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June 3, 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

NCQA’s Final ACO Standards in July May Have Later Impact on Medicare
Reprinted from ACO Business News

The National Committee for Quality Assurance tells ABN it will release final ACO accreditation standards in July “or soon thereafter,” and also will submit comments by the June 6 deadline on provisions in the draft Medicare Shared Savings Program regulations related to ACO quality metrics. An industry lawyer asserts that the recent issuance of the rule without any mention of NCQA accreditation calls the relevance of the private-sector organization’s forthcoming standards into question. But NCQA disputes that point — blaming it on timing and saying Medicare eventually may use its ACO accreditation .... Read Full Story

 

From the AIS Blogs

’There’s an app for that’

The ubiquitous phrase first used — and then trademarked — by Apple definitely seems to apply to the pharmacy benefit industry. It seems like every day I get a press release touting a new mobile phone application that helps improve compliance, locate a pharmacy or comparison shop for pharmaceuticals ... Read more

 

Quote of the Day

The preference among oncologists for oral therapies over IV/infused agents “is a trend we’ve observed directly as well. Oncologists have become comfortable with these oral products and comfortable that patients by and large will comply. [An Avalere study showing that 25% of members fail to fill oral oncolytics] will cause physicians to take a step back and ask what is likely to happen. It’s easier to monitor adherence [when physicians are giving infusions in their offices].”

— Dan Mendelson, CEO of Avalere Health LLC, told AIS’s Specialty Pharmacy News.

Click here to read the SPECIALTY PHARMACY NEWS article in which this quote appeared. (Free for SPN subscribers; $17 for non-subscribers).

 

Today's Datapoint

$1.25 billion … was recently paid by CVS Caremark Corp. for the Medicare Part D business of Universal American Corp.

From MEDICARE PART D NEWS.

 

Today from Washington

People on the Move

Medicare Advantage operator Aveta Inc. named Nancy Waltermire chief compliance officer. Waltermire was manager of senior billing and enrollment at Horizon Blue Cross Blue Shield of New Jersey....SynCardia Systems, Inc. said that Rodger Ford, the company's CEO for the past six years, has stepped down. SynCardia President Michael Garippa has taken over as CEO in addition to his current role. Ford is joining MicroMed Cardiovascular, Inc. as CEO and chairman of the board.

 

Today's Featured Health Business Job Opening

The Rawlings Group
Director of New Initiatives, Pharmacy Division
LaGrange, Ky.

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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Upcoming Webinars

Global Payments: Health Plan Strategies for the Brave New World of Accountable Care
Tuesday, June 14, 2011

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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

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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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ACO Business News
Also From AIS
A Practical Guide to Federal Medical Loss Ratio Requirements
Guidance on the big-dollar questions stemming from provisions in the health reform law that set minimum medical loss ratios. Click here for details.

Complying with the Mental Health Parity and Addiction Equity Act
Find out about the legal requirements of the law and complex benefit design decisions that need to be made. Click here for details.
 
AIS's Health Business Daily