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Aug. 2, 2011

Today’s issue is brought to you by Drug Benefit News, biweekly news, proven cost management strategies and unique data for health plans, PBMs, pharma companies and employers.

 
Today's Featured Story

Copay Cards Could Be Win-Win If All Sides Work Together
Reprinted from Drug Benefit News

When it comes to the topic of drug companies’ copayment cards, the consensus among PBMs and health insurers is pretty clear. The discount cards, issued by pharmaceutical companies to defray patients’ out-of-pocket costs, interfere with payers’ ability to manage trend and the formulary process .... Read Full Story

 

From the AIS Blogs

Measure for Measure: How CMS Star-Rating Changes Might Hurt MA Plans

Nobody seems to be ascribing any evil intent to this, but the plans for "retiring" some quality measures used in Medicare Advantage star ratings that CMS unveiled July 27 could have some negative effects on many MA plan sponsors. That's because, observers say, the retired measures generally fall in areas either where MA plans are doing very well or where most plans are ranked at about the same levels. And the new measures to be introduced in their stead are likely to be ones in which lower scores will be prevalent ... Read more

 

Quote of the Day


“Right now it’s harder for many people to buy fruit than Fruit Loops; chips and Coke are a common breakfast. And since the rate of diabetes continues to soar – one-third of all Americans either have diabetes or are pre-diabetic, most with Type 2 diabetes, the kind associated with bad eating habits – and because our health care bills are on the verge of becoming truly insurmountable, this is urgent for economic sanity as well as national health.”

Mark Bittman, writing in The New York Times “Sunday Review” on July 24 about implementing taxes on unhealthy foods.

 

Today's Datapoint

$5,107 … was the average annual premium for small-group coverage in 2010 ($13,409 for families), according to a member survey released recently by AHIP.

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

 

FierceHealthPayer News from our partner FierceMarkets

Insurers encourage less-costly ER alternatives

Research shows that up to 20 percent of emergency room (ER) visits could be diverted to less-expensive retail sites, so health insurers like Anthem, UnitedHealth, and Kaiser Permanente are experimenting with various ways to educate their members about valid emergencies and encourage them to take advantage of less-costly alternatives for non-emergency needs, reports the Denver Post ... Read more

 

Today from Washington

People on the Move

Medworxx Inc., a developer of clinical patient flow tools, named Brian Goffenberg chief financial officer (CFO). Goffenberg was CFO at Wynford Inc....American CareSource Holdings appointed William Simpson president in addition to his role as chief operating officer (COO). Simpson joined the company as COO in December.

 

Today's Featured Health Business Job Opening

Blue Cross Blue Shield Association
Executive Director, Care Delivery Innovation
Chicago

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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New Insurance Exchange Regs: Strategies for Health Plans, Brokers, Providers and Employers
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Tuesday, August 30, 2011

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New Reform-Driven Claims and Appeals Procedures: Practical Steps Plans Should Take Now
Tuesday, September 13, 2011

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Encounter-Data Requirements for Medicare Advantage: How to Get Ready for the Huge Change in January
Wednesday, September 14, 2011

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Thursday, September 22, 2011

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