Wednesday, November 30, 2011

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

Tuesday, November 29, 2011

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.

Monday, November 28, 2011

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

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.

Monday, November 21, 2011

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?

Thursday, November 17, 2011

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!

Thursday, November 10, 2011

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.