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

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

Download it here.

What can you look forward to from MMCC 2012?

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

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

Season's Greetings from the Medicare Congress Group

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

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

- The Medicare Congress Team

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

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

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

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

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

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

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

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

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

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

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

See who is attending The Medicare Congress 2012!

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

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

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

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

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

We hope to see you in sunny Orlando!

How can hospitals decrease readmission for Medicare patients?

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

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

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

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

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

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

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

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

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

The 2012 Government Programs Summit Agenda is Available for Download

By March of 2012, this country will be entrenched in the election and Healthcare reform will no doubt be a subject in every political debate. Changes already rolled out have expanded government payer channels for pharmaceutical drugs beyond the scope of where they have ever been before. The impact is so widespread that entire departments are being restructured and integrated.

The 2012 Government Programs Summit Agenda is available for download! Click here to see the ONLY program where you will hear directly from the regulators who affect your business, and receive the government perspectives you can't get anywhere else.

Download the brochure here.

The GP Summit has more than 25 Government Officials from the following agencies: CMS, State Pharmacy Representatives, OIG, OPA, PVP, PSSC and VA.

These government insiders will present never before heard insight on how to:
• Prepare for the impact of AMP Guidance/Proposed Rule
• Decipher 340B program changes
• Improve processes for Medicare Part D Rebates
• Comply with False Claims Act Violations and Kickback Statue Violations
• Manage the Medicaid Managed Care Utilization Claims invoices
• Calculate the new Medicare Part B and ASP definition for coverage and coding
• Present new State Reporting requirements
• Identify processes for working with VA and DoD formularies
• Validate the Pharmaceutical Industry Fee
• Deliberate the potential to change the reimbursement mechanism (AAC)

As a member of the Government Programs Pricing Compliance LinkedIn group, use code XP1751LINK to receive an exclusive discount of 25% off of the standard rate when you register to attend us this March 7-9, 2011 in Baltimore, Maryland. If you have any questions about the program, please feel free to contact Jennifer Pereira at jpereira@iirusa.com or visit the Government Programs webpage: http://bit.ly/voyOYO.

Medicare claims database to open up for examination

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

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

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

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

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

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

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

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

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

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

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

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

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

The failure of the congressional super committee

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

What changes will these triggers have on your business model?

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

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

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

• - “2012 Election Outlook: Examine Today’s Headlines to Find the Real Signals and Implications for ACA”
Presented by: Fred Barnes, Executive Editor, The Weekly Standard, and Commentator, Fox News 

• - “Politics as Usual: Debate the 2012 Election’s Impact on Healthcare, Medicare, and ACA”
Presented by: -Murray Ross, PhD, Vice President, Kaiser Foundations Health Plan Inc., and Director, Kaiser Permanente Institute for Health Policy -Joseph Antos, Resident Scholar, American Enterprise Institute 

• - “What Does It All Mean for Main Street?”
Presented by: John Gorman, CEO, Gorman Health Group

• - “Annual Wall Street Report: Economic Outlook for Medicare Advantage Health Plans”
Presented by: -Court Houseworth, Managing Director, Cain Brothers -Chris Rigg, Senior Managed Care Analyst, Susquehanna Research Group

• - “Health Rebooted: How Taking Technology All the Way will Solve Both the Cost and Quality Problems”
Presented by:-Charles Mackay, CPHQ, Health Insurance Specialist, Centers for Medicare & Medicaid Services

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

States looking to Medicaid Managed Care plans to control costs

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

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

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

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

Save the Date for the 20th Medicaid Managed Care Congress

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

At the 2012 Conference, we will discuss:

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

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

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

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

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

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

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

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

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

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

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


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


Topics covered include:

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

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


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

The Medicare Congress Brochure is Ready for Download!

