Wednesday, April 30, 2014

Get the Complete GTN Perspective | Last Chance to Save $400 is This Friday, May 2nd

The 2nd Annual Gross-to-Net Accounting Forum is less than 2 months away, and I couldn't be more excited about the enthusiasm and excitement surrounding the event. Join the growing list of attendees to see why timely and imperative GTN content is and how crucial it is to your business.

We've got a packed agenda including in-depth coverage on chargebacks and the impacts of healthcare reform on Medicaid accruals and liability to ensure you leave with the complete GTN perspective. You will hear directly from experts at big and small pharma, and branded and generic companies on key areas such as:

  • Automation
  • Pipeline Strategy
  • Medicaid Liability
  • Chargebacks
  • Returns
  • Managed Care
  • Loss of Exclusivity   
Click here to download the updated brochure.

Seats are filling up rapidly, so hurry and register today! This Friday, 5/2 will be your last chance to save up to $400! Be sure to use code: XP1911BLOG

Click here to register.

I look forward to meeting you in Philadelphia this June.

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Friday, April 25, 2014

Decode Big Data to Drive Decisions | Register for HDI by Friday to Save $500!

 According to PricewaterhouseCoopers, big data and predictive analytics help companies better understand their audiences and how to engage them.

We're not talking to the "data guy". We're talking to YOU-the person making informed decisions based on data that is material to your business (claims data, member feedback, clinical data, etc.) By translating this information into actionable insights, you have the power to make more efficient and effective business decisions.

Don't fall behind as more and more companies grow increasingly data-driven and are more willing to apply analytics-derived insights to key business operations. Join us in Chicago this June 23-25 at IIR's all-new Healthcare Data Insights, where you will hear from speakers who successful implement big data analytics into their business strategy.

Discover how to make the best data-driven decisions for your company with speakers including:
•    Elizabeth Benz, Associate VP of Community Outreach & Engagement, Molina Healthcare of Wisconsin   
•    Greg Poulsen, Senior Vice President, Chief Strategy Officer, Intermountain Healthcare   
•    Bob Gladden, Vice President of Decision, Support & Informatics, CareSource   
•    Dan Munro, Contributor of Healthcare IT, Innovation and Policy, Forbes

Register by Friday 4/25 to save $400! Plus take an extra $100 off when registering with the code: XP1902BLOG

That is $500 in total savings, register today!

Learn more about Healthcare Data Insights here.

Thursday, April 24, 2014

Summit for Oncology Management Podcast Series with Dr. Ronan Kelly of John Hopkins

Below is a teaser from our podcast series with Dr. Ronan Kelly...
Director of Gastroesophageal Cancer Therapeutics Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins and the Medical Director of Global Oncology, John Hopkins International

To begin, the Institute of Medicine has declared that cancer care in the US is a system in crisis. Do you agree? 

Dr. Kelly: The word “crisis”, I think, may not be the best word to use. I certainly think that major changes are needed. If we, as a cancer community, do not take ownership of some of the problems that we will talk about today, then I think others will make the tough decisions for us.
What we have learned, especially in the last couple of years, is that costs will not constrain themselves and that we really are reaching a tipping point where we need to take definitive and direct action. Often, some uncomfortable actions will be required to get on back on path.

Some of the trends that are amplifying the crisis – as pointed out by the Institute of Medicine – is that we do have an aging population of, thankfully, more and more survivors. But, what we are seeing is a 30% increase in cancer survivors by 2020 as a result of many of the significant scientific treatment advances that we’ve been able to achieve in the last couple of years. But we are also seeing that the incidence of cancer is expected to go up approximately 45% by 2030. So, because of these changing or increasing patient survivors and increasing cancer numbers, we are seeing that the cost of cancer care is really, really going up. In the US we are expecting between 2010 and 2020 that there will be a 39% increase in the cost of cancer care up to $173 billion and some experts are even saying that this may be conservative estimate.

So, I think we certainly need to make changes. The current system that we have right now is not sustainable. So, some direct and often uncomfortable actions will need to be done in order to get us back on track. And to ensure that we continue to treat future generations with better and better treatments. So, some decisions are needed right now. I would agree that the system needs to be altered and, in some cases, needs to be dramatically fixed.

To hear more from Dr. Kelly, please join us July 21-23 in Philadelphia, PA for IIR's Summit for Oncology Management. 

To receive 15% off the standard registration rate, use the code: XP1914BLOG

Save 15% today, register now.
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Wednesday, April 16, 2014

HDI Podcast Series with Steward Health Care Network

Healthcare Data Insights Podcast Series
 Below is a teaser from our podcast series. Thank you to our participants...

John Donlan, Chief Operating Officer
Dominique Morgan-Solomon, Vice President, Population Health
Steward Health Care Network

What are some of the challenges you faced when implementing data-driven strategies and how did you overcome them?

