Friday, January 27, 2012

Video: Dr. Lauwrence Baker on Drug Pricing

I came across this video recently while perusing Khan Academy's videos on healthcare and medicine and thought this one discussing how drug prices are set would interest our readers here almost as a primer to the topic but it has some interesting commentary on U.S. drug pricing v. Europe:

Valerie M. Russo is a Senior Social Media Strategist at IIR USA with a technology, anthropology, marketing and publishing business acumen, covering the MDRP Summit beat. She is a published poet and also maintains a literary blog. She may be reached at Follow her @Literanista.

Thursday, January 26, 2012

Mark McClellan on the future of the ACA & Healthcare Reform

This week, Marc McClellan was at the Drug Delivery Partnerships Conferncee and shared a few of the insights he had into the future of healthcare with the coming changes of the 2012 Election.  We'd like to share that with you.

Will it Help or Hurt? The Impact of Healthcare Reform on Drug Delivery Innovation, Reimbursement, and Patient Compliance
Mark McClellan, Engelberg Center for Healthcare Reform, Brookings Institute, Centers for Medicare and Medicaid Services

The healthcare world is anxiously awaiting the the decision from the Supreme Court as to whether or not the ACA is legal. McClellan believes that some of the Act will be overturned, but not the whole thing. No matter the individual mandate to buy healthcare insurance will be delayed or repealed entirely. A lot of the other aspects are directly impacted by the 2012 Election. Since it is unpopular, Congress will delay the implementation. McClellan believes that this whole process will take longer and won’t be implemented on schedule in 2014. What won’t change? The insurance market will change, and those with chronic conditions will be covered. Republicans can’t repeal the whole law should they win the 2012 Election. The challenge is how to figure out how to cover more and more people who aren’t covered by insurance.

Rising healthcare costs that are coupled with a lot of rules to restrict spending means it will be very difficult to find a way balance the budget.
 As for FDA Drug Approvals, they are up. This includes more personalized treatments. The process of developing new treatments is very long and uncertain. So success rates are still running around 11-13% for approval. Pharma is moving towards targeting therapies and innovative develop methods require new ways for the FDA to approve them.

Quick approval methods currently from the FDA: Fast track, Priority review, Accelerated approval. There were 8 drugs over the past few years approved this way. It’s hard to set up post approval success measures to get the drugs approved as well.

In the future, McClellan believes that there will be an evidentiary standard (Progressive approval), Targeting , better regulatory guidance and premarket development science

McClellan believes that personalized medicine will have a huge impact on health care in the future, but only if the reimbursement structure is changed from its current structure.

Wednesday, January 18, 2012

Look who’s Attending the 2012 Medicare Congress

We're less than 3 weeks away from the Medicare Congress in Orlando, February 6-8. We’re expecting a big turnout this year so don’t miss your opportunity to attend the largest, longest running Medicare event in the industry and network with Health Plan executives and CMS officials.

Look at the companies who are attending:
AARP, Aetna, Allergan, American Enterprise Institute, Ameri-Plus Select Services , Arcadian Health Plan & Management Services, Arkansas Blue Cross Blue Shield, BCBS of Minnesota, Bloom Marketing Group, Blue Cross Blue Shield Northern Plains Alliance, Blue Cross Blue Shield of Alabama, Blue Cross Blue Shield of Illinois, Bristol Myers Squibb, Cain Brothers, Capital District Physicians Health Plan, Care N Care Health Plan , CareFirst Blue Cross Blue Shield of Maryland, Cazma LLC, Centers for Medicare & Medicaid Services, CIGNA Healthcare, Colibrium Partners LLC, DMW Worldwide, Dynamic Healthcare Systems Inc, Endo Pharmaceuticals, Epstein Becker Green, Family Physicians Group, First Recovery Group, Forbes, Forest Laboratories, Gorman Health Group LLC, Health Alliance Plan of Michigan, Healthcare Partners, HealthPlanCRM , HealthSpring, HMS Permedion, Humana, Inter Valley Health Plan, Kaiser Family Foundation, Kaiser Permanente, Kaiser Permanente, KBM Group Health Services, LA Care Health Plan, Matrix Medical Network, Milliman USA, National Committee for Quality Assurance, Oliver Wyman Actuarial Consulting, Optum Health, OptumInsight, PharmMD, Preferred Care Partners, Silverlink Communications, Sterling Life Insurance Company, Susquehanna Research Group, SXC Health Solutions Corporation, SXC Health Solutions Corporation, 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

