MDRP Lifetime Achievement Award

Each year the MDRP audience selects who should receive the “Lifetime Achievement Award.” Nominations are now open. Make sure to get your choice in for consideration now.


As the longest running MDRP conference, we are honoring the best and recognizing the dedication of those who have propelled this industry forward. Please submit your award nomination(s) here. We have divided the nominations by role in the industry, as so many have worked together to make the Medicaid Drug Rebate Program what it is today. The deadline for nominations is Monday, August 11, 2014 and the winners will be announced at the event during the networking reception on Tuesday, September 16th - So make sure you register to attend the event now. Save $300 when you register by 8/8 with the code XP1958BLOG.

To learn more about the program, download the brochure now. 

See you in Chicago this September!

Rising Healthcare Costs | What are the Biggest Challenges?

 

Welcome to the Specialty Pharmacy Collaboration Summit podcast series. Joining us today is Robert Popovian, Senior Director, US Government Relations, Pfizer Pharmaceuticals. 

Download the complete podcast & transcript here.

What are the biggest challenges that you face presently with rising healthcare costs?

Robert: Well, healthcare costs are increasing. We are close to about 20% of our GDP is spent on healthcare expenditures and that number is going to continuously go up, just because of the demographics in the United States.

If you look at spending and healthcare in general with regards to pharmaceuticals, pharmaceutical spending has risen slowly and overall healthcare spending – as well as other healthcare segments in the last few years – and the price increases have been pretty much in line with the other segments of healthcare.

The challenge that we have with healthcare expenditures in the United States is that we have a very dysfunctional payment mechanism in the US where we are challenged with an outdated insurance policy model where we don’t necessarily pay for the best interventions in healthcare because of the mechanisms of reimbursement where we have pharmaceuticals vs. hospital payments vs. outpatient payments vs. other services being paid separately. Because of that, no one cost beneficial intervention is the one that is put in the front of the others.


To hear more from Robert, please join him at IIR's Specialty Pharmacy Collaboration Summit, September 15-17 in Boston. Also, you can save an EXTRA $100 off the current rate when registering with the code: XP1968BLOG - Register now. 

See you in Boston!

Assess the Value of Specialty Drugs with Robert Popovian, Senior Director, Pfizer | Last Chance to Save $700 is this Friday

Last Chance for MAXIMUM Savings is this Friday, June 27th

Register Now to Save up to $700 with the code: XP1968BLOG

Assess the Value of Specialty Drugs with Robert Popovian, Senior Director, Pfizer

Managing costs and determining the value of specialty drugs is key in understanding if the specialty model is sustainable. Hear from Robert Popovian, Senior Director, US Government Relations, Pfizer at IIR’s all-new Specialty Pharmacy Collaboration Summit, as he addresses the optimal methodologies to assess the value and cost proposition of specialty drugs in the evolving payment policy environment.

Learn How To:
• Define quality measures for specialty medicines
• Ensure global payment models which encapsulate all costs and outcomes including those for pharmaceuticals
• Develop measures of quality and value that are relevant to patients


Download the brochure for the full agenda and speaker details.

Don’t miss out! This Friday, June 27th is your last chance to save up to $600! Plus take an EXTRA $100 off when you use the code XP1968BLOG. Click here to register or call 888-670-8200 to register.

Oncology Management Podcast Series with Bill McGivney

Welcome to the Oncology Management Podcast Series - Presented by IIR's Annual Summit for Oncology Management. Joining us today is Bill McGivney, Principal, McGivney Global Advisory LLC & former CEO, National Comprehensive Cancer Network

Download the complete podcast & transcript here.

To begin, could you please comment on what appears to be a seemingly never-ending call to define value in healthcare?

Bill: To answer your question about the definition of value in healthcare, you know I really do continue to be amazed at the calls that come out of national committee meetings and publications, etc. to say that we continue to have to define and develop a national standard for what value is in the healthcare system. To me, it seems really simple. I mean, I’ve been around the healthcare system for almost 30 years now. The value is the clinical benefit derived by patients, specifically, for the expenditure of a specified amount of healthcare dollars. That’s pretty simple. Sometimes when people try to develop these long equations to which I’ve seen, it’s a gust of bodies when they have their conferences. I mean, I saw one once years ago and I just commented to the moderator of the session that one, the long equations for the definition of cost effectiveness was mind-numbing and two, it would never see the light of day. I was right on both accounts. 