Dominique: We are a very heterogeneous network, we have over 2700 providers. With that we are on over – I want to say at least 30, but there are more than that – EMRs. They all look different and the data coming out of them is different. So, our challenge over the last two years has been about how do we integrate or aggregate the data that’s coming out of those EHRs such that we can use it and use it in a much more real-time fashion because that’s really what’s meaningful. That’s one of the larger challenges.

We also have the challenge of while we sit on the Network – and I’m glad that John described the larger system – we are part of a larger hospital-based system and so how do we integrate information that is coming out of those EMRs, along with the information that is coming from the ambulatory-based provider’s EMRs to be able to get to the clinical data that is necessary for us to be able to identify the population. As well as from a performance perspective, be able to articulate who are the people who fall into various populations, like our diabetic and our heart failure patients. A lot of that information is defined based off of clinical measures and not claims-based measures. So, getting access to that data is one of the larger challenges that we face.

One other challenge that is tied into that is getting information in a real-time manner. One of the interesting challenges of being part of a pioneering ACO is that the population turns over on an annual basis. While we retain a significant proportion of the population year-over-year, when January 1st comes along, we have either an influx of new patients or potentially an out flux of old patients based off the methodology that CMI uses to do attribution. Because of that, in order for us to effectively impact that population in a real-time manner, we have to be able to pull data out of systems and use real-time information so that we can quickly stratify, identify and engage that population within a less than 12 month period in order to make an impact in that performance year. So, timeliness of data, I would say, is a huge challenge in the integration of the heterogeneous system that we have within our Network are two of the biggest challenges that we’ve had with data.

Now, how do we go about overcoming them? We’ve engaged some partners who have helped other organizations resolve this problem and who have some background and experience in being able to access various EMR data sets and integrate and aggregate that data. Certainly, it’s a challenge that I wouldn’t say today that we’ve overcome it, but we have a plan to overcome it and we’re moving forward on it. But, I would also say the other quick and dirty, so to speak, are boots-on-the ground way of overcoming, which is what I said before which is we have to spend a lot more time engaging providers and members themselves to get to some of the information that is more actionable in a real-time basis.

As John mentioned, we have a very robust governance structure, but underlying that governance structure is an operational structure where we have field operations teams that are aligned to a local chapter and aligned to our local provider groups so that they can be much more in the practices and much more engaged with the providers so that they can glean a lot of that information, like Mrs. Jones who has financial issues and that’s why she’s not filling her medications, which won’t be apparent in an EMR or we don’t have access to that information in the EMR quickly.

So, we’ve chosen in the interim – as well as really trying to leverage the medical home kind of model – we leverage our field operations team being much more embedded in our local chapters. The folks who make up those teams are both clinical, as well as operational in nature. So, our performance improvement advisors are really working on workflow enhancement and work hand-in-hand with a nurse care manager and social workers and pharmacists who are also working with the providers to best identify and manage the populations for which they serve.

To hear more from Steward Health Care Network, join us June 23rd through 25th in Chicago for IIR’s Healthcare Data Insights Conference.

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Friday, April 11, 2014

Download Gorman Health Group’s expert summary of the 2015 Final Rate Announcement from CMS

John Gorman predicted that -- if the rate announcement was enacted as outlined in the draft call letter -- it would be "just about a worst-case scenario for flabby, distracted, uncommitted health plans in Medicare."  John declared "there is no question that the 2015 call letter is an evolutionary event and some inferior species will be eliminated."

Now that the Final Rate Announcement has been released we can finally get some concrete answers. Gorman Health Group's renowned financial and policy experts Bill MacBain and Jean LeMasurier are teaming up to provide a detailed analysis and summary of the final regulation.

While Jean and Bill are finalizing the Summary of the Final Call Letter, you can request a copy and we will notify you as soon as it is ready.  But while you wait, enjoy access to some additional resources.  Request a copy of the Summary here.

As an added bonus, Bill and Jean will also be hosting a complimentary webinar today from 2:00PM – 3:30PM to offer insight on the Final Rate Announcement from CMS. You will walk away from this session with critical to-do items and issues to tackle in order to ensure your success in 2015 and beyond. Register now. 


Reminder – Don’t miss IIR’s Healthcare Data Insights taking place June 23-25 in Chicago. Register by Friday 4/25 to save $400 on the standard conference rate.  For more information, click here.

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Thursday, April 3, 2014

Reminder - Complimentary Revenue Leakage Webinar | Register Now

Revenue Leakage:  Industry Definition, Insight and Best Practices to Mitigate Risk
Join us for a Webinar on April 14th—space is limited!
Reserve your Webinar seat here.
Mention Priority Code: XP1911WEB

Understand what ‘Revenue Leakage’ means to branded pharma, start-ups, generics, and biotechs with IIR’s 2nd Annual Gross-to-Net Accounting Forum’s discussion group chairs! 
• Collective Industry Definition
• Customer Segment and Channel impacts
• Financial Statement impacts (accruals, cash flow, forecasting)
• The industry risk between adjudication and audit —the need for continuous improvement.
• Industry best practices and next steps for mitigating risk and continuous improvement.   