The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida. If you’d like to join these companies, use priority code XP1707BLOG to receive 25% off of the standard rate! This is an exclusive discount to this blog. If you have any questions about the agenda or event, please contact Jennifer Pereira.

Monday, January 16, 2012

How Important is Clarification On Current Government Guidance's To Your Organization?

Post Healthcare Reform, not only are Government Programs in a seemingly constant state of flux, but many of the most complicated programs are in a regulatory vacuum period – we know something is coming down the pipe, but have no idea when and how it will affect us.

So what can we do to help? At the Government Programs Summit, we bring together both the key government officials who can offer the most clarity about what to do NOW to prepare for what may come LATER and leading pharmaceutical and generic manufacturer executives who will leave you with practical information on how they are coping with the uncertainty.

In two short days you will:
  • - Have unparalleled access to CMS authorities from the Policy, Technical, and Operations Departments, in the session, “CMS AMP Guidance Answers and Next Steps for Medicaid Drug Rebate Program,” as well as the opportunity for one on one, personalized attention in the CMS meeting room.
  • - Get an update on 340B guidance directly from HRSA officers, including definitions of “Eligible Patient” under the PHS program in the session, “340B PHS Guidance, Definitions and Oversight Update.”
  • - Learn to accrue for the potential 4 million new beneficiaries to Medicare Part D who may fall in to the Donut Hole in 2012 in the session, “Medicare Part D for the Donut Hole: Guidance Updates, Invoicing, Disputes and Appeals Processes.”

Staying up to date on current proposed rules, interpretations, and implementations of government programs is of paramount importance to branded and generic manufactures.

Government Programs and Pricing Compliance Summit will take place March 7-9, 2012, in Baltimore, Maryland. For more information on the program, download the brochure here.

Friday, January 13, 2012

Updates on Duals from Jennifer Coleman of CMS’s Medicare-Medicaid Coordination Office

Your patients with chronic diseases require the greatest investment of money and time for your healthplan. And we know their treatment needs grow more complex if they are dual eligibles. Join us at the 9th annual Medicare Congress - the largest and longest-running conference devoted to the Medicare marketplace – as we have exclusive coverage on the chronically ill and dual eligibles.

Expert speakers include:
  • • CMS’s Senior Advisor for the Medicare-Medicaid Coordination Office, Jennifer Coleman, will detail CMS’s new demonstration program to test new financial models for integrating coverage for dual-eligibles. Learn more about their timelines, coverage areas, and best operational practices required to adapt to these new initiatives.
  • • Karol Attaway, VP of Operations at HealthCare Services, will detail how you can use risk assessment stratification to predict and prepare for the financial costs of your most seriously ill patients.
To learn more about the program, download the program agenda.

The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida. If you’d like to join us, use priority code XP1707BLOG to receive 25% off of the standard rate! This is an exclusive discount to this blog. We encourage you to register ASAP because the hotel block is 80% sold out and the negotiated rate expires this Sunday. If you have any questions about the agenda or event, please contact Jennifer Pereira at or visit the homepage

Thursday, January 12, 2012

New Proposal for Dual Eligibles presented by GWU

Dual eligibiles, those who receive both Medicaid and Medicare, are a relative small portion of those receiving medical coverage fromt the US government.  However, according to UPI, they account for 36% of all Medicare spending and 39% of Medicaid spending.  Part of the reason is the vast amount of coverage and plans they have to deal with in order to have their medical bills paid.  They also often have chronic conditions or are mentally impaired and need continuous care.

