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June 1, 2011

Today’s issue is brought to you by AIS's Medicare Part D News, monthly business, compliance and management news and strategies to help Part D plans increase enrollment, boost revenues and minimize their risks of CMS fines, penalties and repayments.

Today's Featured Story

Despite Complaints, Humana-Walmart Part D Plan Surges Ahead of the Rest of the Field
Reprinted from Medicare Part D News

Humana Inc. said on May 2 that membership in its stand-alone Prescription Drug Plans (PDPs) increased to 2,353,100 on March 31 from 1,670,300 on Dec. 31, 2010. “This increase resulted primarily from higher gross sales year-over-year,” particularly for the company’s Humana-Walmart Preferred Rx Part D plan, offered in partnership with Wal-Mart Stores, Inc. Despite its popularity among seniors, beneficiary advocacy groups continue to oppose the plan.... Read Full Story


From the AIS Blogs

Part D and ACOs

Everywhere you turn today people are talking about accountable care organizations.... Read more


Quote of the Day

“From a patient perspective, they have the ability to opt out [of an Accountable Care Organization], but if they opt out, then the doctor, the primary care provider who’s a part of the ACO, is not going to be available for them. So typically what folks are assuming is a lot of seniors will not agree to opt out.”

— Anil Kottoor, president and CEO of MedHOK, a health care IT firm, told AIS’s 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

46% ... of high-dollar Medicare payments to facilities were inappropriate between October 2006 and December 2007, according to a new audit report from the HHS Office of Inspector General.



Today from Washington

People on the Move

Avivia Health named Jodi Harrington area vice president for eastern region sales. Harrington served as vice president, business development at OptumHealth….Solis Women’s Health, which provides screening and diagnostics for breast cancer, has appointed James Polfreman its president and CEO. Polfreman previously served as CEO of Memorial Herman Hospital System’s retail health businesses.


Today's Featured Health Business Job Opening

Catalyst Rx
Clinical Manager
Chicago, Puerto Rico, Atlanta, Orlando, St. Louis

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Upcoming Webinars

Global Payments: Health Plan Strategies for the Brave New World of Accountable Care
Tuesday, June 14, 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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Health Plans vs. Drug Coupons: Tactics to Combat Brand-Name Drug Promotions
Wednesday, July 13, 2011

Click here for details.

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

Click here for details.

Managed Medicare and Medicaid Factbook 2011
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