Friday, October 31, 2014

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

Top Stories:

How The Upcoming Elections Might Shift The National Health Care Landscape
Here’s a solid prediction about next Tuesday’s elections: They’ll be crucial to the future of universal health care in America — or at least its near-term future.

Health Care Catches Data Fever
The United States is arguably in the midst of a health care crisis, but there is hope on the horizon and it involves learning how to make sense of big data. Over at Communications of the ACM, Oak Ridge National Laboratory (ORNL) shares how it is helping the health care industry benefit from patient data using the power of graph computing.

CFOs Feel Powerless When It Comes To Managing Healthcare Costs, Poll Finds
With U.S. enterprises spending more than $620 billion each year on healthcare costs, and nearly half of all Americans receiving their coverage through their employer, it’s no surprise that four out of five chief financial officers (CFOs) across all industries are feeling the pressure. In fact, nearly all CFOs (97%) believe that employers must “step-up” to the plate to help fix the broken healthcare system.

Omidria™ Granted Pass-Through Reimbursement Status from CMS
Omeros Corporation (NASDAQ: OMER) announced today that it has received transitional pass-through status for its lead product Omidria™ (phenylephrine and ketorolac injection) 1%/0.3% from the Center for Medicare & Medicaid Services (CMS), the federal agency that administers the Medicare program.

Health Groups Aim to Grow Pharmacists’ Care Delivery
Community Care of North Carolina (CCNC), GlaxoSmithKline (GSK), and the University of North Carolina (UNC) Eshelman School of Pharmacy have collaborated to generate new approaches to care delivery through pharmacists that will lower medical costs and improve health outcomes.

Have a great weekend!

Wednesday, October 29, 2014

The Medicare Congress Brochure is Now Available | Register Now to Save $600

The 12th Annual Medicare Congress was designed with you and your team in mind—covering Medicare and Dual Eligibles from A-Z. Make sure you join us this February 3-5 in New Orleans!

Let us help you navigate through the evolving landscape so you can increase reimbursement with stronger Star ratings, build relationships with provider networks to improve quality of care, meet the clinical needs of dual eligibles to attract and retain new members— and much more!

What’s new at Medicare Congress 2015:
• C-Level Sound Off
• Patient Advocacy Group Panel
• Think Tank Roundtable Luncheon
• Town Hall Round-up
• And more!

Register now and SAVE $500 but use the code XP2007BLOG and take an extra $100 off – total savings of $600! Register here.

PLUS! Dual Forum and Stars University are back by popular demand. Click here to learn more.

Tuesday, October 28, 2014

Rising Drug Costs

Welcome to this FDA/CMS Summit for Payers podcast.

Below is a teaser from our podcast with Bill Winkenwerder, Former CEO, Highmark Inc.

How should manufacturers determine drug prices and what consideration should there be?

Bill: Well, certainly manufacturers need to recover their costs – their investment in R&D – and it’s important that they make a profit. Nobody can be in business for any period of time without being able to make a profit. Now, more recently – especially with respect to certain manufacturers that have brought very expensive medications to the market – have been criticized and have been identified as charging too much. That’s the common perception, but I see the immediate evidence that the prices for these medications – given the relatively small population of people that would benefit from them – that there is a serious over-charging that’s going on. But, certainly we need to sit down and talk and determine if there is a better way to arrive at the price. What is a fair price? What is a good, market-based price? That’s what this Conference is about.

To see more from Dr. Winkenwerder, download the complete podcast here.

Download the updated event brochure here. 

Bill will be joining us at the FDA/CMS Summit for Payers in Washington D.C. for his closing keynote address "An Industry Perspective: Payment Policy for Clinically Valuable But Very Expensive Pharmaceuticals" on Friday December 12th.

Register now to save an extra $100 off the current rate with the code XP1917BLOG.

See you in Washington D.C.

Friday, October 24, 2014

Health Care Insights | Weekly Round Up

Health Care Insights brings you your weekly healthcare round up. Below you will find relevant articles on key industry topics that we thought our readers would benefit from - enjoy.

