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April 21, 2011

Today’s issue is brought to you by AIS’s Health Reform Week, the nation’s leading publication on the business implications of the massive changes for the health industry mandated by reform.

Today's Featured Story

Private Insurers May Diverge From Medicare In Forming ACOs Amid Consolidation Issues
Reprinted from AIS’s Health Reform Week

Commercial payers may not necessarily follow HHS’s lead on developing a framework for accountable care organizations, despite certain protections the newly proposed regulations may provide. In the meantime, the industry’s major trade group remains concerned about the potential for Medicare ACOs to “become the recipe for further consolidation, which may lead to higher prices and higher costs for consumers.”... Read Full Story


From the AIS Blogs

OIG Allows MFCUs to Data Mine Medicaid Payments

The HHS Office of Inspector General (OIG) released a proposed rule that would let Medicaid Fraud Control Units (MFCUs) ask for federal funds to start data mining Medicaid claims to look for fraud and abuse ... Read more


Quote of the Day

“I could see both the state and the feds really moving to a structure of paying health plans that turns them into something that looks like public utilities. [State and federal governments] are going to get extremely creative in limiting excess profitability of health plans. They are a political piñata.”

John Gorman, CEO of Gorman Health Group, LLC, told AIS’s Health Plan Week.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

More than
60%…of HIPAA covered entities that have experienced a data breach said encryption would have been a mitigating factor had they used it, according to a recent study by the Ponemon Institute.

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


FierceHealthFinance News from our partner FierceMarkets

Declining Workplace Health Costs Hospital Employers

Although hospital staff work to improve the health of patients, their own health seems to be slipping, and it's costing hospital employers a pretty penny. Between 2005 and 2009 the health of the U.S. workforce dropped 2 percent, costing employers an average $670 a year to address their healthcare issues, concludes a new study by Thomson Reuters .... Read more


Today from Washington

People on the Move

Rite Aid Corp. promoted Tony Montini to executive vice president of merchandising. Montini was senior vice president of category management....WellPoint, Inc. named Meg Rush vice president of consumer experience and e-Marketing. Rush was vice president of product management and design for WebMD Health Services.


Today's Featured Health Business Job Opening

WellPoint, Inc
Regulatory Compliance Manager
Milwaukee; Mason, Ohio; or Denver

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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

New ACO Regulations: Discover the Opportunities and Pitfalls Ahead
Thursday, May 5, 2011

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

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

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Medical Loss Ratio Regs: What 2010 Data Suggest About Potentially Huge Rebates in 2011
Thursday, June 23, 2011

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