The Medicare Congress Session Spotlight: Working with Your provider network: increase ratings through Better communication

Better communication with the PCPs in your network leads to a better understanding of star rating measurements. This ensures they ask the right questions and talk members through the tests they are receiving so they’re more likely to report having been tested. This February at The Medicare Congress, you’ll learn how to increase communication with providers to increase star ratings and ensure members are getting the necessary preventive care necessary with the session "Working With Your Provider Network: Increase Ratings Through Better Communication."

The Medicare Congress will take place February 11-13, 2013 in Phoenix, Arizona.  For more information on this session and the rest of the agenda, download the brochure.   If you'd like to join us, as a reader of this blog when you register with the code XP1807BLOG, you'll save 15% off the standard rate!

Featured Session: Working With Your Provider Network: Increase Ratings Through Better Communication

Featured Speaker: Joe Johnson, M.D., Chief Medical Officer, Arizona Integrated Physicians

About the session: Physicians are always striving to provide the best care for their patients, and typically are asking the right questions and preforming the right tests so you receive a high star rating.

• • Identify which measures are most likely determined based on what happens in the exam room
• • Learn how to ensure providers accurately code what they’re doing so you get credit

Leading through the M&A Process

In the past 18 months, more than $18 billion in M&A activity has occurred in the healthcare space and the trend will continue as healthcare companies take advantage of opportunities created by the ACA. It’s easy to assume that going through a merger or acquisition is difficult and leads to a sense of uncertainty, but what’s it like to live through it?

At the 10th Annual Medicare Congress, Robert Fahlman, former Chairman & CEO of Arcadian Health Plan will share his insight on his experience going through Humana's acquisition of Arcadian. Fahlman will provide an overview of the full process, starting with gaining approval from the federal government to integrating IT systems, marketing efforts and more. He will also share what he wishes he would have known when starting the process in August 2011.

 “The M&A process throws things your way that you may not even count on that can delay, significantly modify or cancel a transaction such as some of the key components regarding the antitrust principles that can come into play with the US Department of Justice as part of any health insurance merger. I am especially looking forward to sharing this information with people.” – Robert Fahlman, former Chairman & CEO, Arcadian Health Plan

To find out more about the sessions offered, download the agenda.

 As a reader of the Medicare Congress blog, you get a 15% discount off the standard rate when using code XP1807BLOG when you register. We look forward to seeing you February 11-13 in Phoenix, AZ! If you have any questions about the agenda or event, please contact Kate Devery at kdevery@iirusa.com or visit our webpage.

Wishing you a safe & healthy holiday season!

Cheers,
The Medicare Congress Team

The Medicare Congress Homepage
The Medicare Congress Twitter
The Medicare Congress Blog

Could the fiscal cliff hit Medicare doctors the hardest?

While the United States is days away from the new budget, many of the doctors serving Medicare are most worried about how hard it will hit their bottom line.  As we draw closer to January 1, many fear that it's the Medicare budget that will be hit the hardest, leaving physicians without $10,000-$35,000 of their current pay after a 27% cut in the budget.  While this has been a temporary cut in the past years, a stopgap is unlikely this time.  Forbes reports that in addition to the physicians, Health Plans could be affected with doctors withdraw from them because they can't afford to keep running at the reimbursement rate the government can provide.

During the Stars Summit at The Medicare Congress 2013, the session Survive A Dip In Reimbursement Rates will look at how plans can prepare for lower reimbursement rates, which may become a reality after Congress decides on the plan of action to avoid the fiscal cliff.  For more information on this session and the rest of the program, download the agenda.  If you'd like to join us this February at The Medicare Congress, register and mention code XP1807BLOG and save 15% off the standard rate.

What do you think the ultimate impact on plans will be if doctors bottom lines are hit with up to a $35,000 loss in their reimbursement rates?

Get the 360 Degree Government Programs Perspective at the GP Summit!

You don’t work in a vacuum. Things outside your company affect the way you do business and you affect their businesses in turn. In government program reimbursement, these external forces include states, wholesalers, TPAs, pharmacies, PBMs and managed care plans. The 5th Annual Government Programs Summit is the only event giving you content on the entire pharmaceutical reimbursement ecosystem so that you are more educated about those organizations that direct your company’s profitability.

