The AIS Guide to Blue Cross and Blue Shield Plans: 2010

Webinars on: Conducting Internal Investigations; Electronic Health Records; Star Ratings for Medicare Quality Bonuses; Medication Therapy Management


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Free Report: Strategies to Reduce Oncology Care Costs -- Without Sacrificing Outcomes

AIS's Health Reform Week - Informing savvy business leaders in health care of what reform means to them ... and how to take advantage of new opportunities ahead

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Free Report: Strategies to Reduce Oncology Care Costs -- Without Sacrificing Outcomes

AIS's Health Reform Week - Informing savvy business leaders in health care of what reform means to them ... and how to take advantage of new opportunities ahead

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Free Report: Strategies to Reduce Oncology Care Costs -- Without Sacrificing Outcomes

AIS's Health Reform Week - Informing savvy business leaders in health care of what reform means to them ... and how to take advantage of new opportunities ahead

 

 

 

 

 

 

 

 

 

 

 

 

AIS Health Plans Marketplace

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Books, Directories & Reports Listing
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More Health Plan products are available at the AIS Pharmacy Benefit MarketPlace

The AIS Guide to Blue Cross and Blue Shield Plans
The AIS Report on Blue Cross and Blue Shield Plans
• AIS’s 2003-2007 Health Plan Enrollment Statistics: Comparative 5-Year Market Share, Trends and Data

AIS's Directory of Health Plans
AIS's Health Reform Week
The Aging of America: Implications for the Business of Health Care
CMS’s Part D Audit Findings: A Roadmap for Plan Sponsors
Disease Management: Outcomes, Strategies, Outlook
Complying With the Mental Health Parity and Addiction Equity Act

Health Insurance Plan-Design Trends for Group and Individual Markets

 

Health Plan Facts, Trends and Data
Health Plan Pay-for-Performance Programs: The Next Generation
Health Plan Strategies for the Individual Market
Health Plan Strategies for Value-Based Benefit Design
Health Plan Week
Health Reform’s Impact on Commercial and Medicare Health Plans
Key Financial Indicators for Leading Health Plans
Managed Medicare and Medicaid Factbook
Medicare Advantage News
Medicare Part D: A Comprehensive Analysis of CMS Rules
Medicare Part D News
Medicare Plan Marketing in the Regulatory Crosshairs: New Enforcement Initiatives
The Next Generation of Disease Management
Special Needs Plans: Regulatory Challenges and Market Strategies

Print an order form: If you do not wish to place your order online, click here to download a printable order form (PDF file), then submit your order via fax or mail, as directed on the form.

Newsletters

AIS’s HEALTH REFORM WEEK is a weekly newsletter that delivers timely, reliable news and sound strategies to help health care managers reinvent their business and protect their bottom line. A subscription provides business executives with a steady stream of sharp ideas from top managers with plans and providers alike ... along with special insight from policymakers and how-to guidance by top consultants and attorneys in each market. 45 issues annually ($365 for 1-year Charter Subscription); includes print copy and e-mail delivery.
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THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS, valuable news and penetrating analysis of new products, market share, strategies, conversions, financing, profitability and strategic alliances of Blue Cross and Blue Shield plans. Written by insightful managed care writer/analyst Jill Brown. (Published independently by AIS. Not affiliated with or sponsored, endorsed or approved by the Blue Cross Blue Shield Association or any of the independent Blue Cross and Blue Shield companies.) 12 issues annually ($477 per year) or 2-month intro ($72 for 2 issues); both include print copy and e-mail delivery.
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HEALTH PLAN WEEK, timely business, financial and regulatory news of the health insurance industry — with the inside news, targeted data and expert analysis that will help you monitor all of the changes ahead under health reform and improve your organization's bottom line. The health plan industry's most respected and widely read weekly news source since 1991. 45 issues annually ($677 per year) or 2-month intro ($91 for 8 issues); both include print copy and e-mail delivery.
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MEDICARE ADVANTAGE NEWS, timely news and strategies to boost revenues, increase enrollees and cut costs in Medicare Advantage and Medicaid managed care. 24 issues annually ($471 per year) or 2-month intro ($69 for 4 issues); both include print copy and e-mail delivery.
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MEDICARE PART D NEWS, monthly news and strategies to help you increase Part D enrollment and boost revenues while complying with complex CMS and state enforcement actions and regulations. You’ll also get valuable updates on how Part D will be impacted by health reform. 12 issues annually ($467 per year); includes print copy and e-mail delivery.
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Books, Directories & Reports


