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 Bob Gladden of CareSource - A Speaker at IIR's Healthcare Data Insights

This June at IIR’s Healthcare Data Insights, Bob Gladden, Vice President for Decision Support and Informatics at CareSource will speak on a session titled “Taking a Persona-Centric, Not a Disease-Centric, Approach to Care Management & Engagement”.

Session Info:
The typical member management program entails profiling members based on their disease states without taking into account the patient as a whole. Beginning in the Fall of 2013, CareSource started using claims and enrollment data to segment their members into a specific persona, then began services to members based upon the persona in which they were identified. Learn how they build data driven personas and understand the results they’ve seen to date.


Q&A:

1. What does data driven decision-making mean to you?

To me it means that when possible, we eliminate the guess work component of decision-making.  There will always be a component to decision making that is not quantitative, but that should be by choice, not because the data isn’t available in a format that can be incorporated into the decision-making process.
2. How do data sets (EHR data, claims data, member feedback, etc.) to inform your business strategy?

As a Medicaid managed care organization, we use claims data extensively to help shape everything from care programs to business strategy.  Ongoing, our strategy continues to be to augment the claims data view of our membership with other data sets that can enrich our view of our members, and help us to identify their needs at the earliest possible moment.  As one example, we are currently working on a partnership with a state Health Department and a major university that will expand our view beyond claims data to include social/economic data. 

3. In general, how difficult is it to get internal buy-in to build out programming that’s based on data?

Actually, at CareSource the difficulty has been to build out the data to support and enhance programs fast enough to keep up with the requests.  Senior leadership here has for some time been asking for more data support to build all of their efforts.  Having leadership asking for this support goes a long way toward the success of having an organization focus decision making on fact and less on hunches.

4. How do you see your use of data evolving in the upcoming year? Are there new opportunities to use data to create more effective, innovative programming?

There are a number of changes that are coming. The most notable in health care is the provider base moving to electronic medical records. Many of these systems were first stood up just to meet requirements for enhanced reimbursement, but now the effort is to fully incorporate this information in work-flow and use it in a meaningful way.  To that end, there are more changes coming that could even eliminate traditional claims as we know them today. It is all part of many exciting developments that will change how we all do business to deliver far more effective and higher quality care.


To hear more from Bob, please join us at Healthcare Data Insights, June 23-25 in Chicago.

Register now and save an additional $100 off the current rate when using the code: XP1902BLOG

Oncology Management Podcast Series with Bill McGivney

Welcome to the Oncology Management Podcast Series. 

Joining us today is Bill McGivney, Principal, McGivney Global Advisory LLC & former CEO, National Comprehensive Cancer Network. Below you will find a teaser from Bill's podcast session, click here to listen to the complete podcast and to download the transcript.

How and to what extent do various stakeholders bring value to the treatment of patients with cancer?

Bill: Well, I think that’s something that we really need to look at closer because there are a lot of discussions, obviously, about the level of healthcare expenditures and the increase and rate of rise and expenditures of care to treat patients with cancer.

First of all, you look at providers and clearly their expertise, their acumen and their understanding is really about providing what the optimal treatment recommendations are for patients. Carrying out that treatment plan brings a lot of value to the system.

And then you look at the manufacturers, the biopharma companies, the medical device companies and they bring innovative products to the market that address the many, many needs and unmet needs that still exist for the many different types of cancer specifically. And that’s critical. They bring value to patients directly.

Then, you start to get down into other areas of the healthcare system that are more management operations oriented and you look at managed-care companies. They bring value in the sense that they help to organize the system. They pay the claims and the develop networks of clinicians to work with patients specifically.

But, really, what I think we need to do is, as we expend resources to bring care ultimately to patients with cancer, we really need to take a closer look at, again, which components, which stakeholders bring actual value to the treatment of patients.

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!

Online Exclusive - IIR Healthcare Events Memorial Day Flash Sale! How can you save 26% off the Full Access Pass? Details here!

To celebrate Memorial Day, we're throwing a healthcare sale!

For the next three days, we're offering you a chance to attend a select number of our healthcare events for 26% off the standard full access pass rates*!

What events are included?



Gross-to-Net Accounting Forum | June 17-18, 2014 | Philadelphia | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1911MDAY* to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• Registrants will receive 26% off the standard registration rates
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Healthcare Data Insights | June 23-25, 2014 | Chicago | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1902MDAY to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• This offer is only available for the Full Access (All 3 Days)
• This offer is not eligible for Main Conference Only (June 23-25)
• Registrants will receive 26% off the standard registration rate.
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Annual Summit for Oncology Management | July 21-23, 2014 | Philadelphia | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1914MDAY to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• This offer is only available for the Full Access (All 3 Days)
• This offer is not eligible for Main Conference Only (July 21-23)
• Registrants will receive 26% off the standard registration rate.
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.



