis, and the fiscal pressures that follow, spotlight both the challenges and opportunities for the program in health reform efforts. Several legislative proposals in Congress include measures that would expand Medicaid to cover more low-income people as a platform for larger reform.

Because many states have already used Medicaid as a vehicle to expand health coverage, Medicaid officials expressed general support for an expanded role for the program in health reform. Even in these tight fiscal times over half of the states in FY 2009 and FY 2010 are moving forward with efforts to improve eligibility standards or the streamline application processes in a bid to cover more people. Among the states implementing the broadest reforms and eligibility expansions are Colorado, Maryland, New York, Oklahoma and Wisconsin.
However, state Medicaid officials did register concerns about health reform, too, reflecting current state budget situations. Three-quarters of states expressed concern that Medicaid eligibility expansions, mandated minimum provider rates and new administrative costs – depending on how they were financed -- could add to state fiscal woes.

States Report Sharp Increase in Medicaid Enrollment and Spending Amid Worst Recession in Decades


Today's blog post was sponsored by The Medicaid Drug Rebate Program Summit

Event: http://bit.ly/BuykF
Brochure:http://bit.ly/iG6TT
Register: http://bit.ly/KnBae

Most Americans are Willing to Fund Healthcare Reform that Works

A recent telephone survey poll conducted by Thomas Reuters found in this post on Reuters highlights that there is an underlying strong belief that Americans are entitled to the best healthcare, but there is skepticism that the government can deliver that. According to the survey, 63% are willing to pay for healthcare reform, but only 35% believe that Obama's reform agenda will lead to better service, and 41% believe that it will lower costs.

The survey shows that most Americans are ready to pay extra taxes to ensure that the country receives the best healthcare possible. What's your take on it?

E-Records Get a Big Endorsement

Steve Lohr of the NYTimes reports today that North Shore-Long Island Jewish Health System plans to offer its 7,000 affiliated doctors subsidies of up to $40,000 each over five years to adopt digital patient records. That would be in addition to federal support for computerizing patient records, which can total $44,000 per doctor over five years.

The federal program includes $19 billion in incentive payments to computerize patient records, as a way to improve care and curb costs. And the government initiative has been getting reinforcement from hospitals. Many are reaching out to their affiliated physicians — doctors with admitting privileges, though not employed by the hospital — offering technical help and some financial assistance to move from paper to electronic health records.

This endorsement is a huge step in the movement toward e-records for hospitals. As medical offices look to reduce paper consumption and human error, e-records are getting more attention.

For more information, please visit the article mentioned in its entirety.

E-Records Get a Big Endorsement

Mandate minus price controls may increase healthcare costs

The Los Angeles Times reports that many experts believe an insurance mandate is vital to a healthcare overhaul. With everyone in the system, the nation's medical bill could be spread more broadly, alleviating pressure on those who have insurance to pay for those who don't. All of the major healthcare bills would penalize people who do not get health insurance.But Democrats have shied away from regulating premiums in the face of charges from business leaders and Republicans that controlling what insurers charge would be meddling too much in the private sector. As a result, while states have long supervised what companies charge for mandated automobile and homeowners insurance, the idea has been largely banished from the healthcare debate.

What do you think about the lack of price controls within the healthcare bill? Will this have a negative effect on healthcare costs for Americans? We'd like to hear your thoughts.

Mandate minus price controls may increase healthcare costs

White House Address - Eliminating Waste in Medicare Advantage Will Not Affect Benefits

Today the White House uploaded a new video on YouTube in which Mike Hash of the White House Office of Health Reform gets into deeper detail on how reform would eliminate wasteful subsidies to insurance companies in the Medicare Advantage program, without hurting benefits or care and leaving the trust fund intact. Do you agree? Watch the video below.

The current state of healthcare reform -- Are you ready?