• - Hear State Perspectives in our “State Spotlights”
• - Hear about the Pharma Ecosystem – from manufacturer to pharmacy
• - A full day 340B Summit for Manufacturers, presented by Apexus and the Office of Pharmacy Affairs

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

Government Programs Summit will take place March 11-13, 2013 in Baltimore, Maryland. As a reader of this blog, you get a 15% discount off the standard rate when using code XP1878BLOG. If you have any questions about the agenda or event, please contact Kate Devery.

HHS on Medicaid Support: No funding for partial expansion

Earlier this month, Kathleen Sebelius released a statement encouraging states to fully expand Medicaid.  For full expansion, they will cover 100% of all costs for new enrollees for three years.  By expanding Medicaid, the states will provide better services and better fit the needs of their citizens.

Brett Norman at Politico believes that this has put many governors in an interesting spot.  Many believe that the current healthcare system is broken and simply expanding partially, or completely, will not fix that.  He also points out that by only supporting full expansion, some states will pull back on partial expansion leaving many that could become insured left without health insurance.

This May, the Medicaid Managed Care Congress will discuss the newest developments in Medicaid expansion and how it will impact the plans working to give insurance to those newly covered.  For more information, and to receive latest updates from the program, sign up for updates.  If you'd like to join us May 20-22 in Baltimore, register today and mention code XP1826BLOG to save 15% off the standard rate!

What do you think?  Was offering to pay complete costs for the first three years a positive move for the government?  Will more states choose to fully expand Medicaid now?

The D.U.A.L.S. Forum brochure has arrived!

On behalf of IIR, I am proud to invite you to download the brochure for the inaugural D.U.A.L.S. Forum, taking place from April 4 – 5 in Baltimore.

As your partner in dissecting and understanding healthcare and all that it encompasses, we are pleased to provide you with a forum to learn industry insights from health plans making waves in the dual eligibles space.

Download our 2013 brochure.

As a reader of the D.U.A.L.S. blog, you get a 15% discount off the standard rate when using code XP1804LINK to register. If you have any questions about the agenda or event, please contact Kate Devery at kdevery@iirusa.com or visit our webpage.

We look forward to seeing you in Baltimore this spring!

Best,

The D.U.A.L.S. Forum Team

The D.U.A.L.S. Homepage
The D.U.A.L.S. Twitter
The D.U.A.L.S. Blog

IIR’s Inaugural Pharmaceutical Manufacturers’ Gross-to-Net Accounting Forum – Call For Papers!

The Institute for International Research is looking for suggested sessions for our upcoming inaugural Pharmaceutical Manufacturers’ Gross-to-Net Accounting Forum, June 17-18, 2013 at the Hyatt Harborside in Boston.

We invite you to submit a proposal for a speaking opportunity directly to Heather King, by January 11th, 2013. Please send to hking@iirusa.com. We are currently recruiting pharmaceutical and generic manufacturer executives who can share NEW DATA and industry practices through detailed case studies related to Gross-to-Net calculations, forecasting and accruals.

Submission Guidelines & Details
In your abstract, please provide the following:

Proposed Title of Session: Objective and purpose

• • A descriptive paragraph of 3-4 sentences describing what is unique or special about the information you plan to share- aka Background Information
• • 3-4 bullet points highlighting the strategies, tools and techniques attendees will walk away with- aka Key Takeaways

These are just a few things we will cover at our event. Please feel free to suggest other timely and relevant topics. Feel free to email hking@iirusa.com with any questions.

The Medicare Congress Spotlight: Determining Cost Efficiencies, Financial Implications and Market Strategies for Future Stars Success

This week, we continue to focus on the star ratings new role in terms of Medicare and their reimbursement levels.  The Academy of Managed Care Pharmacy published this every detailed White Paper which looks at how the new star ratings are directly impacted by the performances of the pharmacies.  The shift towards integration leads to Pharmacies having a large impact on the actual star rating.  For more, read the White Paper Framework for Improving Medicare Plan Star Ratings.

