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From Inside Health Insurance Exchanges - Kevin Counihan, who successfully navigated the implementation of Connecticut’s insurance exchange — and headed marketing for Massachusetts’ Commonwealth Health Insurance Connector Authority — has been tapped by CMS to head the federal exchange portal, HealthCare.gov. Counihan’s last day with the Connecticut exchange is Sept. 5. The exchange’s board tapped Chief Information Officer James Wadleigh to serve as interim CEO of Access Health CT (see table, below). Read more

From Health Plan Week - It takes nearly two computer screens to scroll through the list of state-mandated medical services that health insurers in California must cover. And on Aug. 22, a clarification of an existing state law added one more when the Department of Managed Health Care informed carriers that abortion services are a basic health service in the state and must be covered. Read more

From Inside Health Insurance Exchanges - It’s been 10 months since state and federal insurance exchanges sputtered to life. While most of the major problems have been addressed — and 8 million people found coverage through the new marketplaces by the end of the enrollment period — industry observers aren’t confident the kinks have been permanently smoothed out. And a recent proposal to automatically re-enroll consumers who found coverage through HealthCare.gov could add another layer of… Read more

From Medicare Advantage News - Despite persistent and varied efforts by CMS to foster their spread, less than half of Medicare Part D enrollees eligible for medication therapy management programs receive them, and only 11% of all Part D enrollees were part of MTM programs in 2012, according to a new study of CMS data from that year by consulting firm Avalere Health LLC. Moreover, Avalere found that just 1% of Part D enrollees in… Read more

From Drug Benefit News - When it comes to targeting patients for medication adherence interventions, many health plans continue to rely on pharmacy claim “triggers” such as a prescription not being picked up and retrospective adherence measures such as a medication possession ratio below 80% for a certain period of time. But only 7% of plans recently surveyed by AllazoHealth are using the newer method of predictive analytics to prioritize patients at risk of not… Read more

From Report on Patient Privacy - What if…someone at Community Health Systems, Inc., had discovered the cyber intruder that had wormed its way into CHS’s network before it bundled up and off-loaded data for 4.5 million patients? With a workable incident response plan in place — which is required under the 2005 HIPAA security rule, by the way — CHS very well could have stopped the attack and prevented the data loss. A threat that is contained and… Read more

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