The proof is here - when providers share their expertise and put their heads together, you get lower costs and more quality. Accountable care organizations and medical home models stand to transform healthcare structure and costs and health plans need to act now to effectively integrate them into their benefit offerings. However, how health plans can effectively integrate these new models of care into their benefit programs and benefit from these cost savings remains at the center of “the cost conundrum”. Attend Next Generation Health Delivery to learn how to integrate innovative healthcare delivery models into value based benefit design. Participants walk away with:

• Insights from the latest Medical Home Model and Accountable Care Organization pilot programs
• Understanding of novel payment structures and implementation tools that make integration possible
• First hand experience from the those already benefiting from these new models including Capital District Physicians Health Plan, Priority Health, Goodyear Tire & Rubber, California Association of Physicians and Barbara Starfield, Johns Hopkins University.

Join us in Washington on the eve of reform as the government looks to tackle excessive spending head on and convene with other Healthplan reimbursement and benefit design professionals to prepare for change that’s coming to ensure sustainability and profitability in the years to come.

We'd also like to share a free web seminar on this topic with you:
Free web seminar: Leveraging Health: improving health status and bending the financial trend through value-based designs

Presented by: Cyndy Nayer, MA; John J. (Jack) Mahoney, M.D.; and Jan Berger, M.D., M.J. of the Center for Health Value Innovation

Date: Thursday, September 24, 2009
Time: 12:00 PM - 1:00 PM EDT

Find out more about the web seminar and register here:
http://bit.ly/TQ915
Mention Priority Code: P1455W1LIBlog



To become more involved with other professionals working in the next generation healthcare delivery field, join our LinkedIn Group!

Canadian Health Care Tops U.S.

Bloomberg news reports today that as the debate for universal health care within the United States continues, some opponents are basing false assumptions about the success of universal health care in Canada. In a study released by Organization for Economic Cooperation and Development says that Canadians live two to three years longer than Americans and are as likely to survive heart attacks, childhood leukemia, and breast and cervical cancer, according to the OECD, the Paris- based coalition of 30 industrialized nations.

Deaths considered preventable through health care are less frequent in Canada than in the U.S., according to a January 2008 report in the journal Health Affairs. In the study by British researchers, Canada placed sixth among 19 countries surveyed, with 77 deaths for every 100,000 people. That compared with the last-place finish of the U.S., with 110 deaths.

For more information about the success of health care in Canada, please click the Bloomberg article here.

Canadian Health Care Tops U.S. in Studies Showing Wait Worth It

Mobile Tools and Applications Can Help Patients Better Manage Their Health

According to this article in iHealthBeat which features research from the California HealthCare Foundation, mobile tools and platforms can help chronic disease patients manage their health at home or at other places.

The author of the report, Jane Sarasohn-Kahn, offers guidance to healthcare providers that are looking to promote these health tools and applications. Jane mentions that these health applications should:

• Allow input on a full range of patient health activities;
• Consistently monitor patient health status;
• Continuously adjust recommended health regimens based on health status;
• Interpret patient data according to individual treatment goals;
• Proactively communicate tailored health advice to the patient; and
• Repeat these steps as needed.

Take some time to read this informative report it is worth the read.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group.

Health care premiums on the increase

In the Business section of the New York Times, they look at how health care premiums are on the rise, and will continue to grow at steep throughout the next few years. According to the blog, the annual cost of a family policy is $13,375. This has doubled in the past decade. The prediction made in the blog is a family policy in 2019 will be $24,180. Click here for an in-depth look at what is predicted to happen to health care premiums over the next few years.

Report: Mobile Tools Can Improve Chronic Disease Management

Ihealthbeat.org reports today that mobile platforms and applications can help chronic disease patients manage their health care at home or elsewhere, according to a new report from the California HealthCare Foundation, Mobihealthnews reports (Dolan, Mobihealthnews, 9/10).

The report, titled "Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care," describes several online and mobile applications that can help patients actively participate in their care management (CHCF release, 9/9).

In the report, author Jane Sarasohn-Kahn offers guidance for health care providers looking to promote participatory health tools.

For more information, please click here: Report: Mobile Tools Can Improve Chronic Disease Management

AHRQ Takes a Look at E-Prescribing Issues

According tot his post on FierceHealthIT the AHRQ wants to know how many medical practices have successfully implemented functional e-prescribing systems and what factors hurt and help adoption.