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

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

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

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

Health Insurance Exchange Roundup: October 28

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Fox News: Obama’s Health Care Law Penalizes Marriage, Analysts Say
Maryland Healthcare Commission: Health Care Spending in Maryland’s Individual and Small Group Market
Get Insured: Predicting the Future of Health Insurance
Virginia Public Radio: Employer-Sponsored Health Insurance

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Hear Former HIX Director on the Status of States’ Exchanges

This is your last chance to register for the Health Insurance Exchange Congress and hear Joel Ario, former Director of the Office of Health Insurances Exchanges speak. Joel Ario was the Director of the Office of Health Insurance Exchanges.

His presentation is entitled "The State of the States: Health Insurance Exchange in Various States". It will take place during the event, taking place November 9-11, 2011.  This session will provide you with:

• • How the political climate within states will affect how they organize their Exchanges
• • How states are utilizing their innovator grants
• • Updates on the status of high-populous states that are establishing exchanges
• • Opportunities regional Exchanges present

For more information about this presentation and the rest of the agenda, download the brochure here and we hope to see you in Baltimore next month!

Health Insurance Exchange Roundup: October 26

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Nashville Public Radio: Health Interests Prefer State-Run Insurance Exchange
ASC Review: Kansas Governor's Rejection of $31.5M Health Insurance Exchange Grant Prompts Criticism
Bureau of National Affairs: HHS Doing All It Can to Help States Establish Health Exchanges, Official Says
AM 610: Nebraska- Vs. Federal-Based Health Insurance Exchange
Lansing State Journal: Jack McHugh: Don't rush to create health exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: October 25

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:

AIS Health: Good News for Small Carriers: Exchanges Could ‘Dilute’ Brand
Lawrence Journal World: Brownback’s rejection of health insurance grant continues to spur questions
Becker's Hospital Review: Virginia to Map Out Health Insurance Exchange Framework

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Essential Health Benefits: Specific Recommendations and Implications

Our post today comes from guest blogger David Jacobson. He is a consultant for HealthCare Strategic Management – SM. He is a knowledgeable and creative thinker of healthcare reform strategies, and a subject matter expert about Medicaid managed care and the Affordable Care Act including the purchasing Exchange and other reform initiatives. David has over 16 years’ experience and developed Medicaid managed care products for chronically ill, disabled and long term supports and services. 

Specific Recommendations and Implications
Part 1 of this Blog discussed IOM’s overall recommendation for HHS to define Essential Health Benefits. It is a balance of coverage and affordability, and affordability should be a key to support the goals of ACA. This Blog drills-down on the specific recommendations and includes analysis of implications.

Following are IOM committee recommendations and editorial analysis. The detailed recommendation framework was comprised of three major areas. See the IOM report for more specifics.

• • Policy Foundation that included stewardship of limited resources under an Ethic dimension
• • Summary of Criteria for the: 1) aggregate package, 2) specific components, and 3) defining and updating the specific components
• • Eight recommendations addressing in the six categories that address:
• o Establish initial EHB: Reality will be in the specifics of how HHS interprets and applies the IOM guidelines. The IOM strongly recommended effective public deliberation and the process will need to make tough a-political decisions to define EHBs that will support affordability. A challenge will be the level of benefits for the chronically ill and disabled segment. This segment may need special consideration such as targeted programs and effective risk-adjustments that can actually attract health plans with care management expertise. Additionally, the EHB needs to consider Medicaid benefits to support continuity of care for enrollees that switch between subsidized and Medicaid plans (bubble population).
• o Foundation for updating with monitoring and research: Establishing data standards is a valuable component in order to have information to evaluate performance and outcomes to improve the system. This will increase administrative costs in the short-term and, when done right, can reduce cost and improve outcomes in the medium term. Useful and actionable data is essential to reforming the system.
• o Allow for State innovation: This component is needed in order for states to continue to design programs for the local market and be a laboratory for innovation. However, it will also create challenges to maintain actuarial neutral benefit designs and avoid an onerous waiver process like what states currently face for Medicaid.
• o Update the EHB with evidence-based information and explicitly consider costs:A challenge here is that new treatments may initially lack sufficient evidence-based data. Additionally, cost neutrality presents the challenge of comparative effectiveness and politicizing the process when choices need to made about what benefits to add or change. It will be important to maintain affordable premium price-points and avoid political influence driving the cost up or complaints of rationing.
• o HHS strategy to address rising costs across all sectors: As noted above, this is critical for the success of ACA and American healthcare in general. To highlight, the recommendation is across all sectors which can help minimize pushing the financial bubble around the system between payers and providers.
• o Create a National Benefits Advisory Council (NBAC): This needs to be kept non-partisan. The ACA says that the council would be staffed by HHS and appointed through a non-partisan process.