 Top Stories:

4 Principles Guiding Healthcare’s Age of Enlightenment
There are many emerging themes and movements driving healthcare innovation and evolution, which is comparable to the Age of Enlightenment with its new discoveries and ways of solving problems.

“There’s no mystery, no magic… you can access all patient data at the bedside“
 Katleen Smedts, Project Manager ICT at University Hospital Antwerp (UZA) and Bernard Algayres, GM Radiology IT EMEA, GE Healthcare, discuss how vendor neutral archiving can improve access to patient data, facilitate clinical collaboration and drive up quality of care.

Experts say Texas needs more than specialized centers to fight Ebola

Dr. Thomas Geisbert, a scientist at the University of Texas Medical Branch at Galveston, was at a conference in Germany in 2000 when he and a Canadian collaborator decided to work together on a vaccine against the deadly Ebola virus.

Avalere Analysis: Medicaid Managed Care Enrollment Set to Grow by 13.5 Million

A new analysis from Avalere Health projects that enrollment of Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries in managed care – i.e., state payment of private companies to provide benefits – will increase by 13.5 million individuals from 2013 to 2016.

CMS launches $840M effort to spur medical practice ‘transformation’

The effort, called the Transforming Clinical Practice Initiative, is a first-of-its kind effort from the public sector and large-scale investment dedicated solely to sharing information among physicians. CMS estimates that only about 185,000 of the country’s doctors take part in similar programs that strive to transform industry practices through the use of collaboration and technology.

Relaunched health IT company offers MDs chronic condition patient data between visits

A health IT company that previously provided migraine patient data to pharmaceutical companies, Ubiqi Health, has relaunched as Klio Health. The new business, which CEO Jacqueline Thong started earlier this year,  aggregates data from patients with chronic conditions with the goal of assessing effectiveness of treatment between visits through a portal.

Have a great weekend!

Tuesday, October 21, 2014

Center for Drug Evaluation and Research, New Drug Review: 2013 Update

FDA/CMS Summit 2014 speaker John K. Jenkins, M.D., Director, Office of New Drugs, Center for Drug Evaluation and Research, FDA.


Below you can access his presentation from last December at the FDA/CMS Summit. In his presentation, Dr. Jenkins addresses these key topics:

•    How is CDER doing with regard to meeting PDUFA goals?
•    What are the trends in new drug approvals?
          o    IND activity, NME submissions, and NME approvals
•    Implementation of PDUFA V/FDASIA
          o    “Program” for NME review
          o    Breakthrough Therapy Designation Program
•    Update on PMCs/PMRs

Dr. Jenkins also addresses the main themes in new drug review:

•    Continuing resolution – the new normal
•    PDUFA V; hold the additional resources
•    FDASIA implementation; what new resources?
•    The “Program” takes off
•    Breakthroughs breaking out
•    Sequestration bites
•    Shutdown shuffle
•    Patient-focused drug development refocused
•    “Slow down?” in NME approvals – not really
•    Despite challenges, new drug review program successes continue!

To access the complete presentation from Dr. Jenkins, click here.

Join us this December 11-12 in Washington D.C. to hear Dr. Jenkins address these challenges for the upcoming year. This is an event you do not want to miss. Register now and save $300 off the standard rate, just use the code XP1917BLOG at checkout. To register, click here.

Thursday, October 16, 2014

mhpa2014, Medicaid Health Plans of America’s event for the Medicaid managed care industry

mhpa2014, the annual conference of Medicaid Health Plans of America and a must-attend for Medicaid MCOs, is on October 26-28 in Washington, DC.

mhpa2014’s sessions, expert insights, and networking receptions will provide health plan attendees all they need to succeed in the new age heralded by the ACA. 

Meet health plan executives, policy experts, state and federal Medicaid officials, and business leaders to discuss the latest in Medicaid managed care.

