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August 4, 2015

Today's Featured Story

CMS Plan on Knees, Hips Leaves Questions for Carriers Active in Bundled Care Space
Reprinted from Health Plan Week

Health insurers may view the new proposed CMS program to bundle knee and hip replacement surgeries in Medicare with some trepidation, as the effort may complicate their own efforts in the space and how they negotiate with providers who are part of the 75-market, five-year trial, according to some market consultants. But one insurer takes a nuanced approach to the CMS effort, telling AIS that bundles are a way to “dip your toe” in the alternative payment world, and as such are more of a starting point in preparing physicians for broader population health reimbursement models.... Read Full Story


Quote of the Day

“None of the obesity drugs have actually been shown to improve health outcomes, such as cardiovascular events (e.g., heart attack, stroke) or cardiovascular deaths of patients. There is some evidence that they decrease weight in the short term, blood pressure and blood glucose control. However, this does not always translate into improvements in the health of the patient. In addition, we don’t know what the long-term harms are associated with the drugs. So for these manufacturers to actually show a health benefit along with these drugs is incredibly difficult, because the weight loss is so modest that it would take a huge study to show any kind of health benefit and it would also take a pretty good-sized study to show the harms associated with the drugs.”

— Jim Carlson, Pharm.D., vice president for professional pharmacy services at OmedaRx, told AIS’s Drug Benefit News.

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today's Datapoint

$454 million ... in Medicare funds were saved in 2014 by CMS’s Fraud Prevention System, up 80% from two years ago, according to the third annual report on the program released by the agency on July 14.



FierceHealthcare News from our partner FierceMarkets

First Medicare-approved transitional care center opens for business

The first Medicare-approved, third party transitional care provider began taking patients this month. But it won't be long before other healthcare providers focus exclusively on this type of service.... Read more


Today from Washington

People on the Move

WellCare Health Plans, Inc. promoted South Carolina Chief Operating Officer Kathy Warner to state president....CTI BioPharma Corp. appointed Bruce Seeley executive vice president and chief commercial officer. He most recently was senior vice president and general manager of diagnostics for NanoString Technologies, Inc....Otic Pharma Ltd. named Gregory Flesher CEO. Flesher previously was chief business officer at Avanir Pharmaceuticals, Inc....Edmund Baxter joined Evercore as senior managing director in its health care division. Baxter previously had held the same title at Bank of America Merrill Lynch.


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