John Coster from CMS Confirmed to Speak at GP Summit!

CMS is Confirmed to Speak on Wednesday, March 25th at 8:30-9:15 AM!

IIR's 7th Annual Government Programs Summit is the one-stop-shop for all things government programs! We're delivering the most government officials AND experts from pharma and biotechs - all under one roof!

We're excited to announce that John Coster, Director, Division of Pharmacy, Center for Medicaid and CHIP Services (CMS) is confirmed to open on March 25th, 2015! Hear directly from him, as he provides insights and updates on:

• Policy and operational issues affecting the Medicaid pharmacy program
• Latest Medicaid DUR survey report
• Issues and challenges facing the Medicaid pharmacy program

In addition to John Coster, hear from:
• Health Resources and Services Administration (HRSA)
Krista M. Pedley, PharmD, MS, CDR, USPHS, Director, Office of Pharmacy Affairs
• VA Office of Inspector General (VA)
Michael Grivnovics, Director, Federal Supply Schedule Division, Office of Contract Review
• US Government Accountability Office (GAO)
Carolyn L. Yocom, Director, Health Care Team
• National Association of Chain Drug Stores (NACDS)
Don Bell, Senior Vice President & General Counsel
• National Council for Prescription Drugs (NCPDP)
Phillip Scott, SVP Business Development
• Safety Net Hospitals for Pharmaceutical Access (SNHPA)
Jeff Davis, Counsel, Legal and Policy Affairs
• Biotechnology Industry Organization (BIO)
Erin Estey Hertzog, Director, Reimbursement & Health Policy

Don't miss out on these regulatory and policy leaders as they provide answers to strategic, compliance, operational, technical and tactical issues on all things government programs.

Register online now to join us this March 23-25, 2015 in Arlington. Click here. Be sure to use XP2051BLOG to save $400!

 
ATTENTION ALL PHARMA, BIOTECHS & MED DEVICE MANUFACTURERS
We've launched a special, 50% off discount* on registration just for you!

Be sure to use code XP205150OFF to activate the discount! Click here.

*Qualifications, rules and regulations:
1. Offer only applicable to employees of pharmaceutical, biotech and medical device manufacturers subject to IIR approval
2. Offer cannot be applied to the Gross-to-Net Accounting Forum One-Day Workshop Only or Government, Hospitals or Covered Entity Only Rate
3. Offer cannot be applied retroactively to confirmed or pending registrations from today's date and prior
4. The 50% discount cannot be combined with any team discounts or other promotions and/or discount offers

Back by Popular Demand at MMCC | 4 Crowd Favorites

"Anyone involved in Medicaid policy or a stakeholder they should be there."
- Russell Harper, Aetna

2014 was about strategy and understanding Obamacare and the ACA. Now implementation begins. 2015 is the year for tactical execution. How are payers, providers and vendors going to collaborate effectively?

As a Medicaid stakeholder, MMCC provides you the tools and insight to develop cost-efficient programming with 3 jam-packed days of health plan case study presentations, face time with government officials and up-to-the-minute information from CMS.

Back by popular demand, attend the Medicaid Managed Care Congress and check out our unique programming and formats that continues to make MMCC the must-attend event year after year:


CMS Presentations
Receive clarification from federal regulators for additional insights on new managed care regulations

Government Roundtable Discussions
Participate in off-the-cuff conversations with government officials who create the regulations you're currently implementing, and get a sneak peak of what you'll be tasked with implementing in the future

State Medicaid Officials' Panel
Gain access to Medicaid Directors across the country to proactively prepare for future programming and learn how other states have prospered in the era of Reform Implementation

State Spotlights
Take a deep dive into programs states have rolled out in the past year (hits and misses) to better understand state regulations that may be in your near future.


Download the complete agenda.

Register now and save $400 - Use the code: XP2026BLOG

Have any questions about the event? Reach out to Ryan Geswell at rgeswell@iirusa.com

This is the Only Government Programs Event You Need to Attend

How many Government Programs events do you attend a year?

IIR's 7th Annual Government Programs Summit is the one-stop-shop for all things government programs, merging together regulatory compliance and financial calculations to maximize revenue potential. We're delivering the most government officials AND experts from pharma and biotechs — all under one roof! They'll provide policy answers to strategic, compliance, operational, technical and tactical issues on all things government programs. 

