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March 17, 2011

Today’s issue is brought to you by Drug Benefit News, biweekly news, proven cost management strategies and unique data for health plans, PBMs, pharma companies and employers.

Today's Featured Story

With an Eye on 2012 Quality Ratings, PBMs Help MA Plans Fire Up Their Star Power
Reprinted from Drug Benefit News

Medicare Advantage plans have only from now until June of this year to make changes that can help them enhance their star quality ratings for 2012, and the clock is ticking. PBMs are discovering ways they can make themselves indispensable allies to MA plans in this effort, helping them to boost their ratings and become eligible for coveted bonus payments .... Read Full Story


From the AIS Blogs

OIG Plays Up Plans to Exclude Executives, Owners

Apparently the HHS Office of Inspector General (OIG) can’t make it clear enough that it won’t suffer fools gladly when they own or manage companies that get in trouble for fraud ... Read more


Quote of the Day

“The mental-health and substance-abuse disorders of the population are prevalent, they’re serious, and they have a profound impact on health outcomes and expenditures. So any organization [such as an ACO] interested in bending the cost curve…has to reckon with substance-abuse and mental health disorders. If you don’t you’re sort of putting your head in the sand.”

— Steven Adelman, M.D., director of behavioral health and addiction medicine for Harvard Vanguard Medical Associates, told ACO Business News.

Click here to read the ACO BUSINESS NEWS article in which this quote appeared. (Free for ABN subscribers; $17 for non-subscribers).


Today's Datapoint

½…of Americans surveyed recently are concerned about privacy, but 64% said the benefits of electronic health records outweigh privacy concerns, according to the National Opinion Research Center at the University of Chicago.



Today from Washington

People on the Move

WellPoint, Inc. named Andrea Schell vice president of underwriting for its National Accounts business. Schell replaces Norm Sowatzke, who was named vice president of its Commercial Underwriting business. Schell was regional vice president of underwriting at WellPoint's Ohio local market....Ora, Inc. appointed Larry Amdahl director of clinical operations for Dry Eye. Larry was director of clinical affairs at Dow Pharmaceutical Sciences.


Today's Featured Health Business Job Opening

Catalyst Rx
Medicare Formulary Pharmacist
Anywhere in the U.S.

Place Your Ad Here

Content questions or suggestions should be directed to BJ Taylor, editor of AIS's HEALTH BUSINESS DAILY, at If you are interested in sponsoring AIS's HEALTH BUSINESS DAILY, please contact Bailey Sterrett at

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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

Click here for details.

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

Click here for details.

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

Click here for details.

Medicare Advantage Marketing for 2012: Steps to Take Now to Succeed Amid Reform-Driven Changes
Tuesday, May 10, 2011

Click here for details.

A Practical Guide to Federal Medical Loss Ratio Requirements
AIS's Health Business Daily