The biggest problem that the Agency for Healthcare Research and Quality has encountered is that most e-prescribing systems do not have the same features, and so rolling out with a national system might be difficult. Also, pharmacies are having trouble with e-prescribing software and integrating it into workflow. Because of this, the AHRQ is planning to conduct a 2 year survey which will include physicians, medical directors, IT administrators, pharmacists and other relevant staff members at 110 organizations as participants.

Obama's Health Care Proposal -- Are American's Ready?

In last night's speech by President Obama on the state of American health care, he said that the US was the "only advanced democracy on earth … that allows such hardships for millions of its people." So how can we, working within the health care arena work to enhance the lives of our fellow citizens? What steps can we take to ensure that our insurance, medical care and preventative medicine offer the best tools for a healthy nation?

The President said his plan would meet three basic goals: provide more security and stability to those who have health insurance, provide insurance to those who do not have it, and slow the growth of healthcare costs.

Here are a few great articles that we've found discussing last night's speech.

• Obama's health care speech gets mixed reviews
• GOP banking on big gain due to President Obama's health care follies
• HMO shares rise after Obama health reform speech

The current state of healthcare reform -- Are you ready?

Are you ready for the Healthcare reform?

If a bipartisan agreement is not reached by October 15th, a republican filibuster is not possible and healthcare reform is a done deal with 50 votes in the Senate. With the democrats holding 58 seats, it is irrational to think some level of reform will not happen this year. While it is difficult to predict what the final bill will look like, every reform proposal currently under consideration mandates individual coverage and ends barriers to coverage for people with preexisting medical conditions. If no other policy reforms are included in the final bill, the ramifications for the health insurance business are still tremendous.

How will Health Plans survive this direct hit on their current business model?

Through the vital restructuring of the healthcare delivery models they currently employ and the Next Generation Healthcare Delivery event, scheduled for October 26-27 in Washington, DC. This is your best opportunity to convene with other health plan leaders from across the nation to evaluate and integrate innovative healthcare delivery models to ensure sustainability and profitability in the years to come.

How will Health Plans expand coverage to previously uninsurable populations and maintain profitability?

Traditional medical management has been maxed out, if health plans want to survive, it is essential that they act now to incorporate value-based benefit design and outcomes driven provider structures that ensure that health and wellness are managed effectively and efficiently. At the Next Generation Healthcare Delivery join your industry colleagues at this critical crossroads and reshape your current provider model by taking simple steps to obtain measurable improvements in clinical outcomes.

• Utilize Shared-decision making and let patient choice lead to the use of less costly healthcare delivery options
• Incorporate Medical Home Models to support a better organization of care and gain ideas to make it more effective
• Implement value-based tools to manage risk and help members make better choices
• Leverage ways that e-visits can increase access to specialty care while maintaining lower cost structures
• Develop a value-based integrated health care delivery system for the future

The moment is now. Register for Next Generation Healthcare Delivery and evolve your business into a true partner in care delivery and improved health outcomes!

Healthplans must integrate these delivery models by redesigning their benefits and reimbursement structures. The Next Generation Healthcare Delivery event provides you with the tools you need to implement and integrate new delivery models into your program benefit design for better health outcomes, higher member satisfaction, and a greater competitive advantage.

Through pilot programs, case studies, panels and roundtable discussions, our expert speaking faculty shares best practices and RESULTS on new delivery models and how they can improve healthcare quality while maximizing ROI.

Register today!


To become more involved with other professionals working in the next generation healthcare delivery field, join our LinkedIn Group!

Study on e-prescribing to start

According to Government Health IT, the Agency for Health Care Research and Quality will begin the collection of information in order to help other agencies with the transition e-prescribing. They will be in contact with pharmacies and physicians who already use the process to find out their troubles and find other reasons many doctors aren't making the switch. They'll then use this information to work with health care organizations to work towards the adoption and valuable approaches to increase e-prescribing. Read the full article here.


To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group.

