Thursday, January 31, 2013

Nordian granted five year Medicare Claims processing contract

This week, Nordian was granted a new Medicare contract. The contract, which will last for five years, will be responsible for 15 % of the claims, and in turn create 200 + jobs, making it the largest contractual agreement known to date.

Under the five-year contract, Noridian will administer claims for Medicare Part A, which includes hospitals, and Part B, which includes physicians, for a region that includes California, Nevada, Hawaii, Guam and American Samoa. The area, which includes more than 3.5 million covered beneficiaries, represents almost 9 percent of the total volume of Medicare fee-for-service claims administration business nationwide.

In this case, Medicare is creating jobs, what other ways do you see it impacting the health care industry in 2013?

For the first time ever, government-supported healthcare expenditures are expected to outpace private insurance. It's imparative to build a long-term, post-election strategy in a time of tighter budget constraints and a growing medicare population. So where do you start? With us! The 10th annual Medicare Congress is just weeks away, to learn more, download our brochure.

 As a reader of The Medicare Congress blog, you can use priority code XP1807BLOG to receive 15% off of the standard rate to register.

Monday, January 28, 2013

The challenge of companion diagnostics, FDA approval & reimbursement

Companion diagnostics offer a lot when paired with a drug, but most Pharma companies are having troubles bringing the diagnostics to market.  These test that are used that are likely to identify whether or not a person will respond to a treatment once they receive a drug.  Companies often have to work together to develop the diagnostic at the same time as the drug, but partnering does not often last throughout the development process, and then affordability developing a test to determine this diagnostic.

The reason for this, according to PharmExec is:
Timing is also key. The Tufts report emphasizes that collaborations between drug companies and companion diagnostics developers need to take into account the basic discrepancies in their business models. This is true not only within the context of effectively co-developing these products, but in maintaining harmony and pace between both entities to ensure the drug and diagnostics components are ready at the same time for review and approval before the regulatory bodies.

This May at the 2nd Annual Future of Companion Diagnostics Commercialization Summit, during the presentation Commercial Considerations that Must Factor into your Companion Diagnostic Partnership Decisions Andrea Lauber, of Bristol-Myers Squibb will be on hand to discuss the important things to consider when selecting a partner in developing a companion diagnostic. If you'd like to find out more about this session and the rest of the program, download the agenda. If you'd like to join us in Boston this May 22-23, 2013, as a reader of this blog, you'll save 15% off the standard rate when you register and mention code XP1812BLOG.

Monday, January 21, 2013

Better coordination could help save billions, Unitedhealth Center reports

Unitedhealth Center's recent report states that around $190 billion dollars could be saved by 2022, if the coordination of care for Medicaid and Medicare individuals improves. The majority of the states dual eligibles are spent on long-term care services, so by decreasing this number, the state will save immensely. The Centers for Medicare & Medicaid Services will implement a type of managed care plan that will blend payments of both Medicaid and Medicare.

UCH estimates the current CMS model will cover roughly one-fifth of all dual eligible beneficiaries. The report proposes states can more aggressively institute managed care models to better manage Medicaid funds for dual eligibles.

What are the best ways to improve the managed care model?

What are the overall strengths and weaknesses of the managed care model, including the opportunity to reduce readmission rates? At this year's D.U.A.L.'s Forum, Anthony Evans, RN, CP VP of Integrated Health, CareSource, leads our session: Managed Care Model for Dual Eligibles. To learn more, download our brochure.

We hope to see you April 4-5 in Baltimore, MD! 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.

Friday, January 18, 2013

Just Released: IIR's Medical Device Pricing, Reimbursement and Market Access Forum Agenda

A substantial setback to higher profitability and success for medical devices is the ambiguity of how to demonstrate value to potential customers. With the shift to an evidence-based value proposition, device manufacturers are seeking clarity for how to sell their products in this new environment. The all new Medical Device Pricing, Reimbursement and Market Access Forum brings together leaders across the commercialization value-chain to answer the reimbursement questions challenging the success of your product.

Get exclusive multi-stakeholder perspectives on how to overcome reimbursement challenges for market success:
  • ● Health Plan Keynote: Michael Sherman, MD, an d Senior Vice President and Chief Medical Officer, HARVARD PILGRIM HEALTH CARE
  • ● Government Keynote: David Seltz, Special Advisor, Health Care Cost Containment Office, OFFICE OF THE GOVERNOR OF MASSACHUSETTS
  • ● Provider Perspective: Lawrence Schecter, MD, Chief Medical Officer, WASHINGTON REGIONAL PROVIDENCE HEALTH & SERVICES
  • ● State Technology Assessment: Josh Morse, Program Director, WASHINGTON HEALTH TECHNOLOGY ASSESSMENT PROGRAM
  • ● Device Manufacturer: Robert Giffin, Vice President, Healthcare Policy and Reimbursement, COVIDIEN

This will also be located with the 2nd Annual Future of Companion Diagnostics Commercialization Summit! As a reader of this blog, when you register to join us in Boston this May 22-23, 2013 and mention code XP1813BLOG, you’ll save 15% off the standard rate. If you have any questions about this event, feel free to email Jennifer Pereira.