So, I think my simple definition is pervasive in terms of this is what value is. It’s really, again, the clinical patient benefit that’s obtained for a specified expenditure of healthcare dollars.

Download the rest of the Podcast here.

To hear more from Bill, please join us at IIR’s Annual Oncology Management Summit, July 21-23 in Philadelphia, PA.

To save 15% off your registration rate, use the code: XP1914BLOG

Register Now!

Q&A with Amy Ramazio of GlaxoSmithKline – A Speaker at IIR’s Gross-to-Net Accounting Forum

At IIR's 2nd Annual Gross-to-Net Accounting Pharmaceutical Manufacturers, Amy Ramazio, Finance Director at GlaxoSmithKline will be the Big Pharma Chairperson, in our all new tailored discussion groups for your specific company size and function!

Below Amy sat down to do a quick Q&A session with us...enjoy!


Q&A:

1. How feasible is collaboration between managed markets, commercial, government programs and Finance?

Successful collaboration will largely depend on the particular individuals involved.  The key is for everyone to have an enterprise view.

2. Key questions to ask before investing and building an automated GTN system?

- What functionality is most important to your organization?
- How much are you willing to invest?
- When do you need the system to go live?

3. How to accrue and forecast patient/ payer related items? What critical/essential information is required and what aspects you can’t afford to overlook.

Forecasting and accruals are typically based on past history with some adjustments where there are specific changes expected in the future.  Having information to develop these adjustments is critical and could include: segment lives and expected trends, TRX data, formulary changes, legislation changes.   


To hear more from Amy, please join us in Philadelphia, June 17-18 for the 2nd Annual Gross-to-Net Accounting Forum. Plus register with the code XP1911BLOG to receive $100 off the current rate!

Register Now!

Q&A with David A. Mericsko, GE Healthcare Life Sciences

 At the 2nd Annual Gross-to-Net Accounting Forum for Pharmaceutical Manufacturers, David Mericsko, GE Healthcare Life Sciences will be presenting a case study. The case study will be followed up by a panel discussion on chargebacks, David will moderate the panel.

Case Study: Chargeback Reserve Estimates and Methodology
• Reserve True-up methodology
• Developing point of sale accrual rates for products
• Various operational metrics used by accounting and FP&A departments to analyze and monitor reserve balances
• Using external channel data in our true up and monthly metrics analysis
• Picking an external inventory channel vendor and monitoring and maintaining the data received from the wholesalers; setting up wholesaler 852/867 fees
• Leading internal and external audit teams through the wing to wing chargeback process

Follow-up Chargeback Panel Discussion
• What are key complexities to the chargeback process and how are these managed?
• What are considerations for contractual renewal, reporting requirements and discounts between commercial and governmental customers?
• Process considerations for validation activities

Moderator:
• David A. Mericsko, Assistant Commercial Controller, GE Healthcare Life Sciences

Panelists:
• Marijo G. Bustos, Manager, Chargebacks, Fresenius Kabi USA, LLC
• Jeff Miller, Senior Manager - Financial Accounting, Impax Laboratories Inc.
• Rosemary Schaab, Controller/Director, Chargebacks Administration, AmerisourceBergen
• Jon Brier, Product Manager, Revenue Manager, Revitas



Q&A:

1. How feasible is collaboration between managed markets, commercial, government programs and Finance? 

Constant dialogue between departments is a necessity.  From my an accounting point of view, we here at GE Life Sciences promote this through a variety of measures including:

• Monthly GTN meetings with commercial, finance and accounting department leaders to discuss point of sale rates and operational results/ metrics;
• Monthly GTN accrual meetings with commercial and government teams;
• Commercial contract “workflows” that ensure the impact of new/ revised contracts are reviewed/approved by each of these groups;
• Daily adhoc communications via email, phone etc. to ensure new issues are communicated to each group.