In this week's Session spotlight for The Medicare Congress, we look at the session "Determining Cost Efficiencies, Financial Implications and Market Strategies for Future Stars Success" presented by Charles J. Russo, Regional Vice-President: Tennessee & Virginia, Medicare & Retirement, United Healthcare. For more information on this session and the rest of the program, download the agenda. If you'd like to join us in Phoenix this coming February 11-13, 2013, register today and mention code XP1807BLOG to save 15% off the standard rate.

Featured Session: Determining Cost Efficiencies, Financial Implications and Market Strategies For Future Stars Success

Featured Speaker: Charles J. Russo, Regional Vice-President: Tennessee & Virginia, Medicare & Retirement, United Healthcare

About the Session: Once you get a 3.0 star rating, the financial implications of changing your rating play a very important role in the future of your business. Learn how to increase star ratings in the following ways:

• • Measure how much a half star rating or one full star improvement will impact your business
• • Learn which measurements carry the most weight when CMS scores your plan
• • Evaluate the costs/contracting strategies associated with raising some of these highly weighted measures
• • Building a quality infrastructure within your organization that will meet the long term needs of the Stars Program

Star Ratings and their impact on Medicare

Star ratings have grown in importance for Medicare plans.  Where they were previously used by beneficiaries to judge which plan they would choose, they have grown in importance with the Affordable Care Act.  Now, only those plans with four and five stars are eligible for their MA quality bonus payments.

According to the article at Mintz Levin, MAs star ratings come from these five categories:

• - Staying Healthy: Screenings, Tests and Vaccines (10 measures);
• - Managing Chronic Long Term Conditions (13 measures);
• - Member Experience With Health Plan (6 measures);
• - Member Complaints, Problems Getting Services, and Improvements in the Health Plan's Performance (4 measures); and
• - Health Plan Customer Service (4 measures).

Star Ratings come from a collection of information from these sources:

• - The Healthcare Effectiveness Data and Information Set ("HEDIS").
• - The Consumer Assessment of Healthcare Providers and Systems ("CAHPS") Survey.
• - The Health Outcomes Survey ("HOS").
• - CMS administrative data, including but not limited to member satisfaction, appeals processes, audit results, and customer service.
• - Prescription drug event ("PDE") data submitted to the CMS by the drug plans (for Part D).

This February at The Medicare Congress, we'll host the first annual Stars Summit,which will bring professionals from around the industry together to help professionals in the field raise their star rating. For more information on the Summit and the rest of the agenda, download the brochure. If you'd like to join us, register and mention code XP1706BLOG and save 15% off the standard rate.

Do you agree with the new Star Rating System? What is the one thing you think needs improvement?

The Medicare Congress Spotlight: How has your plan changed its business model now that reimbursement rates are tied to star ratings?

Beginning in 2012, federal reimbursement rates are tied to health plans’ star ratings so even small changes to your rating will have big financial implications for your plan. Learn how you can strategically focus on different measurements to make a big difference.

In this week's Session spotlight for The Medicare Congress, we look at the session "Where We Stand Now: An Update on Dates, Current Measures and More" presented by Laurel Hudson, Enterprise Star Operations Group,Healthspring. For more information on this session and the rest of the program, download the agenda. If you'd like to join us in Phoenix this coming February 11-13, 2013, register today and mention code XP1807BLOG to save 15% off the standard rate.

Featured Session: Where We stand now: an update on dates, current Measures and More

Featured Speaker: Laurel Hudson, Enterprise Star Operations Group, Healthspring

About the session: With the Supreme Court Of The United States ruling in 2012, followed by the 2012 elections, star ratings (and the reimbursement rates tied to them) have been up in the air for the past couple years.

• • Understand the political undertones of star ratings
• • Examine measurements that are coming into effect in the next year
• • Review upcoming dates and deadlines created by CMS

10th Annual Medicare Congress: More content focused on tactics to increase star ratings

Star ratings are important to every area of Medicare health plans, from the clinical side to marketing to customer service and for the first time ever,star ratings are tied to reimbursement rates. Every department within a Medicare health plan must pull together to ensure they raise, or maintain, their star ratings.