Wednesday, January 16, 2013

CMS proposes new rules for Medicaid

On Monday, January 16th, the Centers for Medicare & Medicaid Services proposed a new rule addressing issues concerning eligibility notices, process of appeals, notification, medicaid benefits, medicaid cost sharing, and verification of employer-sponsored coverage. The purpose was to help strengthen medicaid, childrens health insurance, and the health marketplace.

HHS said the proposed rule would give states more flexibility when operating their Medicaid programs and sheds light on how consumers will receive coordinated communications on eligibility determinations and how they can submit appeals. You can read the detailed proposal here.

How is your state preparing for a health insurance exchange?

Want to learn more about the integration between exchanges and Medicaid? Register for the Health Insurance Exchange Intensive a preconference option at the 22st annual Medicaid Managed Care Congress, taking place on May 20 – 22 in Baltimore, MD.

To view our full program, download our brochure. As a reader of the Medicaid Managed Care Congress blog, you get a 15% discount off the standard rate when using code XP1826BLOG to register.

Monday, January 14, 2013

Medicare Marketing’s Top Ten

Today's guest post comes from Lindsay Resnick, Chief Marketing Officer, KBM Group: Health Services, Lindsay can be reached at

 With over 14 million Americans enrolled in a Medicare Advantage and 10 million having a Medicare Supplement plan, generating leads and converting them to new sales is challenging every Plan. However with 3 million people aging-in to Medicare every year and thousands of plan “switchers” still making annual decisions, there are still opportunities to grow in this segment.

These market dynamics mean that Medicare Advantage plans looking for organic growth must juggle an array of skills to not only survive, but thrive:

 1. COMPLIANCE – Today’s Medicare marketers must understand and respect the important role compliance plays in the member acquisition process. This means making sure the link between marketing, sales and compliance is as strong as possible.

 2. DATA DRIVEN – Don’t leave Medicare marketing to chance. Start with data. It needs to be sorted, cleaned, refined, and turned into actionable intelligence. From building predictive models for most likely responders to variable direct response call-outs to optimizing media buys, data is king.

 3. AGE-INS – With thousands aging into Medicare every day, new approaches are needed to attract today’s boomer-seniors. It takes a combination of meaningful education, sequenced messaging, and different approaches to outreach to connect with “turning-65” audience.

 4. MEMBER RETENTION – The cost of acquiring a new member is 5X the cost of retaining an existing one. Loyalty-based member engagement plays a big role in a health plan’s long-term success and ultimately, member LifeTime Value.

5. STAR RATINGS – Marketing’s role is critical to ensure member communications reinforce customer satisfaction. Engagement marketing goes a long way in a Medicare plan’s ability to achieve the highest possible Star Rating and payment bonuses that come with it.

6. CUSTOMER INTERACTION – Give beneficiaries a reason to engage and connect with their Medicare plan. It takes direct-to-consumer offers that invite seniors to reach out to receive clear, sound and personalized recommendations. Create personalized opportunities for one-on-one interactions.

7. DIGITAL MEDICARE – As more Medicare shoppers use the Web as their primary research tool, it’s essential to have a Medicare online experience that’s user tested, compelling, and built for seniors.

8. MULTI-CHANNEL SALES – Different Medicare customers require different doors of entry, from agents to telephone to online to retail outlets. There’s tremendous value in the expanded reach of a multi-channel sales distribution strategy.

 9. DIFFERENTIATED VALUE – Being the health plan of choice is achieved by building trust, credibility and relevancy around your Medicare value proposition. This means understanding drivers that motivate prospects to select your plan and answering a beneficiary’s biggest question, “What’s in it for me?”

10. MARKETING ROI – Pressure on Medicare marketers has never been greater. The ability to track, analyze and measure results throughout the marketing cycle will bring you success…you can’t manage what you can’t measure! In a Medicare market, characterized by cutthroat competition and abundant product choice, potential customers looking for a resource to help guide their Medicare purchasing decision. A structured, mutli-disciplined approach to Medicare marketing has never been more important.

ABOUT US KBM Group: Health Services is a healthcare marketing and consumer engagement services provider that combines its proprietary national database consumer database with sophisticated segmentation and predictive analytics to drive offline/online direct-to-consumer marketing campaigns.