The next step is for HHS to conduct listening sessions and the IOM report targets the definition of the initial EHB package by May 1, 2012. The sooner the better due to the implications of EHB and the ever narrowing window to implement ACA. The next steps will be an intense process and fortunately the IOM committee proceeded in the right direction and recommended a solid framework to support the ACA.

Contact David at: djacobson@healthsm.com

Health Insurance Exchange Roundup: October 24

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Kaiser Health News: Can A Small Business Insurance Marketplace Take Root In Florida?
Richmond Times Dispatch: Virginia officials to meet about setting up health-insurance exchange
Las Vegas Sun: Report finds high numbers of Nevadans lack health insurance
Baltimore Business Journal: Maryland seeks bids to build health insurance enrollment system

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

US Healthcare rate climbed in 2011 but at a slower pace

The average cost of healthcare services covered by commercial services and Medicare grew 5.73% from August 2010 to August 2011.  This is the lowest growth rate in six years, however still outpaced the overall inflation rate of 3.1% according to the CPI Index.  According to Health Leaders Media, the cost of hospital and professional services rose, but it is believed to be a result of  rising employment and wages.

David M. Blitzer, chairman of the Index Committee at S&P Indices, said in the report, stated:
"As the summer of 2011 ended, we continued to observe the recent trend of a deceleration in the annual growth rates of Medicare costs and a sustained acceleration in the annual rates of commercial healthcare costs.....With this month's data, the Medicare index is almost one-fourth of its peak annual rate of +8.02% recorded in November 2009. This is a very sharp deceleration."

At the 9th Annual The Medicare Congress, Centers for Medicare & Medicaid Services will be on hand to present, "Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries," identifying the problems posed by the increasing cost of Medicare.  For more information about the event, download the brochure here.

Why do you think the average cost of healthcare had a lower rate of growth in 2011?

Health Insurance Exchange Roundup: October 21

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Detroit News: Health care cost-cutting touted
Progress Illinois: Health Exchanges Still In The “Studying” Stage
The Lund Report (Oregon): Oregon’s Health Exchange Gets a B- in National Study
ASC Review: North Dakota Lawmaker Touts State-Run Health Insurance Exchange Over Federal Intervention
Green Bay Press Gazette: Wisconsin Senate limits abortion funding

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: October 20

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Associated Press: North Dakota GOP lawmaker pushes health insurance exchange
Connecticut News Junkie: Protesters To Board: Add More Members Or Scrap The Exchange
Heartlander: Arkansas Governor Temporarily Halts Insurance Exchange
Mackinac Center for Public Policy: NFIB: 'No Rush' on Creating Obamacare Exchange


The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Health Insurance Exchange Roundup: October 19

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:

The Associated Press (Illinois): Group calls for action on insurance exchange
Milwaukee Public Radio: Lawmakers Hoping to Block Health Care Reform in Wisconsin Propose Constitutional Amendment
California Healthline: As Health Jobs Grow, a Prescription for Smart Growth

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

See who’s attending the Health Insurance Exchange Congress

Even if the federal government overturns the Affordable Care Act, many states are still moving forward with establishing their own Health Insurance Exchanges. Utah and Massachusetts have exchanges while New York, Oregon, Vermont and West Virginia are pursuing state legislation to establish their own. Your best bet to learn what’s going on is to attend the Health Insurance Exchange Congress taking place November 9-11, 2011, in Baltimore, Maryland. Join us and align your company's strategies with the state's progress to ensure you benefit from state sponsored Insurance Exchanges. Because regardless of the federal government's ruling, states are still moving forward and you don't want to miss out on the estimated 24 million new eligibles.