THE AIS GUIDE TO BLUE CROSS AND BLUE SHIELD PLANS, a competitive intelligence resource from the editors of The AIS Report on Blue Cross and Blue Shield Plans. It contains reliable information on Blues plans’ products, market strategies, acquisitions and alliances — including financial projections and hard-to-find data on revenues, earnings, enrollment and medical loss ratios. (Published independently by AIS. Not affiliated with or sponsored, endorsed or approved by the Blue Cross Blue Shield Association or any of the independent Blue Cross and Blue Shield companies.) ($427) CD version also available.
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AIS’S 2003-2007 HEALTH PLAN ENROLLMENT STATISTICS: COMPARATIVE 5-YEAR MARKET SHARE, TRENDS AND DATA, exclusive data compiled from AIS’s proprietary database. This comprehensive analysis of 5 years’ worth of comparable health plan enrollment data includes national enrollment for all U.S. health insurance companies offering fully insured medical coverage, with state-specific breakdowns and enrollment by product type where available. Includes CD with raw data and a summary report. ($6,235)

AIS’s DIRECTORY OF HEALTH PLANS,
the most comprehensive resource available on the U.S. health plan market — more than 500 pages of thoroughly researched and verified information. It contains the most up-to-date enrollment data and contact information for health plans and primary care preferred provider networks operating in the U.S. Database also available on CD, so you can easily create the specific kind of analysis best suited to your needs. ($652)

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THE AGING OF AMERICA: IMPLICATIONS FOR THE BUSINESS OF HEALTH CARE is packed with data, trends, projections and other research findings on how Baby Boomers are about to reshape U.S. health care ... with contributions from organizations like The Brookings Institution, First Consulting Group, The Commonwealth Fund, RAND Corp. and The Urban Institute; and government agencies like the Administration on Aging, CDC, Congressional Budget Office, Congressional Research Service, Institute of Medicine, Census Bureau, and Bureau of Labor Statistics. Separate chapters focus on how Boomers will impact hospitals and other providers, health plans, long-term and home care services, age-related diseases, and much more. ($187)
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CMS’s PART D AUDIT FINDINGS: A ROADMAP FOR PLAN SPONSORS, a collection of summaries of CMS’s recent audit reports that will help Part D plans avoid becoming agency targets. It highlights the top five audit hot spots and other areas that CMS and Medicare Drug Integrity Contractors have been focusing on — and will likely continue to focus on — during audits. ($84) PDF version also available.
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COMPLYING WITH THE MENTAL HEALTH PARITY AND ADDICTION EQUITY ACT provides insight for health plans and plan sponsors into the Mental Health Parity and Addiction Equity Act’s legal requirements. Written by experienced health benefits attorneys John R. Hickman, Esq., and Laurie Kirkwood, Esq., of the law firm of Alston & Bird, LLP, the book provides hands-on guidance for making complicated benefit design decisions that comply with the parity requirements. ($179)
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HEALTH INSURANCE PLAN-DESIGN TRENDS FOR GROUP AND INDIVIDUAL MARKETS contains valuable insight and examples from health insurers, brokers and agents, employers and other industry observers on how the changing needs of employers are being met. This report takes a comprehensive look at how new plan designs are altering the employee benefits landscape, and examines trends among employers, individual health plans, account-based plans, wellness programs and other disease management initiatives. ($84) PDF version also available.
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HEALTH PLAN FACTS, TRENDS AND DATA, a best-selling annual book brimming with insightful news on important trends that are re-shaping the health care industry, and reliable data, directories and other valuable resources you can put to work today! Written and organized by AIS's experienced health reporting staff. ($398)
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HEALTH PLAN PAY-FOR-PERFORMANCE PROGRAMS: THE NEXT GENERATION explores the dramatic change in the scope and depth of pay-for-performance (P4P) programs during the past several years. This book looks at such trends as P4P programs with specialist physicians and PPOs, P4P programs with hospitals and programs geared toward specific diseases, and also contains three case studies from well-respected health insurers. ($124) PDF version also available.
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HEALTH PLAN STRATEGIES FOR THE INDIVIDUAL MARKET contains valuable insight on the benefit design innovations, marketing tactics and legal challenges being faced by health plans in the individual (non-group) commercial health plan market. This report features enrollment data, exclusive insight from executives at Blue Cross and Blue Shield plans, Aetna, CIGNA and others on balancing premiums against rising medical costs, and detailed analysis of coverage rescission issues. ($84) PDF version also available.
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HEALTH PLAN STRATEGIES FOR VALUE-BASED BENEFIT DESIGN examines the experiences of health plans and employers that have implemented value-based benefit design programs, and provides details of how companies adjusted copays and other benefits, provided incentives to join disease management programs, educated enrollees and measured results. It includes case studies and presentations from pioneers in the value-based insurance design movement, with best practices — and key pitfalls to avoid — when launching a new program. ($84) PDF version also available.
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HEALTH REFORM’S IMPACT ON COMMERCIAL AND MEDICARE HEALTH PLANS addresses administrative challenges posed by the reform law, and delves into the likely impact of the act on coverage, benefit designs, medical costs and pharmacy benefits. In this report, insiders close to HHS and in leadership positions at health plans, provider organizations and PBMs spell out what form the rules might take — and who will be the winners and losers. ($84) PDF version also available.
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KEY FINANCIAL INDICATORS FOR LEADING HEALTH PLANS, a quarterly spreadsheet with up-to-date financial data points for 50 leading health plans. The Excel file compares nine indicators — premium revenue, hospital/medical costs, pharmacy costs, total medical costs, medical cost ratio, administrative costs, administrative expense ratio, net income (loss) and net margin. ($141 per quarter)
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MANAGED MEDICARE AND MEDICAID FACTBOOK, a valuable resource with information on rates, benefit designs, enrollment, contacts, trends and strategies on the Medicare Advantage, Medicare Part D and managed Medicaid programs. Conveniently tracks the enrollment trends, plan design information and market share statistics you need in the strategic planning process. Written and organized by AIS's experienced health reporting staff. ($443) Expanded CD version also available.
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MEDICARE PART D: A COMPREHENSIVE ANALYSIS OF CMS RULES distills from thousands of pages of CMS regulations and guidance the major rules, guidelines and deadlines you need to comprehend the complex Medicare drug benefit program. It includes nine detailed chapters on sponsors, eligibility and enrollment, formularies, CMS enforcement and much more. ($124)
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MEDICARE PLAN MARKETING IN THE REGULATORY CROSSHAIRS: NEW ENFORCEMENT INITIATIVES provides information on meeting current — and future — rules from CMS and the HHS Office of Inspector General on marketing of Medicare Advantage and Part D plans. This report includes details of new requirements, what proposed new regulations are likely to mean for enforcement in the future, and lessons learned from regulatory actions already taken against violators. ($84) PDF version also available.
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THE NEXT GENERATION OF DISEASE MANAGEMENT: 2009 AND BEYOND, a thought-provoking book that provides expert insight into where the DM industry is headed. Ten leaders in the DM industry weigh in on pressing issues such as: the build-versus-buy debate; using predictive modeling; measuring results; integrating care coordination; leveraging technology; and much more. ($223)
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SPECIAL NEEDS PLANS: REGULATORY CHALLENGES AND MARKET STRATEGIES answers questions about major developments in Medicare Advantage Special Needs Plans (SNPs) during the past few years, from both a business and regulatory standpoint. Find out what the most successful SNPs are doing, what problems other SNPs are running into, and what impact the health reform law will have on SNPs. The report also includes a comprehensive directory of SNPs and their enrollment. ($84) PDF version also available.
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Webinars

