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July 13, 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

Potential ACO Sponsors Warn CMS They Need Payment, Other Changes on ‘Pioneer’
Reprinted from AIS’s Health Reform Week

In what one Medicare-industry consultant describes as a last-ditch effort, several potential sponsors of Medicare accountable care organizations met with CMS the week of June 27 to hash out differences on payment and other basics of CMS’s proposed “Pioneer model” initiative for experienced ACO entities. The consultant, John Gorman, CEO of Gorman Health Group, LLC, insists that these potential sponsors won’t participate unless they find common ground with CMS on what they consider to be a financially viable business model .... Read Full Story


From the AIS Blogs

Legislature Passes Bill to Stop Recoupment in New York

Change is in the air in New York state, where the state Legislature has passed a bill that stops the Office of Medicaid Inspector General from recouping overpayments based on administrative or technical defects (unless there's intent to defraud) and gives providers 30 days to fix the defects and resubmit the claim ... Read more


Quote of the Day

“Having been in this business for some years, it is my experience that there is easily, and I would have to say anecdotally, more fraud and abuse in the fee-for-service Medicaid program than there is in a Medicaid managed care program.”

— Mesfin Tegenu, president, PerformRx, tells Drug Benefit News

Click here to read the DRUG BENEFIT NEWS article in which this quote appeared. (Free for DBN subscribers; $17 for non-subscribers).


Today's Datapoint

24% … of patients surveyed by Quintiles Transnational Corp. for the second edition of The New Health Report had heard of personalized medicine.

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


Today from Washington

People on the Move

Passport Health Plan named Mark Carter CEO. Carter has served as interim CEO since late last year, when Larry Cook, M.D., chairman and CEO, resigned....H. D. Smith, a large pharmaceutical wholesaler, appointed Mark de Bruin corporate vice president, managed care. De Bruin was CEO at Asteres, Inc.


Today's Featured Health Business Job Opening

Health Plan
Compliance Analyst

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