Funding Recommendations for President Obama's Health Care Reform

More and more people are beginning to disapprove of Obama's health care reform as time goes by. Les Leopold detailed in this recent article in The Huffington Post a couple of things President Barack Obama could do to gain back the trust of the public with his health care reform. Les mentioned that Obama has yet tapped into the wealthy in order to fund the health care reform, even though Wall Street has received a bail out. Here are some things Les believes the president should consider:


1. Increases taxes on those who have adjustable gross incomes of over $1 million a year.
By collecting an extra 10 percent surcharge for health care from these wealthy returns we can collect an extra $140 billion per year.
2. Place a 90 percent windfall tax on Wall Street profits and bonuses.
If executives are able to still collect bonuses from banks that we own, then the majority should be taxed back to us. It is only fair.
3. Install a very small tax on each and every financial transaction on Wall Street.
A fee on Wall Street transactions would generate nearly $50 billion a year.

Do you agree with Les Leopold's recommendations?

Should Obama step in for heatlhcare reform?

In a recent article at Fox News, they look at the current state of health care reform in Congress. While the House and the Senate have been bouncing back and forth between different versions for weeks, many are now calling for President Obama to step in and give his own bill to Congress. Obama called for a new health care plan, but left it up to Congress to write the bill which subsequently left the Democrats divided on many issues.

Read the full Fox News article here. What do you think? Would a new health care system be more likely if President Obama stepped in and wrote the bill then presented it to Congress?

Democratic Health Care Bill Divulges IRS Tax Data

Declan McCullagh of CBS News writes that Section 431(a) of the (Democratic health care) bill says that the IRS must divulge taxpayer identity information, including the filing status, the modified adjusted gross income, the number of dependents, and "other information as is prescribed by" regulation. That information will be provided to the new Health Choices Commissioner and state health programs and used to determine who qualifies for "affordability credits."

Should this tax information be a factor when deciding health care for an individual or a family?

Democratic Health Care Bill Divulges IRS Tax Data

The Most Influential People in the Health Care System

According to this blog post on the NY Times, Modern Healthcare recently released its list of the 100 most influential people in the health care system. The top 3 people on the list, which should come as no surprise, are Barack Obama; Health and Human Services Secretary Kathleen Sebelius; and Nancy-Ann DeParle, director of the White House Office of Health Reform.

Who are some other very important people in the health care system that should be part of this list?

See the full list here.

Complimentary Web Seminar: Leveraging Health: improving health status and bending the financial trend through value-based designs

Title: Leveraging Health: improving health status and bending the financial trend through value-based designs

Date: Thursday, September 24, 2009

Time: 12:00 PM - 1:00 PM EDT

Register here: https://www1.gotomeeting.com/register/478763376
Mention priority code: P1455W1BlogTwitter

About the web seminar:
The unique challenges presented by the health cost inflation and the economic downturn are also the unique opportunities. The tension that exists in managing health care costs at this time is exactly the spotlight that was needed to change the dialogue on health care. In fact, even the questions we’ve been asking should be changed.

Instead of asking “How much will this cost,” the road to real, sustainable change lies in the question, “How much health will this dollar buy?” Value-based designs have consistently shown the results in improved health status and reduced financial strain. This seminar will showcase the learnings, the levers, and the dividends that accrue when a total health management approach is used to create sustainable results through aligned risks and rewards.

What you will learn:
- The definition and process of a value-based design, including the categories for improvement.
- The metrics of success and the time to achieve them.
- The data required to begin the shift to investing in value.
- The case studies of others who have implemented over 100 levers to drive change and improved health and economic outcomes.


Presented by:
Cyndy Nayer, President and co-founder
Center for Health Value Innovation

Jack Mahoney MD, Chief Medical Officer and co-founder
Center for Health Value Innovation

Jan Berger MD, Strategic Advisor
Center for Health Value Innovation

Joe Biden Announces Grants for Electronic Medical Records

According to this article in ABC News Vice President Joe Biden will announce nearly $1.2 billion in government grants to help hospitals transitions to electronic medical records. This is a way for for the White House to finally demonstrate how the taxpayers dollars will be spent. Joe Biden mentioned "With electronic health records, we are making health care safer, we're making it more efficient, we're making you healthier and we're saving money along the way."