Who can you meet when you attend the 2011 conference?

AARP * Aegis Sciences Corporation * AmeriChoice * Amerigroup * AmeriHealth Mercy * Aon Hewitt * Brier Law Group * Cambiare * CareContinuum, Inc * CDPHP * Colorado Access * Consumer Reports * Deltek * Dominion Dental Services * Enroll America * Essex Woodland * Express Scripts Inc * Health Partners * Health Plan of San Mateo * HHS * HMS * Independent Insurance Agents & Brokers of America * JP Morgan * Massachusetts Health Insurance Connector * Medicaid Health Plans of America * MedSolutions * Microsoft Corporation * Molina Healthcare * Monroe Plan * National Association of Health Underwriters * National Association of Medicaid Director * National Foundation of Independent Bus* National Governors Association * National Committee for Quality Assurance * Network Health * Optimetra * State of Oklahoma * State of Utah * Summit Solutions Unlimited * Transamerica Life & Protection * University of Arizona Health Network * WellPoint *

For more information on the event, visit the webpage to download the brochure.

Health Insurance Exchange Roundup: October 18

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Savannah Now (Georgia): Carter: Making health insurance mandatory
Associated Press: Rhode Island Community Forums to hold discussion on state's health insurance exchange
Dallas Morning News: Texas receives 'incomplete' on health insurance exchange report card
The Intelligencer: West Virginia Insurance Plan Promising
Gazette News (Maryland): Program could reduce by half those without health insurance, state official says

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Essential Health Benefits – IOM process recommendations: Part 1

Our post today comes from guest blogger David Jacobson. He is a consultant for HealthCare Strategic Management – SM. He is a knowledgeable and creative thinker of healthcare reform strategies, and a subject matter expert about Medicaid managed care and the Affordable Care Act including the purchasing Exchange and other reform initiatives. David has over 16 years’ experience and developed Medicaid managed care products for chronically ill, disabled and long term supports and services. 


Affordability is key to ACA Essential Health Benefits

Essential Health Benefits (EHB) of the Affordable Care Act (ACA) require a balance between coverage and cost, and affordability was weighted heavily by the Institute of Medicine (IOM). The IOM committee introduction said “If you don’t control costs, the goal to increase coverage will be undermined” when they released the anxiously awaited recommendations to the Department of Human and Health Services (HHS) on October 7. The recommendations are for the guidelines and criteria for HHS to specify the EHB package. The EHB packages will be offered through purchasing Exchanges and have far reaching impacts on the success of the ACA. More than 68 million people are expected to meet EHB requirements.

The regulations received intense public interest during the IOM development process and there were several hundred people on Friday’s teleconference meeting. The website with the full report became blocked on Friday afternoon as a surge of people retrieved the report.

To put this in context, the principal reason for ACA is to enable people to purchase health insurance and cover more of the population. This is supported by subsidized plans for low and moderate income individuals and small employers that is sold through a purchasing Exchange.

Specifying the EHB is a tremendously difficult task due to the competing goals of comprehensiveness and affordability, many trade-offs, and diverse public interests. It’s a balance of wallet and heart. If EHB is too expansive, then it will be too expensive and there will be less consumer uptake. If it is too limited, individuals will not get access to the services they need and outcomes will suffer. The IOM created a multi-stakeholder committee and obtained extensive public input to set the parameters and guidance.

The IOM recommendations are a solid point of departure and reference point for HHS, even if it seems vague in spots. The IOM committee recognized that benefit packages need to be affordable to obtain the necessary level of enrollment and we also have limited resources. They viewed it as a ‘market basket” to know what you can spend and spend it carefully rather than a filling up your shopping cart with as much as you can. A committee member said: “Everyone cannot have everything they want. “

This raises tough questions about the level of benefits, especially for chronically ill and disabled. Special consideration, programs, and rate adjustments will be required for high-risk individuals.