Specialty Pharmacy Collaboration Summit | September 15-17, 2014 | Boston | Download the agenda

This offer is EXCLUSIVE to online registrations. Click Here to register and be sure to use code XP1968MDAY* to receive the discount. This limited-time offer expires Monday, May 26, 2014 at 11:59PM ET.

If you have any questions, reach out to Jennifer Pereira at jpereira@iirusa.com.

Rules and Regulations Apply:
• Registrants will receive 26% off the standard registration rates
• This offer only applies to passes purchased on Thursday, May 22, 2014 to Monday, May 26, 2014
• This offer only applies to online registration

*This offer cannot be retroactively applied on existing registrations nor combined with other offers, discounts or promotions. Offer only valid between May 22 - May 26, 2014.

Register for the Oncology Management Summit by Friday 5/23 to Save $400!

The recent debate over healthcare reforms has made one thing clear: unsustainable costs are leading to fundamental shifts in the way cancer care is delivered. There is a growing expectation that healthcare represents good "value".

As a stakeholder within the cancer care value chain many complex issues vie for your time and attention. You must simultaneously grasp the big picture, staying abreast of the changing oncology landscape, and keep focused on the day-to-day concerns that impact delivery of effective and efficient patient care. At IIR's Oncology Management Summit you will walk away with solutions to the most critical issues: cost, access to care, incorporating new technology, and meeting standards for patient-centered care. Oncology pioneers provide an understanding of the big picture, but also with practical, useful information to help you improve care now.

IIR's Annual Summit for Oncology Management is your 360° view of the cancer value chain; where stakeholders and influencers including payers, providers, hospital systems, leading cancer centers, and pharmaceutical executives convene to discuss how to control costs, increase quality, determine value and improve overall patient experience for cancer care.

For a more detailed look into the Oncology Management Summit, download the agenda.

To learn more about the evolution of cancer care, join us July 21-23 in Philadelphia, PA. Register by this Friday – May, 23rd and save $400! Just use the code: XP1914BLOG


Register Today!

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!

Join the Largest MMCC Ever | Last Chance to Register

The 22nd Annual Medicaid Managed Congress is less than a week away, and this year will be the largest and best attended meeting to-date. With more attendees and companies attending than ever before, you can’t afford to miss the industry’s leading event. Reserve your seat today before time runs out…

Don’t just take our word for it—the numbers speak for themselves:
350+ attendees representing 39+ states   
75 speakers representing 27 states   
187+ companies   
19 health plan case studies    
10+ hours of dedicated networking time   
9 luncheon roundtables hosted by government officials   

Reserve your seat before time runs out! Plus save 15% when using the code: XP1926BLOG

Register now & download the brochure to view the full agenda.

The numbers don’t lie—based on this year’s turnout, your healthcare peers are ready to harness the new opportunities due to healthcare reform including Medicaid Expansion, exchanges, providing higher quality care, partnering with ACOs and more! Join us May 19-22 in Baltimore as we drive next generation Medicaid managed care alongside health plan and government heavyweights.

P.S. Interested in decoding your exponentially-growing data points to drive data-driven decisions? Check out IIR’s all-new Healthcare Data Insights event here.

Poverty and the Social Determinants of Poor Health

Guest Post Via Healthify


“Healthcare crisis,” “disparity” and “poverty” are popular words these days in American journalism and the blogosphere despite the recovering economy and the rocky implementation of the Accountable Care Act. A return to growth and expanded coverage should be good news. Poverty should be alleviated and health outcomes improving under such auspicious circumstances. What’s gone so wrong that it still gets the pundits so hot and bothered?

More Americans are enrolled in Medicaid than in any other point since its creation over forty years ago. Forty-two million have enrolled in managed care plans, 74.22% of beneficiaries–the highest percentage it has ever been (Medicaid Managed Care Enrollment Report). The increase in Medicaid beneficiaries is due to two main reasons:

1) The expansion of Medicaid services in 26 states to 138% of the federal poverty level; and
2) The dramatic increase in poverty and wage stagnation following the crippling financial crisis that started in 2007.

These patients range from the country’s most impoverished who are struggling to get by to lower-middle income earners who are fighting to stave off poverty as they float between Medicaid and health information exchange plans.

The increase of poverty and enrollment in Medicaid managed care is both boon and bane for Managed Care Organizations. Revenues will increase steadily as more beneficiaries elect their managed care plan. Unfortunately, the influx of new members, many of whom suffer disproportionately from issues related to the social determinants of health, will put pressure on existing healthcare infrastructure. These patient populations are more likely to suffer from insufficient food, substance abuse, and housing instability than other members and are less likely to have support when attempting to resolve these issues. This leads to an overutilization of services like emergency care at high cost with little gain.