The Vice President also made the argument that paper records take up too much time and is prone for medical errors. Electronic medical health records will definitely ease communication between physicians and patients in the near future.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group. You can also follow us on Twitter.

Town hall meeting on Healthcare

CBS News anchor Dr. Jon LaPook recently attended a town hall meeting with Senator Bernie Sandors met with residents of Vermont to see what the public believes about the current state of health care. Watch the video below to see what the citizens of Vermont believe about healthcare reform.


Watch CBS Videos Online

Healthcare Co-Ops-- a Real Alternative?

The LATimes reports that congressional Democrats and Republicans are already sparring over an alternative to government-run insurance -- a series of private regional cooperatives that advocates say could achieve the goals of a public plan without the potential for government interference.

One of the six -- Democrat Kent Conrad of North Dakota -- is the leading Senate proponent of co-ops. He and others point to cooperatives in Seattle and Minnesota that employ doctors and own their own healthcare facilities, giving them more control over costs and the quality of care. Conrad says that under his plan, the federal government would play no role in managing the co-ops, but would only provide seed money to help them get started.

It seems that under this plan, some could choose their healthcare just like they choose a new apartment. But what about regulation of fees and fights over which doctors to choose for their co-op?

Healthcare co-ops emerging as viable alternative

Baxter Loses Medicare Reimbursement Suit

This article in Forbes discusses how a US District Court has ruled against Baxter International Inc. stating that it is not entitled to a higher Medicare reimbursement price for its hemophilia drug Advate. Baxter has previously asked Medicare to reclassify the drug so that reimbursements would increase because according to Baxter its Medicare reimbursement prices were less than the drug's sale price. Medicare's reasoning for not reclassifying the drug was that Advate was put into the "multiple drug source" category because it reached the market in the summer of 2003, about two months before the change in regulations took place.

If you'd like to join a group of professionals in the MDRP field, join our Medicaid Drug Rebate Program LinkedIn Group!

Patient compliance would cut healthcare expenditure

According to Fierce Pharma, medication compliance would save the government $290 billion a year in health care expenses, which is a total of 13% overall savings. The article suggests that the government look into a compliance push, as many of the medications that are not taken as prescribed are for chronic diseases. Read the full article here.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group. You can also follow us on Twitter.

White House Backs Away from Gov't-Run Insurance

Andrew Zajac of The LA Times reports that the Obama administration signaled Sunday that it was on the verge of abandoning a government-run insurance option in its healthcare overhaul -- a bow to political reality and a big win for insurers.

Health and Human Services Secretary Kathleen Sebelius told CNN's "State of the Union" that a public option is "not the essential element" of healthcare overhaul, but that lowering insurance costs and preventing insurers from dumping customers for preexisting conditions or for exceeding coverage caps are must-haves.

Should the Obama Administration stay out of the healthcare insurance business, or should privatized insurance be the pathway towards better healthcare?

White House backs off public healthcare option

Obama Makes his Case on Healthcare at Town Hall

As we wait and see what will happen over the course of the next week when Obama makes several appearances to convince the American public that his proposed plan will benefit them, make sure to check out the live-blogging being done by David Stout of the NY Times. So far President Obama has mentioned that Americans spend roughly $5,000 to $6,000 more on healthcare than people of other advanced countries. Check the NY Times blog to see live updates of his town hall meeting.

Survey Results Prove High Medical Fees are Common

According to this article in the NY Times results posted from a survey conducted by America's Health Insurance Plans show that show that fees charged by doctors and hospitals are astoundingly high when comparing Medicare payments to payments private insurers pay.

The article gave an example of how a patient in Illinois paid $12,712 for cataract surgery when Medicare pays $675 for the very same procedure. Legislation that is being passed in Congress right now would require insurers to disclose to patients possible out-of-network costs. This is sparking serious debate in Obama's proposed health care plan in which we are seeing decreasing approval levels.

Obama to Hold Town-Hall Meetings to Face Growing Concerns from Democrats

This latest article in The Wall Street Journal blog discusses how President Barack Obama will hold three local town-hall meetings in order to convince the American public that his new health insurance plan will benefit them.