Due to this significant shift in Medicare reimbursement rates, the 10th Annual Medicare Congress is providing more content focused on tactics to increase star ratings. The Stars Summit, a preconference option, provides you with the tactical know-how to make minor adjustments that impact your star ratings. Be sure to attend our session:

The Best of the Best: Lessons Learned from Five Star Plans
February 12, 2013 at 9:40am:

Only the highest-ranked plans benefit with bonuses of up to 5% and the new Special Election Period (SEP). Hear from Health New England and Martin's Point Health Care to learn best practices for managing chronic conditions, increase the customer experience by managing member complaints and providing better customer service and work with PCPs to ensure they're asking members the right questions.

Michael J. Orlosky, MD, MMM, CPE, Medical Director, Health New England

Larry Henry, Vice President, Senior Products & Vice President, Business Transformation, Martin’s Point Health Care

To view the 2013 program, download the agenda.

As a member of the The Medicare Congress Group, you get a 15% discount off the standard rate when using code XP1878LINK.  If you have any questions about the agenda or event, please contact Kate Devery at kdevery@iirusa.com or visit our webpage here.

We look forward to seeing you this February 11-13 in Phoenix, AZ!

Cheers,

The Medicare Congress Team

The Medicare Congress Homepage

The Medicare Congress Twitter

The Medicare Congress Blog

Where can Medicare spending be cut?

Recently, the Washington Post took a look at how the US Government has worked to cut $360 billion from their healthcare budget:

What the government is proposing to do is transition Medicare over to a Part D type Drug Pricing Program in order for Medicare subscribers to have access to their drugs at a lower price. with this move, it is projected that the government will save $156 billion over 10 years. The other major cut will be to what is paid to post-care facilities such as nursing homes and by cutting $63 billion, although not elaborating exactly where the cuts will come from.

This February at The Medicare Congress, Court Houseworth, Managing Director, Cain Brothers and Chris Rigg, Senior Analyst, Managed Care, Susquehanna Research Group will be on hand to present "Wall Street Report: The Economic Outlook for Medicare" which will examine how the Affordable Care Act will impact the coming year of Medicare along with how the Fiscal Cliff cuts will impact the way Medicare works.  To find out more about this session, download the agenda. If you'd like to join us February 11-13, 2013 in Phoenix for this event, as a reader of this blog when you register and mention code XP1807BLOG, you'll save 15% off the standard rate!

The Government and Costs: Should Medicare be cut?

As the fiscal cliff is fast approaching the US Government, the House is debating what can and cannot be cut to improve the budget.  On of the big glaring expenses is Medicare.  It is one of the fastest growing accounts in the United States.  As it stands, it's not currently sustainable in the long term.  The program did see cuts $116 billion from the Affordable Care Act, but this was not to beneficiaries but to insurance programs and hospitals.   According to the Huffington Post, the Democrats see this as one of the places that can be cut, but care can still be accounted for.  It is unanimous that eligibility and the retirement age can't change.

This February at The Medicare Congress, John Gorman, Founder and Chairman, Gorman Health Group will be on hand to present "Know Thyself in the Post-ACA Era: Government Program Strategies for
Payers and Providers" to discuss the effects after the the cuts to the program and will address the current state of the funding.  For more information on this session and the rest of the agenda, download the program.  If you'd like to join us February 11-13, 2013 in Phoenix, Arizona, as a reader of this blog when you register to join us and mention code XP1807BLOG, you'll save 15% off the standard rate.

Do you think that Medicare will be a part of the Fiscal Cliff?  If so, what do you think is the best way to reduce costs of Medicare to the US Governed?

Does the dual eligibles population make financial sense for your plan?

The dual eligibles population comprises 24% of Medicare enrollees, but accounts for almost 35% percent of Medicare expenditures. With healthcare expenditures increasing at an alarming pace across the board, managing the care (and finances) for serving duals is now more important than ever.

At the Annual Medicare Congress, taking place on February 11 – 13 in Phoenix, you’ll hear best practices to determine if providing coverage for dual eligibles makes sense for your health plan. Panelists will share their insight on evaluating the financials of providing care to duals, predicting utilization patterns and how to overcome marketing barriers.