Download the Agenda for Full Speaker and Session Details

PLUS! Calculate liability and optimize accuracy and accountability at the newly included full-day summit on Gross-to-Net! Invite your GTN and finance peers to join and experience true collaboration by breaking down interdepartmental silos through candid conversations and networking you can only have onsite at the event!

Register online to join us this March 23-25, 2015 in Arlington. Use the code XP2051BLOG now and save $400!

Are you ready for first quarter-end close?

Be Ready for First Quarter-End Close and Earnings Announcements!

Your time is valuable, that's why this year's Gross-to-Net Accounting Forum is moving to a JAM-PACKED, one-day summit on March 23rd - minimizing the disruption to your work week.

Get a comprehensive overview of the entire pharmaceutical GTN process and minimize liability impacting your bottom line with industry experts such as:

• Amy Ramazio, Finance Director, GlaxoSmithKline
• Mila Tartakovsky, Sr. Director, Corporate Financial Analytics, Daiichi Sankyo
• Larry Breen, Director of Revenue Analytics, Sunovion Pharmaceuticals
• And more!

Download the agenda for more details and speaker line-ups.

Plus! Tailored Discussion Groups are back! Brainstorm issues, concepts and solutions related to your company size and function in the Gross-to-Net Roundtable Wine and Dinner.

Join us March 23, 2015 in Arlington and click here to register now.

If you have any questions about the event, please reach out to me at rgeswell@iirusa.com 

IIR's Government Programs Summit Keynote Announced!

Announcing: Chief White House Correspondent, Mike Allen

IIR's 7th Annual Government Programs Summit is the most comprehensive government programs event to date! This year, we're merging together regulatory compliance and financial calculations to help you navigate through legal, compliance, strategic and financial updates of ACA expansion!

Plus, for the first time under one roof, hear from CMS, HRSA, VA/DOD, OIG, NCPDP, GAO, NACDS, SNHPA as they join keynote Mike Allen, Chief White House Correspondent, Politico and Creator, Playbook and Morning Money at the gold-standard government programs event. In his session “Political Issues of the Day”, gain perspective on what's going on in Washington behind closed doors, as he shares insights into how healthcare reform may shift due to political changes.


Download the agenda for more details and speaker line-ups.

Join us March 23-25, 2015 in Arlington and register now to save $400. Be sure to use the code XP2051BLOG – Click here to register.

If you have any questions about the event, please contact Ryan Geswell at rgeswell@iirusa.com

Gross-to-Net Accounting Forum for Pharmaceutical Manufacturers is Moving!

Here's the good news. IIR's Gross-to-Net Accounting Forum is back and better than ever and has moved in with  IIR's 7th Annual Government Programs Summit!

Be ready for first quarter-end close and earnings announcements by joining us for a JAM-PACKED, one-day summit on March 23rd! Get a comprehensive overview of the entire pharmaceutical GTN process and minimize liability impacting your bottom line.

Plus, take a step further in understanding how government pricing and contracting functions impact your company's financials beyond Gross-to-Net by adding IIR's Government Programs Summit to your registration. Take advantage of our best savings of the year!

For additional information on this event and all it has to offer, please download the agenda.

Don't hesitate-start 2015 right by crossing off some professional goals with IIR's Gross-to-Net Accounting Forum now occurring alongside IIR's gold-standard Government Programs Summit. Register now and save up to $400! Use the code XP2051BLOG

I hope you join us in March in Arlington.

See What’s New at MMCC 2015

The Medicaid Managed Care Congress is in its 23rd year, and there is a reason why we have been around so long—we consistently provide the newest and freshest insights on the topics that matter most to you and your business. For the 2015 event taking place on May 20-22 in Baltimore.

Here is a sneak peek of what’s new:

8+ New Health Plan Case Studies
Evaluate opportunities to grow membership, increase quality and decrease costs by learning from victories (and lessons learned) from speakers who haven’t presented in the past, including representation from Humana, Community Health Choice, Molina Healthcare executives on a national and regional level, plus many more.