Obama will focus on emphasizing how legislation would help solve these three problems: the practice of denying insurance coverage to those with pre-existing illnesses, keep people from losing insurance coverage if they get sick, and protecting Americans that face high out-of-pocket costs. Republicans already favor two of three changes Obama proposes, but we will see how Democrats will view these changes shortly, as they have already voiced their concerns.

Electronic health records promote health

According to Web MD, a study recently concluded that patients who are receiving electronic reminders will stay healthier and possibly lower health care costs. Electronic health records kept for 421 people with details such as physician visits, laboratory and pharmacy data in order to monitor the effects of cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes. All of the doctors included in the patients care were connected through the electronic health records, which proved that knowledge about the complete treatment of the patients could lead to lower medical costs and improved heatlh. Read the full article here.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group. You can also follow us on Twitter.

Next Generation Health Care Delivery

Obtain the tools you need to implement and integrate new delivery models into your benefit design. Next Generation Healthcare Delivery offers unparalleled access to industry leaders piloting models that are disrupting AND improving healthcare outcomes. Health Plan Clinical Leadership can’t afford to miss out on this result driven discussion of the latest developments in health care delivery.

Improve optimal healthcare delivery to improve quality, compliance and cost structures

Medical Home Model
Evaluate to determine appropriate payment structures and methods
Retail & Specialty Clinics
Utilize Alternate venues of care for better health outcomes and decrease hospitalizations
Medical Tourism
Integrate coverage into plan benefits to reduce overall costs and maintain quality
Online Physician Consults & Home Health
Implement payment structures to ensure provider accessibility and cost transparency

To become more involved with other professionals working in the next generation healthcare delivery field, join our LinkedIn Group!

A CEO's view of health care

At American Public Media, the Kaiser Permanente CEO George Halvorson, about what universal healthcare needs in order to become a reality. This current reform is focusing on cost savings while still providing a high quality, affordable care. Health care also needs to work on taking better care of the people in public.

Halvorson also looks at what is needed to make healthcare available for all. Medicare needs to be available to all low income people, and those in the middle income bracket need to have the option of subsidized care. Its also key for communication to increase between all healthcare providers to provide better care for all.

Read the whole interview here.

Obama Welcomes Drug Lobby to White House Table

Tom Hamburger of the LATimes writes, "the pharmaceutical industry, once condemned by the president as a source of healthcare problems, has become a White House partner." Billy Tauzin, once a target for the President during his campaign has "Tauzin has morphed into the president's partner. He has been invited to the White House half a dozen times in recent months. There, he says, he eventually secured an agreement that the administration wouldn't try to overturn the very Medicare drug policy that Obama had criticized on the campaign trail."

Read the article, to find out more about how Tauzin is influencing the President's healthcare decisions.

Obama gives powerful drug lobby a seat at healthcare table

An Alternative to Obama's Healthcare Reform

Obama has seem much opposition to his proposed healthcare reform. Here in The Ithaca Journal Bob Yates suggests an alternative to Obama's healthcare reform. Bob suggests that instead of setting up a new plan that would be cheaper than private plans but yield high taxes, we should open up Medicaid and Medicare to everyone and allow people to buy into Medicaid which is on average $8,000 a year.

He also suggests a dollar-for-dollar credit on medical spending on everything. While this seems like a great alternative, is it really feasible?

Portable health records

According to BNET Healthcare, many companies are trying to find a way for their employees to create a portable health record. They're turning to the company Dossia to help them do it. Some of the companies investing in this are AT&T, Applied Materials, BP America, Cardinal Health, Intel, Pitney Bowes, sanofi-aventis, and Abraxis Bioscience. Both the employees of this company and the general public would benefit from portable health records as the can help doctors provide better care because of the knowledge of their background. The article also points out that many companeis are intrested in portable heatlth record, but many companies are slow to jump on the offerings of Google and Microsoft.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group. You can also follow us on Twitter.

Baxter comes to settlement in Illinois Settlement

According to Consumer Affairs, the State of Illinois and Baxter have come to an agreement over a dispute where the company inflated the wholesale prices used in setting the rates for Medicaid reimbursements. The case was settled for $6.8 million and those funds have already been placed in the General Revenue Fund to pay Medicare bills. Read more here.