2. Key questions to ask before investing and building an automated GTN system?
 
Key questions would include:
• Is this a global or US IT solution?
• How is data integrity maintained?  How can data be traced to the GL/ be audited?
• How will the solution interact with our current systems?
• Who are the report users?  Do the reports meet their needs?

3. How to accrue and forecast patient/payer related items? What critical/essential information is required and what aspects you can’t afford to overlook. 

Patient/ payer accruals is not really applicable for our distribution chain.  Our products are diagnostic agents used by hospitals for various imaging scans.



To hear more from David, please join us at the Gross-To-Net Accounting Forum, June 17-18 in Philadelphia, PA. 

Register now and save an additional $100 off the current rate when using the code: XP1911BLOG - $300 in total savings! Register now because these rates expire Friday 5/23.


Register here and save $300!

HDI Podcast Series with Bob Gladden of CareSource

Healthcare Data Insights Podcast Series

 Below is a teaser from our podcast series with Bob Gladden, VP for Decision Support & Informatics, CareSource

Download the complete podcast and transcript here.

How do you make data-driven decisions across the organization?
Bob: It’s been an interesting journey that we’ve been on. I think we’ve been on this like a number of other companies. I’ve heard some references to how companies are dealing with this today in terms of how decisions are made. Are they made based on individuals having data and pouring through that and coming up with a solid answer? Or is it based on what they call in the industry “HIPPOs”, which simply translates into ‘highest paid person’s opinion’. Now, we have to be careful about calling people HIPPOs. That doesn’t tend to go over well. But, we are working towards certainly the value that those highest-paid individuals have – a lot of energy and a lot of experience that they bring to the table. But, we are trying to shift a little bit so that data becomes more involved and more a part of the decision processes and use the folks that typically in the past were the highest paid person in the room just making the decision.

We’ve now focused that a little differently and we are now using them to help us identify where we need to look and put some energy into changing things. We are actually right now in the process of redesigning our entire care management process in the organization. Within that, we are actually using a very data-driven approach to even design the program, which is certainly a step forward from where we’ve been in the past. It is allowing us to step away from some of the more traditional ways that you might design a care management program.

To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago. Register with the code XP1902BLOG and save $100 off the current rate. That is $300 in total savings if you register by this Friday, 5/23. REGISTER HERE!

FLASH SALE! Healthcare Data Insights - Buy One Pass & Get One Free (Offer Only Valid Through 5/13)

Buy one pass and get one free when you register for IIR’s Healthcare Data Insights (HDI) by the end of Tuesday 5/13!

Be empowered to do more with all of the data you already have at your fingertips. Regardless of what your role is—medical, sales/marketing, financial—data-driven decision-making will help put together smarter, better informed strategies. Attend HDI to learn how to implement data-informed programming. 

HDI’s expert speaking faculty includes companies like Intermountain, CareSource, Steward Health Care Network, Molina and MDwise who are already deemed pioneers and masters of data-driven healthcare strategies, and will present case studies on how you can become a master as well!

Register by calling (888) 670-8200 to join us and mention code XP1902SAVE to buy one pass and get one free!

Healthcare Data Insights will take place in Chicago on June 23-25 at the Hilton Garden Inn Chicago Downtown. See you there.

Have any questions? Email Ryan Geswell.

Note: This promotion is valid only through 5/13 and cannot be combined with any other discounts.

Download Archived Webinar – Revenue Leakage: Industry Definition, Insight and Best Practices to Mitigate Risk

The term ‘Revenue Leakage’ is used widely in the pharmaceutical industry and is creating management buzz!  In Gross-to-Net the term most commonly references lost net sales as a result of unintentional internal or external data, process and system issues. 

This webinar is to further explore the term Revenue Leakage and what it means to branded pharma, start-ups, generics, and biotechs.  In Gross-to-Net, Revenue Leakage can arise in any customer segment (Government and Commercial) and any customer channel (Medicaid, VA, 340B, Managed Care, Specialty, Part D, etc.). 

