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March 14, 2011

Today’s issue is brought to you by ACO Business News, a hard-hitting monthly newsletter on the latest industry actions to design and create ACOs, for hospitals, physicians, health plans and their advisers.

Today's Featured Story

Vinson Ruling in Florida Seen as Unlikely To Have Major Impact on ACO Ventures
Reprinted from ACO Business News

The recent ruling of a Florida-based federal judge, who sided with 26 states in finding the law overhauling the nation’s health care system unconstitutional, is unlikely to curtail general ACO formation that seems to “have a life of its own” and is proceeding nationwide, health care attorneys tell AIS .... Read Full Story


From the AIS Blogs

Are Part D Plans Covering Approved Colchicine-Based Medications?

The FDA recently removed some unapproved colchicine-based medications from the market. In light of this decision, according to 60 Plus Association, the majority of Part D plans made approved colchicine-based medications accessible to beneficiaries by moving them from Tier III to Tier II or Tier I. However, the association says, not all Part D plans have done this ... Read more


Quote of the Day

“The whole character of this [Office for Civil Rights investigation of Cignet Health, which was fined $3 million just for its failure to cooperate with OCR] was really astounding, from beginning to ending. It really stunned us. They failed to appear, they ignored us, they refused to engage with us to have us understand why they were doing this. It defies any kind of logical explanation.”

— Office for Civil Rights Director Georgina Verdugo told AIS’s Report on Patient Privacy.

Click here to read the REPORT ON PATIENT PRIVACY article in which this quote appeared. (Free for RPP subscribers; $17 for non-subscribers).


Today's Datapoint

63% … is the projected rise in per-member-per-year costs for inflammatory conditions related to rheumatoid arthritis, on top of the PBM’s average cost per prescription of $1,744, according to Express Scripts, Inc.’s 2009 Drug Trend Report.

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


Today from Washington

People on the Move

Horizon Blue Cross Blue Shield of New Jersey promoted Robert Marino to president and CEO. Marino was executive vice president and chief operating officer. Marino replaces William Marino, who retired as chairman and CEO....Huron Consulting Group named Gary Keilty managing director for its compliance and investigations unit. Keilty was managing director and co-founder at RESOLVE Advisory Partners, LLC.


Today's Featured Health Business Job Opening

Homecare Dimensions
Registered Nurses
San Antonio

Place Your Ad Here

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Upcoming Webinars

Social Media: How Insurers Can Strengthen Sales, Improve Member Health and Avoid Privacy Risks
Tuesday, March 22, 2011

Click here for details.

Beyond Buy and Bill: Managing Specialty Therapies Under the Medical Benefit
Tuesday, March 29, 2011

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Medical Homes: Health Plan Pilots that Have Improved Outcomes and Lowered Costs
Thursday, March 31, 2011

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New Reform-Driven Claims and Appeals Procedures: Practical Steps Plans Should Take Now
Tuesday, April 5, 2011

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CMS’s New Past Performance Assessment: Steps MA and Part D Plans Must Take Now to Avoid Harsh Penalties
Thursday, April 14, 2011

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Setting Out-of-Network UCR Rates: Evaluating FAIR Health’s New Benchmark Data and Other Alternatives for Insurers and Employers
Thursday, April 21, 2011

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