Dual Eligibles Summit
It’s not just a few sessions anymore; we now have an entire day focused on increasing revenue by successfully navigating the very complex but extremely lucrative duals market.

A 360º view
The popular Medicaid Managed Care 101 pre-conference summit has been reformatted to give you multiple perspectives on the areas that have the highest impact on your bottom line. A unique 360º view from health plans, government officials, solution providers and other perspectives for a well-rounded understanding of the topics that will grow your skill set, such as ACA implementation, improving quality, the long-term industry outlook and more.

Customize your Agenda (coming soon!)
Create a personal agenda to select which sessions will increase your ROI the most. Prepare your networking strategy in advance to optimize your time at the event and coordinate attendance with colleagues to ensure you get maximum expertise. Stay tuned as we will make this feature available in the coming weeks!

Download the preliminary agenda for more details.

Register now and save $400! Use code XU2026BLOG - Register here.

Medicaid Managed Care Congress is Back | Save $600 Now!

MMCC is back for the 23rd year, bigger and better than ever before, helping you grow membership, decrease expenditures and improve outcomes with advanced Medicaid Managed Care programming.

 Join us in 2015 for...

• The 411 from CMS as they provide clarity on government initiatives to better prepare you for this year and beyond

• 15+ case studies that demonstrate what's working for MCOs so you can strategically grow your business

• 10+ state government officials that share unique programming so you know how states are improving care & access in their states
    

Download the preliminary agenda for more details.

Register by Friday, 2/6 and save $600 when you use the code XP2026BLOG – Register here.

Patient-Centered Care: Health Literacy, HIT and Shared Decision-making

By Nalini K Pande, JD

“When we want your opinion…”

When we talk about patient engagement, a cartoon comes to mind that I often used when I was teaching at Georgetown.  The cartoon depicts a group of doctors conferring amongst themselves while they lean over a patient who is sick in a hospital bed.  The patient is trying to speak and a doctor interrupts and says, “When we want your opinion, we’ll let you know!”

That, in a nutshell, depicts how many patients feel when it comes to interacting with the healthcare system.  Ironically, on the flip side, many healthcare delivery executives are trying to determine how they can increase the value of the care they provide, and as a result, produce better outcomes for their patients.  Increasingly, organizations are recognizing that meaningfully engaging patients and families is the answer to this question. In fact, these organizations are focusing on more than engaging patients in making choices about their care. Health systems are focusing on engaging and supporting patients in self-care for chronic disease management, and asking for patient input on how healthcare organizations can better engage patients.

Payment Reform and Patient Engagement Go Hand-in-Hand

With payment reform leaving providers with increased risk-sharing and accountability, patient engagement may be seen as the Holy Grail to tap into improved patient outcomes and contain costs.  Yet, many patients lack the health literacy to effectively navigate what is now an increasingly complex and confusing health system.  Koh et al propose a Health Literate Care Model that would “weave” health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model).  In this way, health literacy would become an “organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources.” [1] 

Further, the HIT infrastructure can help providers keep patients and caregivers informed, educated and literate about their personal health and medical conditions. It can support on-going self-care and wellness management, including coaching from healthcare providers and ongoing dialogue between those providers and patients.  Additionally, patient portals (available online and via kiosks)  can be effective tools in providing access to electronic health records, appointment scheduling as well as clinical support such as secure provider messaging, patient reminders, alerts, test result views and prescription refill requests. 

Perhaps, most importantly, taking a population health approach to patient engagement is essential.  Bending the cost curve and improving quality requires the management of patients in lower-acuity, primary care settings with diverse access points, education of treatment plans and adherence through clinical care and community partnerships as well as strong patient activation.

Policy makers, payors, providers, patients and caregivers should work together to develop strategies to implement:

 • The health literate care model
 • Provider, patient and system competencies needed for patient-centered care
 • HIT infrastructure & population health approaches to patient/family engagement.

Changing the healthcare culture and allowing for stronger shared-decision-making may not be the top agenda item for many health system executives.  However, given the costs of maintaining the current status quo, health system executives would do well to re-think their priorities.



Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, prevention, population health, patient engagement, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  She previously taught a graduate health quality course at Georgetown University as an Adjunct Professor. Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.

