April 5, 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

Geisinger’s Multi-ACO Efforts May Not Be Easily Replicated
Reprinted from ACO Business News

Geisinger Health System is often touted as being among a handful of integrated health systems that set the “gold standard” in the private sector for ACO-like delivery models intended to increase quality and efficiency and better coordinate care. With its own hospitals, health plan and employed physician base, some industry consultants assert that Geisinger is “doing all the right things,” and its model seems translatable — at least to a certain extent. But Geisinger’s clinical lead for population health initiatives, including ACOs, medical homes and physician group cooperatives, tells AIS that even integrated systems with long years of experience still face significant challenges if payment remains fragmented .... Read Full Story


From the AIS Blogs

Should Part D Plans Try New Tactics for Specialty Tiers?

As the cost of specialty drugs continues to rise, Part D plan sponsors are faced with increasing challenges to manage these drugs on their formularies. While simply pushing them onto the top tier of a formulary has been an adequate solution up till now, CMS may begin making that more difficult to do ... Read more


Quote of the Day

While I “recognize the valuable role agents and brokers play in helping…consumers and businesses purchase health insurance, [I cannot] support a proposal that would allow agents, brokers and health insurance companies to retain the estimated $1 billion in benefits that American consumers will receive next year thanks to the health care reform law.”

— Sen. Jay Rockefeller (D-W.Va.), in a letter to the president of NAIC expressing concern about proposed legislation to remove broker commissions from medical loss ratio calculations.



Today's Datapoint

$107 million … was saved in 2010 by uninsured and underinsured Americans as a result of the Prescription Discount Card Program of the National Assn. of Counties, according to data released by NACo and CVS Caremark Corp.



FierceHealthFinance News from our partner FierceMarkets

Congress Probes AARP's Reform lobbying

AARP, which was one of the prominent institutional backers of last year's healthcare reform bill, is under scrutiny from Congress for the first time since the mid-1990s ... Read more


Today from Washington

People on the Move

Harvard Pilgrim Health Care appointed Michael Sherman, M.D., chief medical officer. Sherman was corporate medical director at Humana Inc....Joslin Diabetes Center named John Brooks, III, president and CEO. Brooks was chairman of the board, but left that role to take the chief executive position.


Today's Featured Health Business Job Opening

University Physician Associates of New Jersey
Coding Compliance Analyst
Newark, N.J.

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

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Upcoming Webinars

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.

Outcomes-Based Contracts: Innovative Payer Deals to Improve Member Health and the Bottom Line
Tuesday, April 19, 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.

Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, May 12, 2011

Click here for details.

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