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May 10, 2011

Today’s issue is brought to you by AIS's Medicare Advantage News, biweekly news and analysis on the Medicare (and Medicaid) managed care programs.

 
Today's Featured Story

CMS Will Stress Outcome Measures in New Star Ratings, Won’t Adjust for Region
Reprinted from Medicare Advantage News

CMS is considering a host of additional measures, many of them related to outcomes and clinical programs, for both the 2012 and 2013 star ratings for Medicare Advantage and Part D plans, the head of its plan-performance division told a capacity audience at the agency’s spring conference in Hunt Valley, Md. ... Read Full Story

 

From the AIS Blogs

Hospitals Could Make Better Use of CMS Compliance-Monitoring Data

Hospitals may not be making the most of the Program for Evaluation Payment Patterns Electronic Report, which is free compliance-monitoring data from CMS ... Read more

 

Quote of the Day

“There are some very reasonable tools that can help control [pharmacy spending], especially in oncology. Increased use of generics, use of preferred products, and following guidelines and pathways will wring out inappropriate utilization. If you can’t get 15% out of those three tactics, then something is wrong.”

— Bill Sullivan, principal consultant for Specialty Pharmacy Solutions LLC, told AIS’s Specialty Pharmacy News.

From SPECIALTY PHARMACY NEWS.

 

Today's Datapoint

10% to 15% … of advanced imaging tests for individuals suffering from heart disease were inappropriately denied to patients by Aetna Inc. and Blue Cross Blue Shield of Delaware, according to an investigation by the Senate Commerce Committee.

From HEALTH PLAN WEEK.

 

FierceHealthPayer News from our partner FierceMarkets

Highmark, UPMC End Negotiations as Aetna Steps In

Provider agreement talks between Highmark and the University of Pittsburgh Medical Center appear to be irretrievably broken after UPMC signed a contract with Aetna that allows the health insurance giant to re-enter the local market, reports the Pittsburgh Business Times ... Read more

 

Today from Washington

People on the Move

The Pharmaceutical Research and Manufacturers of America named Rod Hunter senior vice president of international advocacy, effective June 10. Hunter was vice president of governmental programs in Europe at IBM Corp....HouseWorks, a private-pay home care company, appointed Mark Hollister vice president of strategic growth. Prior to joining HouseWorks, Hollister had held executive level marketing positions at Homebase Abroad, HealthLeaders Media and International Data Group, Inc.

 

Today's Featured Health Business Job Opening

Health Plan
Medical Director
Ft. Lauderdale, Fla.

Place Your Ad Here
 

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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Register for the FIS Healthcare Payment Solutions webinar, Payer and Provider Collaboration – Strategies to Ensure Mutual Success – May 26, 2011; 2:00 p.m. EDT. www.fisglobal.com/
transformation

Upcoming Webinars

Optimizing Drug Benefit Plan Designs for the Coming Wave of Generic Competition
Tuesday, May 17, 2011

Click here for details.

Strategies for Managing Part D Specialty Formulary Tiers
Wednesday, June 15, 2011

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Insurance Exchanges: How Health Plans and Employers Should Prepare for the Radical Changes Ahead
Tuesday, June 21, 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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ACO Results and Strategies: A Case Study in Three-Way Risk Sharing
Thursday, June 30, 2011

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Payer Strategies to Manage High-Cost Specialty Drugs That Will Hit the Market Soon
Thursday, July 14, 2011

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Medicare Advantage News
 
AIS's Health Business Daily