Follow @nalinipande


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[1] Koh et al. “Analysis and Commentary: A Proposed ‘Health Literate Care Model’ Would Constitute A Systems Approach To Improving Patients’ Engagement In Care.” Health Aff. February 2013, 32:357-367. 

Prevention, Incentives and Medicare Costs

By Nalini K Pande, JD

A little over a year ago at my previous consulting job, I served as the project director for a very interesting prevention project.   The project was for the Bipartisan Policy Center’s (BPC) Health Care Cost Containment Initiative¹.   BPC had asked us to develop a financial model of the costs and benefits of a diabetes Type 2 prevention program.  Our report illustrated how the financial incentives for three different payors  (commercial plans, Medicare, and ACOs) vary given different assumptions of who would pay for these prevention services and the age at which individuals would first receive prevention services. We chose to model Type 2 diabetes prevention services given that Type 2 diabetes is reversible and given the tremendous amount that the US spends on Type 2 diabetes² .   What we learned was fascinating.

Prevention Efforts Can Yield Cost Savings

The key finding from our report was that a diabetes prevention program “can produce overall cost savings which increase over time for an individual.” Given this, why wouldn’t we roll out these prevention programs on a widespread basis?  Well, the answer may surprise you.  To delve into this, you will need to understand three key issues:

• - First, who pays for the diabetes prevention program? 
• - Second, who benefits?
• - Third, when do the savings kick in?

Our report showed that if private commercial plans bear the cost of the diabetes prevention program, they may not reap all the benefits.  This is because of two reasons.  First, if individuals switch health plans over time, another plan would reap the benefits – allowing for only small benefits for the plan that implemented the prevention program.  Second, if you’re 55 or older, there is no incentive for a private commercial plan to cover your participation in a diabetes prevention program.  Simply put, by the time the cost savings would kick in (10 years), you would be on Medicare and Medicare, not the plan, would reap the benefits. 

So, what if Medicare paid private plans to cover these diabetes prevention programs?  Perhaps, then, we would all win.  Those with private commercial plans would benefit from diabetes prevention services and Medicare would benefit from healthier beneficiaries who save the program money. Our report found that while the Government does recoup savings when it pays for the program, it only did so for those who are near 60.  In fact, the Government receives very little savings from a younger population who would stay with the private sector and continue to be with a commercial plan during the timeframe when most of the savings would be realized over a 25-year period.

Where does this leave us?

In essence, what we have is a scenario where payors are reluctant to pay for prevention services since they won’t benefit completely.  Has our patchwork system of health care created disincentives around prevention?  Not quite.  Our study found that if patients could join an ACO when they are under 65 (as a commercial ACO) and then stay in the same ACO when they are over 65 (as a Medicare ACO with shared savings between the ACO and Medicare), perhaps the ACO would get the best of both worlds.  In this scenario, an ACO could invest in its patients through prevention programs and recoup the benefits, assuming limited plan switching.

Investing in prevention appears to be a game of “what’s in it for me?” How do we change it to a “win-win” scenario? The answer is simple.  We do so by utilizing new systems like ACOs that allow payors to reap long-term savings. 

Nalini Pande, Managing Director, Sappho Health Strategies has nearly 20 years of experience in healthcare policy and reform.  She has considerable experience in Medicare and Medicaid, prevention, population health, and emerging payment models including accountable care organizations and patient-centered medical homes. Ms. Pande also has strong expertise in dual eligibles and the specific issues facing this unique population.  Ms. Pande is a graduate of Harvard Law School and Princeton's Woodrow Wilson School of Public and International Affairs.


Follow @nalinipande

                                           

¹ Under the leadership of former Senate Majority Leaders Tom Daschle (D-SD) and Bill Frist (R-TN), former Senator Pete Domenici (R-NM), and former White House and Congressional Budget Office Director Dr. Alice Rivlin, BPC’s Health Care Cost Containment Initiative  “explored and evaluated strategies to contain health care cost growth on a system-wide basis, while enhancing health care quality and value.” 
 ² In Appendix D of our report, we noted a study by Dall and colleagues that estimated the costs associated with Type 2 diabetes as $105 billion for medical costs (along with $54 billion for non-medical costs such as lost work days).