Jennifer Sharpe, Revenue Analytics Gross-to-Net, daVIZta

From Big Pharma – Courtney Callihan, Finance Director, GlaxoSmithKline
From Small to Mid-Sized Pharma – Larry Breen, Director of Financial Planning and Analysis/Revenue Analytics, Sunovion Pharmaceuticals
From Generics – Roxana Santiago, Senior Finance Director, Gross to Net, Hospira Worldwide, Inc.

After registering you will receive a confirmation email containing information about joining the Webinar.

Keep the discussion going with our Chairs at IIR's 2nd Annual Gross-To-Net Accounting Forum

2014 Conference Highlights include:
• New tailored discussion groups to collaborate across Managed Markets, Commercial, Government Programs and Finance for Big, Small to Mid-Sized Pharma, and Generics
• First opportunity to get up close and personal with the AMP Final Rule at the pre-conference workshop
• Never-before-heard case studies on GTN automation and chargeback methodology, in addition to strategic forecasting panel discussions
• Quantifying approaches for the impact of Medicaid, 340B and Healthcare Reform

Register by 5/2 and save up to $400 off standard registration rates

If you have any questions about the agenda or event, please contact Ryan Geswell at or visit our webpage.

We look forward to seeing you June 17-18 in Philadelphia!

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Wednesday, April 2, 2014

Post-Hospital Syndrome: The Return to the Community After Hospitalization

Our guest blogger today is David Young, Ph.D., Vice President of the Center for Clinical Excellence at Seniorlink, the parent company of Caregiver Homes this year, Harlan Krumholz, MD, a cardiologist at the Yale New-Haven Hospital Center for Outcomes Research and Evaluation, published a provocative article in the New England Journal of Medicine titled "Post-Hospital Syndrome: An Acquired, Transient Condition of Generalized Risk". In the article, Dr. Krumholz reminds us that recently hospitalized patients are not only recovering from the illness or condition that prompted the hospitalization but are also experiencing a period of generalized risk for a range of adverse health events. He calls this an acquired "syndrome" that involves a temporary period of extreme vulnerability for other health problems.

Naturally, the post-hospital syndrome will vary from patient to patient based on a host of factors. However, care providers – notably those providing Home and Community-Based Services – should be on the lookout for changes in behavior that could include: heightened stress, sleep disturbance, medication changes, cognitive changes and deconditioning that can alter the ability to perform daily living activities. These changes often occur regardless of the original cause for hospitalization; it is a syndrome that can apply to all recent discharges in consumers – both young and old.

Home and community-based service providers, especially those assisting elders, should be comprehensively evaluating patients returning from the hospital for changes that might exacerbate the primary problem (that led to the hospitalization) as well as the syndrome of potential changes described by Krumholz. Details about the hospitalization should be gathered along with a comprehensive re-assessment of medical, functional and emotional status of the patient.

Critical-thinking questions should be asked. Here are some examples:

• Is the caregiver and family able to provide the post-hospital care needed?
• What is the potential caregiver strain (burden)?
• Does the caregiver need education about care requirements?
• Do caretakers have knowledge of the "red-flags" to look for so that decline can be identified early?

Dr. Krumholz suggests that community care providers use "risk-mitigation" strategies that go beyond the cause of the initial hospitalization to look at the potential for infection, medication adverse events, falling and confusion, just to name a few. He suggests that strategies aimed at reducing disruptions in sleep and pain be addressed. Good hydration and nutrition should be emphasized along with judicious, careful physical reactivation and re-introduction of leisure outlets.

Great care transition work in the community starts with great communication between all providers. When a consumer, especially an elder who needs help with several activities of daily living, returns from the hospital, a coordinated care team approach is advised; one that engages in a comprehensive assessment of patient requirements as well as the strengths and needs of the caregiver and family. By identifying areas of risk and then creating care plans that specifically address them in a person-centered manner, the risk of rehospitalization will be greatly reduced.

This is a "win" for all: the consumer is healthier and happier, caregivers feel more capable of providing the supports needed, and avoidable costs are eliminated.

To read more informative articles on person-first care planning, visit the Caregiver Homes blog here.

Caregiver Homes, the leader in Structured Family Caregiving, provides the training, support and financial assistance to keep around-the-clock caregiving in the home. Structured Family Caregiving (SFC) is a quality, 24/7 care alternative for consumers, caregivers, and the professionals who support them. The organization, a wholly owned subsidiary of Boston-based Seniorlink, Inc., is dedicated to helping elders with complex medical conditions and people with disabilities live with dignity and independence in their communities. Caregiver Homes employs highly-qualified professionals and specially-designed communication technology to empower family and community members to provide extremely effective, high-quality care at home while being paid for their commitment. The program was launched in 2005 and currently serves more than 2,000 consumers in Massachusetts, Rhode Island, Ohio, and Indiana, with plans to serve more states soon. For the professionals and families who collaborate with us, Caregiver Homes delivers safety, security, health, and well-being. Visit for more information.