Government Run Healthcare

According to Thomas DiLorenzo's post in the Ludwig von Mises Institute blog the more money we have spent on government-run healthcare in the past, the less healthcare we have gotten in return. He mentions that since there are no profits, there is no rewarding system that penalizes for bad performance and encourages good performance. Thomas notes that the federal government is actually doing the opposite, giving higher budgets to those hospitals that are failing in performance and reducing budgets for those that are performing well. Here are some examples Thomas including in his post from a NY Times article entitled "Full Hospitals Make Canadians Wait and Look South"

* A 58-year-old grandmother awaited open-heart surgery in a Montreal hospital hallway with 66 other patients as electric doors opened and closed all night long, bringing in drafts from sub-zero weather. She was on a five-year waiting list for her heart surgery.

* In Toronto, 23 of the city's 25 hospitals turned away ambulances in a single day because of a shortage of doctors.

* In Vancouver, ambulances have been "stacked up" for hours while heart attack victims wait in them before being properly taken care of.

* At least 1,000 Canadian doctors and many thousands of Canadian nurses have migrated to the United States to avoid price controls on their salaries.

What's your take on socialized healthcare?

Would it be smart to tax unhealthly food?

Melissa Healy has an article in the LA Times looking at the dramatic increase in US obesity and its effects on the current healthcare reform. Obesity in the United States rose from 18.3% in 1998 to 25% in 2006. This has increased government healthcare spending to over $40 billion a year. Healy suggests that it might be beneficial to go down the same road with unhealthy food as was done with cigarettes a few years ago, heavily tax that which is not good for you. Tax the foods to change the way people eat, and increase the taxes 10-30% and use the taxes received to pay for the heatlhcare of the obese. It would also be wise to increase tax subsidies on foods that are healthy, such as fruits and vegetables. What do you think?

What's the deal with the Obama health care plan? Should small business support it?

Steve Strauss of USAToday answers this question in his recent column with, "Small business may have more at stake in this health care debate than any other constituency. Consider: According to a report by the U.S. Public Interest Research Group, roughly 46 million Americans are without health insurance, and of those, more than half — 26 million — are small business owners, employees and their dependents."

What can it mean for America's small business owners if/when the healthcare bill is passed regarding the cost of healthcare?

Strauss answers:

Now, what about this so-called mandate requiring small business owners to provide health insurance or face a government fine? That is more troubling. Under the House measure, employers with payrolls of more than $400,000 a year will be required to provide health insurance or pay an 8% penalty. Businesses whose payroll falls between $250,000 and $400,000 a year would pay a lesser penalty. Businesses with fewer than $250,000 in payroll would be exempt. A Senate version would exempt employers with fewer than 25 employees, and the fine for bigger companies not complying would be $750 fine per employee per year.

Do you think that healthcare reform is worth it for small businesses? Will small business owners suffer more with the mandates? We'd like to hear your thoughts.


Ask an Expert: The good, bad of Obama's health care plan

Obama's healthcare reform

President Obama realizes the nation is not sure about his proposed $1 trillion overhaul of the medical system. He believes that this is the only way for economic recovery to be possible. He believes that our economy could worsen if the overhaul is not completed soon, and that many Americans would continue to be hurt financially. Obama urges Congress to vote in early August to solve this problem as soon as possible because he believes that by controlling cost, the deficit of America and its citizens can be controlled. Read the full article at the New York Times here.

Governors look at new Obama healthcare plan with concern

In an in-depth look at the current state of Medicaid reform from Obama in the New York Times today, they divulge that many policy makers are concerned about the new Medicaid plan that will cover any non-elderly person who is living at 133% or below the poverty level. This translates to an income of $29,300 for a family of four. The Republicans express disapproval, but are yet to come up with an alternate plan. State governors also meet and have expressed concern as to how they'll cover these new plans with dwindeling budgets and no aid from the government. Read the whole story on opposition to the Obama plan here.