Speakers include CMS’s Barbara Edwards, CMO Dr. Steve Miller of Express Scripts, and John Lovelace, president of UPMC for You.

mhpa2014 also features Thomas Duncan, CEO of Trusted Health Plan, William S. George, CEO of Health Partners Plans, and Karen Clark, President, Horizon NJ Health, fielding questions from Forbes writer Bruce Japsen.

mhpa2014 will close with a discussion with Medicaid Directors from Kentucky, Louisiana, Tennessee, and Virginia.

For details, visit 
Questions? Contact Sarah Swango at 202-857-5772

Tuesday, October 14, 2014

What is the problem surrounding the emergence of new medications?

Welcome to the FDA/CMS Summit for Payers podcast series.

Below is a teaser from our recent podcast with Bill Winkenwerder, Former CEO, Highmark Inc. 

Could you tell us a little bit about your background?

Bill: I trained as a Primary Care Physician and practiced for several years. I then became interested in the management of healthcare and population health. That led me to many years as a Medical Director and Chief Medical Officer and then as a Chief Operating Officer and then CEO. For several years I led the Military Health System – a very large job. I had the responsibility of caring for millions of American service members and their families. Most recently, I served as CEO of Highmark Health, which is a large, integrated healthcare delivery system.

Is there a problem with respect to the emergence of new medications that are truly effective for serious and life-threatening diseases, yet these medications are very expensive?

Bill: Yes, there is a problem. The problem is that the drugs are expensive. The problem is not that they are ineffective. In fact, that’s our challenge, that there are some really, truly, miraculous new medications that have come on the market and are going to be coming on the market in upcoming years. Targeted therapy – guided therapy – guided by pharmacokinetics and information that tells us exactly where to target the therapies. But, the problem is that these medications are expensive to develop. The pharmaceutical manufacturers have invested hundreds of millions – if not billions – of dollars into developing these medications and it’s important that they recover their costs.

So, it really does present a challenge for all of us – the pharmaceutical manufacturers, the providers, payers and government policy makers.

Bill will be joining us at the FDA/CMS Summit for Payers in Washington D.C. for his closing keynote address "An Industry Perspective: Payment Policy for Clinically Valuable But Very Expensive Pharmaceuticals" on Friday December 12th

Register now to save an extra $100 off the current rate with the code XP1917BLOG.

See you in Washington D.C.

Friday, October 10, 2014

Celebrate Columbus Day! Register for FDA/CMS Summit for Payers by Monday & save $300!

Register for the following IIR event and receive $300 off*

Mention code COLUMBUSBLOG to save on the following:

Register here for IIR’s FDA/CMS Summit for Payers event taking place December 11-12, 2014 in Washington D.C., visit the website for full details.

Have any questions? Email Jennifer Pereira.

*This promotion is only valid October 10th-13th 2014. Offer cannot be applied retroactively to confirmed paying registrants and cannot be combined with any other discounts or promotions. All registrants and guests are subject to IIR approval.

Thursday, October 9, 2014

How to Reduce Readmissions for At-Risk Medicare Patients Using Information Technology


Community-based health coaches and care coordinators reduce readmissions using information technology to identify and support at-risk Medicare patients after discharge.

Supported by mobile technology, trained health coaches at Elder Services of Merrimack Valley (an Area Agency on Aging in Northeastern Massachusetts) visit recently discharged Medicare patients in their homes and monitor them via telephone to identify and address declines in health status that increase the risk of readmission. Administered in partnership with area hospitals, the 4-week program begins with an in hospital visit to determine the risk of readmission. Patients at medium or high risk for readmission receive an in-home visit within 48 hours of discharge and a weekly phone call for each of the next 3 weeks. During each encounter, the coach uses a tablet-based application that provides suggested questions written in lay language based on the patient’s diagnoses, treatment, and overall risk profile. If the answers indicate a decline in health status, the system sends a real-time alert to a nurse care coordinator, who subsequently uses a different component of the software to help the patient and coach address the issue within 24 hours, including arranging for any needed services. The use of health coaches supported by the tablet-based software significantly reduced readmissions among at-risk Medicare patients, as compared with use of health coaches without the software. This reduction generated substantial cost savings for partner hospitals and the health care system as a whole.