Healthify helps MCOs deal with this critical issue by addressing their members’ social health needs. Our engineering team has developed a dynamic web-based screening tool to assess a member’s social and behavioral health risks at the point of care. Once our software identifies a members’ needs, it automatically connects them to our database of the best federal, state, and community programs that treat those needs. In a week’s time, we send out an interactive text message to see if they accessed the service and whether or not they found it useful. This end-to-end solution improves member referrals, satisfaction, and long-term health outcomes.

 

 What truly makes Healthify’s software so robust are the tools that we offer the care team through our dashboard. We provide the care team with access to our resource database so they can continually update, modify, or add resources to better help their patients manage their needs. More importantly, however, the care team can see trends in their member population’s health through the dashboard and access individual records to send out and respond to messages. We use this as an ideal opportunity to measure patient engagement on behalf of the care team; it also gives them better lines of communication to interact with their case manager, further improving member satisfaction.

Stop by Healthify’s booth at the 2014 Medicaid Managed Care Congress. Our team will be there to highlight how:

• Healthify’s service helps Medicaid managed care better manage the care of their members by addressing the social determinants of health;
• Our software platform helps care teams better care for members and help members more easily access services to help alleviate their needs; and
• We can reduce the cost of care per member per month by 2-6% while improving care quality and patient satisfaction.

Come and tell us what some of your members’ biggest social health risks are. We’ll be ready to help. In the meantime, check us out at www.healthify.us. 

________________________________________________________________

The 22nd Annual Medicaid Managed Care Congress is taking place next week (May 19-21) in Baltimore, MD - Don't miss out on the largest MMCC ever! It is not too late to register, save 15% when registering with the code XP1926BLOG.

REGISTER HERE.

MMCC Podcast Series with Cindy Pigg of Magellan Medicaid Administration

Welcome to IIR’s Healthcare Podcast Series. Today we have Cindy Pigg, Senior Vice President of Pharmacy with Magellan Medicaid Administration. Click here to download the complete podcast. And make sure you join us at the 22nd Annual Medicaid Managed Care Congress taking place May 19-21 in Baltimore.

What are the unique challenges faced by states in Medicaid Managed Care Organizations? 

Cindy: Significant challenges and quite unique. Number one, how do you engage this population in managing their healthcare? We talked a little bit about this already, but we’ve got unique patient characteristics – the prevalence of mental health, the health literacy, the difficulty navigating the system, the cultural sensitivities. So, we’ve got opportunities to figure out how to engage this population. 

The challenge in managing their pharmaceutical care is that in this population, we lack two tools that are critical that we use on the commercial side that just don’t exist in the Medicaid space. Those being co-pays at a level that are significant enough to change behavior and mail order pharmacy – the home delivery pharmacies where we do a lot of utilization management using the pharmacists that are working in dispensing their mail order prescriptions. So, we’ve got to figure out that challenge of how to engage consumers with different tools unlike what we’ve used in the commercial market. 

I think a challenge that the states and the Medicaid Managed Care Organizations are going to face is really predicting the costs. There are so many unknowns. What is this patient population’s pent up demand that we talked about? What is the impact of specialty pharmaceuticals going to be in this population? I think the predictive modeling and the analytics to assist states in Medicaid Managed Care Organizations is an essential skill set that is going to be needed as we navigate these new waters. 

We talked about the access issue. There is going to be no access issue with pharmacies because you have probably have seen this in the press. There are actually more pharmacies than there are McDonald’s or Starbucks. If you just think about it, if you are looking at a pharmacy on this corner, there is probably a pharmacy on the other corner. So, access to pharmacies is not an issue, but access to physicians that we talked about is another unique challenge. 

Then we are seeing in the press every day now issues with Medicaid reimbursement. So, even if we did have enough primary care physicians, the payment mechanisms for Medicaid, I think, is a challenge that will be unique state-by-state in Managed Medicaid Organizations. 

I’d summarize this question by saying that the standardized PBM model just won’t work. These patients are unique. We talked about the challenges, but this need for a customized Medicaid strategy to deal with these unique needs is going to be absolutely essential to help the states and the Medicaid MCOs navigate these challenging waters for this Medicaid and subsidized exchange population. 


To hear more about this topic and many more, please join us at the 22nd Annual Medicaid Managed Care Congress, May 19-21 in Baltimore, MD. 

To save 15% off your registration rate, use the code: XP1926BLOG - Register Now!