Join us February 11-13 in Phoenix, AZ for the 10th annual Medicare Congress, and attend both KMB sessions: Focus on the Members: Building a positive member experience and best practices to increase accuracy for self-reporting  & Medicare’s digital customer: five game-changing marketing tactics. To learn more, download our brochure.

As a reader of The Medicare Congress blog, you can use priority code XP1807BLOG to receive 15% off of the standard rate to register.

Tuesday, January 8, 2013

Do You Know the Future of Medicare?

Of course, none of us know the future of Medicare, although we know that the program will have to change vastly in order to survive past 2024, when Medicare's hospital fund would begin to run out of money. In the past, conversations have focused on raising the Medicare eligibility age two years, but there must be other ways for Medicare to adapt and provide higher quality care without increasing expenses. At the 10th annual Medicare Health Congress we will examine innovative ways to decrease expenditures through cutting-edge care delivery models including ACOs and PCMHs, value based contracting and risk sharing.

At the Medicare Congress, an ACO, a physician-owned healthcare organization and health plan executives come together to discuss how they see the industry moving forward in a time when innovation is not only expected, but necessary.

The Future of Healthcare and Innovative Care Delivery Models:

Randall Krakauer, MD, National Medical Director, Medicare, Aetna

Scott H. Sarran MD, MM, Chief Medical Officer, Blue Cross Blue Shield of Illinois
Debra K. Gribble, Executive Vice President, Essence Healthcare
Palmer Evans, MD, Senior Advisor, Administration, Tucson Medical Center
Joe Johnson, MD, Chief Medical Officer, Arizona Integrated Physicians

To learn more, download the full brochure.

As a reader of The Medicare Congress blog, you can use priority code XP1807BLOG to receive 15% off of the standard rate to register.  Looking forward to seeing you February 11-13 in Phoenix, AZ! If you have any questions about the agenda or event, feel free to email Kate Devery at or visit the homepage.

The Medicare Congress Team 

The Medicare Congress Homepage
The Medicare Congress Twitter

Monday, January 7, 2013

Learn from the Best, Not the Rest

Happy New Year! As far as we can tell, 2013 will be the year of healthcare—post-SCOTUS ruling and 2012 elections the ACA is quickly moving towards implementation. One of the biggest opportunities created by the ACA is the opportunity to provide better care coordination for dual eligibles, one of the country’s most vulnerable populations.

At the D.U.A.L.S. Forum you will hear best practices from health plan leaders who are successfully providing high quality, cost-efficient healthcare to this complex population.

Attend the D.U.A.L.S. Forum on April 4-5 in Baltimore to hear case studies presented by the following health plans:

• Network Health entered the Massachusetts pilot program in late-2012
• CareSource entered the Ohio pilot program in mid-2012
• BlueCross BlueShield of Massachusetts entered the Massachusetts pilot program in mid-2012
• Boston Medical Center HealthNet Plan (BMCHP) entered the Massachusetts pilot program in late-2012
• L.A. Care Health Plan entered the California pilot program in early-2012

To view the 2013 program, download the agenda.

As a reader of the D.U.A.L.S. Forum Blog, you get a 15% discount off the standard rate when using code XP1804BLOG to register. If you have any questions about the agenda or event, please contact Kate Devery at or visit our webpage.

We look forward to seeing you in Baltimore this spring!

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

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

Friday, January 4, 2013

Download the Medicaid Managed Care Congress Brochure!

Get all the details on the largest and most respected Medicaid managed care event, taking place from May 20-22, 2013 in Baltimore, MD.

 See all the exciting new sessions, focused on healthcare reform, best practices for improving health outcomes and creative ways for managing costs. With more than 60 speakers and new preconference summits, this year's event is more relevant and timely than ever before.

 Highlights include:

More than 30 presentations from all of the big players including Wellpoint, AmeriHealth Mercy, Amerigroup as well as smaller regional plans like Network Health, Neighborhood Health Plan of Rhode Island and MDwise.

Preconference summit options focused on health insurance exchanges, predictive modeling, Medicaid managed care for pharmaceutical executives and the ever-popular Medicaid Managed Care 101.

Three newly aligned tracks bringing you everything from financial and administrative considerations to sales and marketing excellence to best practices for complex care management.

To view the 2013 program, download the agenda.

As a reader of the Medicaid Managed Care Congress LinkedIn Group, you get a 15% discount off the standard rate when using code XP1826BLOG to register. If you have any questions about the agenda or event, please contact Kate Devery at or visit our webpage.

Medicaid Managed Care Congress Team Medicaid Managed Care Congress

Medicaid Managed Care Congress Homepage 
Medicaid Managed Care Congress Twitter 
Medicaid Managed Care Congress Blog