You can see the complete study and findings here.

Tuesday, October 7, 2014

Behavioral Economics: Consumer and Patient Engagement & New Models of Care

Extensive work in behavioral economics has demonstrated ways in which people are predictable irrational. This work is now being applied to better understand ways to increase healthier behaviors in a wide range of contexts ranging from health insurance benefit design, cafeteria food layout, smoking cessation, weight loss, medication adherence, and chronic disease management using wireless devices.

At the FDA/CMS Summit for Payers in Washington D.C. this December, Dr. Kevin Volpp, MD, PhD, Founding Director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute will briefly discuss some of the key principles of behavioral economics before talking about elements of choice architecture, incentive design, and 'automated hovering' that are being tested in field settings around the United States with the goal to increase consumer and patient engagement. In his sessions, you will:
- Understand how behavioral economics differs from traditional economics
- Learn ways to apply defaults and choice architecture to drive behavior change
- Understand the core concepts to optimize incentive design
- Be familiar with emerging trends of 'automated hovering'

Below you will find a video of a talk Dr. Volpp did in 2012 at Wharton on Behavioral Economics and Automated Hovering....

Make sure you join Dr. Volpp this December in Washington D.C. to hear what comes next. Download the updated FDA/CMS Summit for Payers agenda now to see who else will be speaking on the program.

And remember, blog readers receive a special $100 off the current rate when registering with the code XP1917BLOG - Register now! 

Wednesday, October 1, 2014

Apexus Wins HRSA Contract to Remain Prime Vendor of 340B Program

Texas-Based Company Will Continue to Assist Safety-Net Providers in Providing Care to More Patients

September 29, 2014

Apexus, LLC, the prime vendor for the 340B Drug Pricing Program, has announced that it has been selected by the Health Resources and Services Administration (HRSA) to continue serving in its role as the prime vendor through September 29, 2019. Apexus, which has held this position for the past 10 years, will continue to work with more than 25,000 safety-net provider locations, drug manufacturers, pharmacy wholesalers, and other stakeholders to negotiate discounts on pharmaceuticals and offer valued services, while supporting compliant operations and helping stakeholders to continue to deliver health care services to underserved populations.

“We are thrilled and proud for the opportunity to continue working with HRSA to strengthen this important program that helps so many families across the nation gain access to essential medications,” said Apexus President Chris Hatwig. “With our team’s unsurpassed knowledge of the 340B Program, our unique national distribution channels, and our highly regarded educational programs, we are able to deliver maximum value to 340B stakeholders through the promotion of program integrity, compliance, and optimization of the program.”

Beyond its contract work, Apexus is also the premier national resource for 340B educational programs, helping 340B stakeholders and healthcare policy experts receive and understand the latest information about the 340B program. Apexus Answers, its national call center, aligns with HRSA to provide up-to-date policy, compliance, registration, and recertification information.

The 340B Program was signed into law by President George H.W. Bush in 1992 with the purpose of requiring drug manufacturers to provide outpatient drugs to eligible hospitals, clinics, and other health care organizations at significantly reduced prices so these covered entities could stretch their resources and be able to provide medications and other services to underserved populations.

Apexus serves as the exclusive prime vendor for the 340B Program, managed by the Health Resources and Services Administration (HRSA). As the 340B prime vendor, Apexus works closely with HRSA’s Office of Pharmacy Affairs to enable approved entities to optimize the value of the 340B drug pricing by both reducing costs and supporting entities to establish compliant operations in the communities they serve. Apexus also operates Apexus Answers, the national call center available for all stakeholder questions, and manages in-depth 340B educational programs through 340B University™ to support stakeholder compliance and program integrity.

Based in Irving, Texas, Apexus currently serves more than 25,000 safety-net provider locations by delivering additional savings on pharmaceuticals through the 340B Prime Vendor Program (PVP).

Lisa Sokol
(972) 910-6665