Evaluate if Dual Eligibles Make Financial Sense for Your Plan Tuesday, February 12, 2013 at 11:45am:

• - John Gorman, Founder and Chairman, Gorman Health Group
• - Rhys W. Jones, MPH, Vice President, Medicare Policy and Market Development, Specialty Products Group, Amerigroup Corporation 
• - Jeff Flick,National Vice President, Government Programs, HealthCare Partners 
• - Austin Ifedirah, Vice President of Medicare

To view the 2013 program, download the agenda.

As a reader of the Medicare Congress blog, you get a 15% discount off the standard rate when you register to join us and when using code XP1807BLOG. If you have any questions about the agenda or event, please contact Kate Devery at  or visit our webpage here.

Have a safe and happy Thanksgiving!
The Medicare Congress Team

Many states are rushing to create a health insurance exchange

The results are in! Now that the election is over the states that chose to 'wait and see' are rushing to create a health insurance exchange. They must decide whether or not they want to create an online marketplace or allow the federal government to run it for them. Currently, there are only 15 states that have created a blueprint for an exchange, the rest have until next Friday to decide.

The election came just 10 days before a critical deadline for states in carrying out the law, and many that were waiting for the outcome must now hustle to comply. Such efforts will coincide with epic negotiations between Mr. Obama and Congress over federal spending and taxes, where the administration will inevitably face pressure to scale back some of the costliest provisions of the law.  Although they've had years to start drafting a plan for their state, many wanted to wait to see the outcome of the election. Those states will now be the ones that are working down to the wire to create an efficient health insurance exchange for their residents.

Want to learn more about the health insurance exchange? Join us next week, November 13-14 in Chicago, IL for the Health Insurance Exchange Congress.

Health Insurance Exchanges are Here to Stay!

Now that President Barack Obama has been elected for a second term in office, it has become even clearer that we need to get to work now to ensure exchanges are ready for January 1, 2014.

Over the upcoming weeks and months, the federal government will continue to roll out regulations, and begin to implement the healthcare reform law. It is vital that we prepare now: either beginning to move forward or continuing on the path to reform implementation.

The Health Insurance Exchange Congress is the FIRST conference following the election. If you are ready to be informed on the future of the healthcare reform, this event is not to be missed! You will walk away with a deep understanding of how states and healthcare plans are addressing the challenges and questions you are facing now.

For more information on the event, download the agenda. The Health Insurance Exchange Congress takes place next week November 13-14 in Chicago, IL.  As a reader of this blog, you’ll save 15% off the standard rate when you register to join us and mention code XP1710BLOG! If you have any questions about the program, feel free to email me at kdevery@iirusa.com or visit the homepage.

Best,

The Healthcare Reform and Health Insurance Exchanges Team

HIX Homepage
HIX Twitter

HIX Blog  

Election day is here!

After months of covering the health insurance exchange, election day is here! The campaign trail comes to an end tonight, and by this time tomorrow we will know the next President of the United States. Some healthcare experts are saying that this may be the most important election since the 1960s. It was a long road, with a lot of information, but we have you covered. Below is a recap on what this year’s election means for healthcare.

Obama’s Position: Signed the 2010 healthcare overhaul bill.Calls for patient protections like allowing coverage for pre-existing conditions, not letting insurers cancel policies when patients get sick, and requiring individuals to buy health insurance or pay a fine.

Romeny’s Position: Created similar legislation in Mass. but believes it's not appropriate for all of USA and wants to repeal. Proposes encouraging individuals to purchase their own health insurance rather than via employers, and allowing insurance across state lines.

For the past few months many states have been finalizing the final details of their health insurance exchange. However, some chose to 'wait and see' how the election turned out and for those states tomorrow will answer whether they will finally set up their own health insurance exchange. The lines may be long, but remember every vote counts, so be sure to take some time and head to the polls! Not sure where to vote? Type in your address here to be directed to the closest polling place.

No matter what the outcome of the election is, the Health Insurance Exchange Congress will answer all your needs for the health insurance exchange in your state.  Join us next week in Chicago, and as a reader of this blog, register and mention code XP1710BLOG and save 15% off the standard rate!