The IOM suggested benchmarking the average covered benefits and premiums for small employer health plans. They were also required to add benefits to reflect the ten categories specified by the ACA. This will increase the cost and create pressure to limit benefits in order to meet premium price-points.

The IOM approach is to start with what we have and then readily adjust as we learn how the Exchange market works. This is a prudent way to begin – progress over perfection – and let the free market do its work. This allows the opportunity for increased consumer take-up rates which will allow a broader selection mix and the ability of Exchanges to learn, adapt and grow. It would allow states and/or insurers to offer additional plans with enhanced benefits vs. overly specific regulations.

Certainly, ACA and healthcare reform will not be successful with the right Exchanges and EHBs alone. Other changes are needed to address the high cost and quality variation in the American system. For instance, other critical success factors include benefit design (i.e. cost-share), administration (i.e. care management), and network requirements. Reform must also address improvements to delivery and payment, risk-adjusted rates for insurers, health information technology, and informed and engaged consumers.

Stayed tuned for Part 2 of this Blog: Specific Recommendations and Implications next Tuesday, October 25.  Contact the author at djacobson@healthcaresm.com.

Health Insurance Exchange Roundup: October 17

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Montgomery Adviser: Market for health insurance in Alabama the least competitive in U.S.
Associated Press: West Virginia still pursuing health insurance exchange
NPR: A Tale Of Two Health Plans: Romney Versus Obama
Washington Post: Some states seek flexibility to push health-care overhaul further

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage.

Nebraska waiting to create their health insurance exchange

Until there is a clearer picture on what the federal health insurance exchange looks like, Nebraska Department of Insurance Director Bruce Ramge has told the state it is best to wait before any recommendations can be made as to build a state run health exchange.  They are also waiting to see what the Supreme Court states as to the constitutionality of the Affordable Care Act.

The Insurance Journal reports that Omaha Sen. Jeremy Nordquist, the Chair of National Conference of State Legislature’s Health Committee, stated: “We lose nothing by moving forward and enacting legislation. If we sit on our hands and the court upholds the law, we’re going to be way behind the game, potentially to the point where the federal government says, ‘Nebraska, you’re not ready. We’re going to run the exchange for you.”

Chiquita Brooks-LaSure, Director of Coverage Policy, Office of Health Reform (OHR), Department of Health and Human Services, will be at the Health Insurance Exchange Congress this coming November to discuss, "Spread Excellence throughout the System: Better Care for Patients and Better Health for the U.S. Population," looking at how a health insurance exchange can be a benefit to those who are covered.  For more information on the event, download the brochure here.

Do you agree with Nebraska's actions?  What are the advantages and disadvantages of waiting until the Supreme Court rules on the Affordable Care Act?

Health Insurance Exchange Roundup: October 14

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
MSN Money: Nebraska insurance head needs data on exchange cost
Superior Telegram (Wisconsin): Democratic bill seeks health insurance market
Baltimore Business Journal: Baltimore-area brokers may win work in new health insurance market
St. Petersburg Times: New state health exchange could become precursor to implement federal health care law
MSNBC: Rhode Island seeks federal aid for health insurance exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Health Insurance Exchange Roundup: October 13

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Washington Examiner: Nebraska insurance head needs data on exchange cost
Montgomery Adviser: Report: Alabama's health insurance market least competitive in U.S.
Times News Magic Valley: Town Hall Will Focus on Health Exchanges
News Review (Nevada): State of health

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Health Insurance Exchange Roundup: October 12

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Bloomberg Business Week: Rhode Island seeks federal aid for health insurance exchange
Bloomberg Business week: Arkansas insurance officials look at health exchange
Wyoming Tribune: Wyoming lawmakers favor more study on health exchange
Arkansas News: Insurance chief: May be too late for state-run health exchange
Public News Service: Indiana on Healthcare Reform: Take the Lead, or Wait for Feds?

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Health Insurance Exchange Roundup: October 11

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Boston Globe: RI seeks federal aid for health insurance exchange
Chicago Tribune: Coalition wants consumer voice on health exchange
California Healthline: Counties Weigh Public Plan as Option in State Health Benefit Exchange
Billings Gazette: Gov. Mead supports health insurance exchange
Idaho Statesman: Idaho small-biz group wants insurers' hands out of health exchange

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Could four conditions help doctors save Medicare money?