Intel and General Electric Plan to Add More Connectivity Options to Intel Health Guide

According to this article in eWeek Intel and General Electric will invest roughly $250 million over the course of the next five years to develop and improve IT technologies in the Intel Health Guide to better aid linking patients to their physicians and caregivers.

The improved system will allow patients to directly connect with their physicians via high-speed broadband and residential phone services. Louis Burns, vice president and general manager of the Intel Digital Health Group mentions, "We believe that deploying technology in the home can help pave the way for a more personalized, cost-effective health care system and we will continue to innovate and develop products that achieve this."

It will be interesting to see how new technology and improvements to the IT infrastructure will pan out over the next couple of years.

To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group.

Increasing funds to Medicaid

Forbes looks at the steps Obama is taking towards ensuring more Americans have health insurance. He would like to stop Medicaid privatization, and has already started off his term by increasing the number of children insured by Medicaid. On Tuesday, the House Democrats introduced a bill that would give Medicaid $438 billion over the next decade. Read the full article on Obamacare here.

Non-compliance, requests for generics on the rise, says survey

Matthew Arnold of Medical Marketing & Media reports that, physicians say patient compliance is getting worse, and they're hearing more requests for generic or OTC alternatives to prescribed medications as the economic malaise takes its toll, according to a Pri-Med survey.

The Pri-Med survey used 473 respondents with 70% said they are hearing patients increasingly request generic or OTC alternatives, and 68% said they've noticed an increase in non-compliant behaviors with regards to medication usage among patients. More than half said they're seeing changes in patient payment, such as increased delinquencies or requests for payment plans, and 88% are seeing changes to patients' appointment behaviors, including increased cancellations and refusals of tests or screening procedures.

Physicans say that they are devoting more time to phone consultations and low-cost alternatives to help serve their patients needs.


To network with health plan and pharma professionals involved in medication and treatment compliance initiatives, join our LinkedIn group.

Key changes needed for Medicare reform

According to a new article at Reuters, they believe the first steps in reforming healthcare have begun. Pharma Research and Manufacturers of America have agreed to cost savings measures as well as hospitals accepting Medicare cuts. The article then goes on to look at two other things that would be critical to Medicare reform: linking doctors pays to improving patients health and boosing the payments for primary care. Read the full article here.

Access to CMS Rebate Operations and Policy teams at MDRP Summit

Are you looking for...

• Access to CMS staff?
• Responses to your questions from CMS?
• How to obtain correct policy decisions from the proper individuals at CMS in a
timely manner?
• Clarification on how to handle specific issues and obtain clear guidance from CMS?
• Insight on CMS' position on chaining versus stacking?

Join over 400 of your industry colleagues to have frank discussions with the CMS Rebate operations team to clarify current data frustrations, policy updates and requirement updates at IIR’s MDRP Summit, so Bring Questions on Current CMS Rebate Data, Operations and Technical/Systems Updates to discuss with:

• Tamara Bruce, Technical Director, CMS Medicaid Drug Rebate Team
• Diane Dunstan, Lead RO DRP and Medicaid Drug Rebate Analyst, Denver Regional Office, CMS
• Samone Angel, Senior Analyst, Medicaid Drug Rebate Team, CMS
• Dusty Kerhart, Senior Analyst, Drug Rebate Operations, CMS
• Dona Coffman, Technical Director, Division of Information Analysis and Technical Assistance, CMS

Are you more interested in Policy Updates?

Bring questions about current CMS policy initiatives to discuss with Kim Howell, Senior Drug Policy Analyst, Centers for Medicare and Medicaid Services (CMS).

Health-care stocks surge as broad market falls

The Wall Street Journal reports that Tuesday's healthcare stocks surged thanks to comments from Cheif of Staff Rahm Emanuel. Emanuel said the administration is open to negotiating a means for stiffer competition among private insurers. "The goal is to have a means and a mechanism to keep the private insurers honest," he said in an interview with The Wall Street Journal. An early report in the Washington Post said hospitals will contribute $155 billion over 10 years toward insuring the nearly 50 million Americans who do not have coverage.

Will we see a continued surge in healthcare stocks? We'd like to hear your predictions.