Jane Hyatt Thorpe, one of the authors, stated "The new state plan option allows states to design a permanent program in partnership with federal officials that integrates financing and care across the Medicare and Medicaid programs to better meet the needs of dual eligibles."

You can read the full proposal here.

At the upcoming Medicaid Managed Care Congress, taking place April 30-May 2, 2012, there will be a full day workshop entitled "Cost Containment Strategies for Dual Eligibles."  This will be a full day focusing on this aspect of the Medicare system.  For more information on this workshop and the rest of the program, download the brochure.  As a reader of this blog, when you mention code XP1726BLOG, you'll receive 25% off the standard rate when you register to join us in Baltimore.

How important is it to manage the care of dual eligibles? Should this be a priority to control healthcare spending in the future?

Thursday, January 5, 2012

Lou Saccoccio’s Exclusive Podcast on Monitoring and Responding to Prescription Drug Abuse

Did you know CMS can now track your healthplan’s performance on even more criteria than ever before? Which means proactive compliance is the most important aspect for survival in our world of CMS sanctions. Your compliance officer must be kept fully equipped and up-to-date, and your entire team must be ready to ensure your compliance strategies are fool-proof.

But what happens when your compliance strategies fail?
If your company was sanctioned, how would it survive? Do you have the right contingency and messaging plans in place? Ensure your compliance defense is tough as steel by attending the 9th Annual Medicare Congress. Hear from keynote speaker Robert Fahlman, CEO of Arcadian Healthplan, as he recounts how they successfully emerged from an 8-month sanction period – all while continuing to negotiate major business transactions! For more about Fahlman’s presentation and the rest of the program, visit the webpage to download the brochure.

For a sneak peek at this year's content, I invite you to download our exclusive interview with Lou Saccoccio, executive director of the National Healthcare Anti-Fraud Association, which delves into the ways that healthplans must prepare for monitoring and responding to evidence of prescription drug abuse.

Download the podcast here.

Don’t forget, as a reader of this 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 at  The Medicare Congress is taking place February 6-8, 2012 in Orlando, Florida.

Wednesday, January 4, 2012

Today’s Weather Watcher for the Medicare Congress

On behalf of the 9th Annual Medicare Congress, we at the Healthcare: From Policy to Practice blog would like to wish you a very happy, healthy, and successful New Year! We are a little more than one month away from the largest and longest-running conference devoted to the Medicare marketplace, and my colleagues and I eagerly look forward to welcoming you to this event. As we get further into winter, don’t miss out on your opportunity to head to sunny Florida so you can learn from and network with the luminaries in healthplan management.

Check out this weekend's weather in Orlando:

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!

Ditch the winter blues and join us in sunny Florida this February!

Tuesday, January 3, 2012

What's the future for Medicare?

In a recent article at Chico News, they examine what has kept the Medicare System running to this point - and what will have to happen for it to run successfully into the future.  The two main problems Larry Mitchell offers are that there is a lack of proper reimbursement from Medicare to the doctors themselves, as well as fewer and fewer doctors due to many of the doctors retiring themselves.  Many doctors have had the time to foster relationships with their patients and collaborate and communicate on what the patients are feeling.  However, with the current process - doctors being paid on the amount of patients they see and treat - this is one of the things that is failing in the system.

At The 2012 Medicare Congress, Charles Mackay, CPHQ, Health Insurance Specialist, Centers for Medicare & Medicaid Services will be on hand to examine many of these problems in his presentation "Health Rebooted: How Taking Technology All the Way will Solve Both the Cost and Quality Problems".  For more information on his presentation and the rest of the event, download the brochure here.  Don't forget, as a valued reader of this blog, when you register and mention code XP1707BLOG, receive 25% off the standard rate!

Do you agree with the statements in the Chico News? How can Medicare step in and fix the issues they face?  What is the best solution to have doctors spend quality time with their patients yet also treat more of them at the same time?