Logo Source: Med City News

The American Medical Association recently sent a request for Medicare to start paying doctors for four tasks that will allow Medicare to save more health care money in the long run by encouraging patients to get their questions answered before they go to the emergency room.


Health Leaders Media reports the four tasks that they have requested for reimbursement are:

• -Responding to calls from patients at least seven days past doctors visits
• -Education and training to help patients better manage their health
• -Management of coagulataen drugs
• -Reimbursement for team coordination when patients aren't

Barbara Levy, MD, chairperson of the AMA's Specialty Society RVS (Relative Value Scale) Update Committee, issued the following in a recent release:
“When treating patients with chronic conditions, such as heart disease and diabetes, physicians provide many services that are currently not recognized or compensated by Medicare. Not only will payment for these services save Medicare money in unnecessary office and emergency room visits......potential savings in Medicare Parts A and D will also offset upfront payment for non–face-to-face services."

At the 9th Medicare Congress, the panel Strengthening Medicare – Better Health and Lower Costs for Medicare Beneficiaries a group of panelists will be discussing the latest changes to Medicare and how better coordinated care can save the industry money.  For more information, download the agenda here.

Do you agree with Levy's statements? Could reimbursing doctors for time spent doing the four things listed above save the Medicare organization more money in the long run?

Health Insurance Exchange Roundup: October 7

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
Westfair Online (Connecticut): M.D.s propose plan in new health exchange
Wall Street Journal: Panel Urges Affordable Health Plans
Bloomberg Business Week: Arizona governor defends health exchange request
News-Medical.net Funding issues affecting health exchanges, community health centers
Mackinac Center: Obamacare Exchange: The People or the Insurers?

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Health Insurance Exchange Roundup: October 6

Healthcare Exchanges are the hot topic in today’s healthcare landscape as well as national news. With states mandated to have a plan in place by January 1, 2013, and a functioning system by January 1, 2014, the majority are trying to figure how they will implement this system. Check here every afternoon for the latest opinions and news on the health exchange.

Here's today's news:
The Capitol (New York): Health Insurance Exchanges Stall In State Senate
Tulsa World: Health-care mandate costly and complex, business leaders tell legislators
The Lund Report (Oregon): Insurance Exchange Must Consider Needs of Tribal Communities
Courier News (Arkansas): Beebe seeks GOP cover on health care
State Paper (Nebraska): Heineman says health exchanges will wait for U.S. Supreme Court decision

The Health Insurance Exchange Congress is the only place for states and health plans to come together as one and discuss the current challenges and opportunities associated with health insurance Exchanges. For more information about joining us, visit our webpage

Preliminary Agenda now available for the Medicare Congress

Save the Date! Join us February 6-8, 2012 at the Loews Portofino Bay Hotel in Orlando, Florida for the 9th Annual Medicare Congress, the premiere Medicare event featuring today's health plans discussing tomorrow's solutions. Last year we had more than 150 attendees from across the country, representing California, Arizona, New York, Illinois, Texas, and Washington, DC to name a few.

Did you know that in 2011 only 3 Medicare health plans received an overall rating of 5 stars? With over 500 Medicare health plans nationwide, the question remains, how did these 3 conquer all? Learn from the highly ranked plans on how they achieved their high scores and hear directly from the federal officials on how to excel on your RADV audit, improve your Star Rating, and remain profitably despite reimbursement costs.
What's new for 2012?

Three New Full Day Summits

• • State-of-the-Art Medicare Compliance Summit
• • Medicare Pharmacy Benefit Management Summit
• • ICD: 10 Payer Implementation Summit

Three New 100% Case Study Tracks

• • Medicare Marketing and Member Retention
• • Complex Care Management that Delivers Clinical and Financial Results
• • Medicare Reimbursement & Revenue Enhancement

Download the preliminary agenda to see what's in store for 2012.