The key to mitigating Revenue Leakage is to recognize, assess and continuously improve.  The industry has made large investments in adjudication systems and performed numerous audits to temper the hemorrhaging.  There is no substitute to a strong cross-functional process with continuous analytics to ultimately control the risk.

Jennifer Sharpe from daVIZta, a Revenue Analytics firm, will moderate the Revenue Leakage discussion.  Jennifer is joined by her fellow co-chairs for the upcoming IIR GTN conference in June:  Larry Breen from Sunovion, Roxana Santiago from Hospira and Courtney Callihan from GSK.

The webinar addresses and provides insight on the following components of Revenue Leakage:

• 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.

Download the webinar here. 

To hear more from Jennifer, Larry, Courtney, and Roxana, make sure you join them at the Gross-to-Net Accounting Forum, June 17-18 in Philadelphia, PA. Save $100 off the current rate when registering with the code: XP1911BLOG

Register Here.

Q&A with Miree Lee of M. Lee Consulting, LLC - A Speaker at IIR's Gross-To-Net Accounting Forum

• 
  

At the 2nd Annual Gross-To-Net Accounting Forum, Miree Lee will be leading a workshop on the Impact of the MDRP AMP Final Rule on Accruals. With the CMS AMP Final Rule scheduled to be released in May, attendees of this workshop will learn about the many variables within the rule that alter government payer forecasting, gross-to-net and accrual calculations. Different types of manufacturers must also consider how their products and their distribution model are specifically impacted.

Key considerations of the final rule, impact for each:

• Pharmaceutical Price Points (AMP, BP, ASP, NFAMP, 340B, etc.)
• Overview of Various Government Programs
• Requirements under Medicaid Drug Rebate Program
• What is AMP?
• What are the inclusion and exclusion filters?
• How is AMP used?
• What is BP?
• What are the inclusion and exclusion filters?
• How is BP used?
• What is the URA?
• What are some potential changes in AMP, BP and URA?
• How do companies accrue?
• How does Medicaid expansion impact accruals?
• Managed Care Medicaid and Duplicate Discounts
• Other changes in Medicaid that may impact accruals

Q&A:

1. How feasible is collaboration between managed markets, commercial, government programs and Finance?  

Collaboration takes on different forms for different companies.  There isn't a "one size fits all" methodology except that the core principle of collaboration is a critical necessity for government pricing/program compliance.  Some companies identify and memorialize the collaboration process via formal process methodology document which outlines the tactical activities of collaboration (e.g. roles, responsibilities, timelines, specific reports and data, meeting schedule, etc.).  Other companies may adopt a less formal process whereby key persons of each department are involved in providing the proper information to the pricing department or responsible individual to ensure government pricing/program compliance.  Depending upon the size, structure, product mix, complexity of business and various other factors, cross functional collaboration may look different company-to-company. 

2. Key questions to ask before investing and building an automated GTN or GP system? 

Number of products, number of NDCs, annual sales, number of direct and indirect customers, classes of trade for direct and indirect customers, number and types of discount contracts, rebate or chargeback, tiered or market share based contracts, volume based contracts, formulary status requirements, bundles, stacked discounts, types of fees - bona fide or not. 

3. How to accrue and forecast patient/ payer related items? What critical/ essential information is required and what aspects you can’t afford to overlook.

• Intimate knowledge of the competitive market
• Shifts in market share and causes for the shifts (pricing, special contracts, supply, reimbursement)
• Thorough understanding of payers and changes in payor reimbursement
• Changes in payor coverage and patient population (e.g. Medicaid expansion, shifts in payor mix)
• Changes in mandatory discount/rebate liability (e.g. Medicaid URA increases substantially or 340B or FSS price decreases substantially)
• Price protection and how price protection is calculated

To hear more from Miree, please join us at the Gross-To-Net Accounting Forum, June 17-18 in Philadelphia, PA. 

Register now and save an additional $100 off the current rate when using the code: XP1911BLOG

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

Download the full podcast & transcript here.

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.