Webinars are listed below in reverse chronological order,
with the most recent first.

STAR RATINGS FOR MEDICARE QUALITY BONUSES: STRATEGIES FOR A NEW ERA OF PERFORMANCE-BASED MEASUREMENT, a 90-minute Webinar on September 21, 2010. Find out how to succeed in the star-rating system. John Gorman, founder and CEO of Gorman Health Group, LLC, and Frank Ingari, CEO of Essence Healthcare, will pinpoint the kinds of operational and clinical process elements needed to boost star ratings and earn the bonus dollars that can be the key to surviving in the post-reform era. ($329)
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INSURANCE EXCHANGES: HOW TO PREPARE FOR THEIR IMPACT ON SMALL-GROUP AND INDIVIDUAL MARKETS, a 90-minute Webinar first held on August 31, 2010. Find out how the state insurance exchanges called for by the health reform law are likely to impact the individual and small-group markets, and what steps you should take to get ready. The panel for this roundtable discussion includes industry insiders Rob Mercado, vice president, technology products and services at eHealth Inc., Vince Ashton, executive director of the New York Health Purchasing Alliance (HealthPass New York), Bruce Caswell, president and general manager of the health services segment at MAXIMUS, and Timothy Stoltzfus Jost, J.D., who holds the Robert L. Willett Family Professorship of Law at the Washington and Lee University School of Law. CD or On-Demand Recording available. ($329)
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REFORM-DRIVEN CHANGES TO RETIREE HEALTH COVERAGE: STRATEGIES FOR PART D PLANS AND EMPLOYERS, a 90-minute Webinar first held on July 28, 2010. Learn how upcoming changes for retiree coverage, as mandated in the new health reform law, can benefit employers and Part D plans. Employee benefits experts from The Segal Company — Stuart Wohl, senior vice president and retirement health practice lead, and George Bognar, lead pharmacy benefits consultant — will detail the changes in the retiree drug subsidy (RDS) and the Part D coverage gap, and ways Part D plans can make the most of these opportunities. CD or On-Demand Recording available. ($329)
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ACCOUNTABLE CARE ORGANIZATIONS: STRATEGIES FOR HEALTH PLANS AND PROVIDERS, a 90-minute Webinar first held on July 21, 2010. Learn what payers and providers can do now to prepare for the new Medicare ACO pilot created by the health reform law. Joe Gifford, M.D.,  senior medical director for Regence BlueShield, and Philip Gaziano, M.D., a medical director and executive board member for Hampden County Physician Associates, LLC (HCPA), will describe current ACO models already operating in the private sector, and answer questions about how to structure and prepare to launch ACO programs soon. CD or On-Demand Recording available. ($329)
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WALL STREET OUTLOOK: HOW HEALTH PLANS ARE EXPECTED TO PERFORM IN THE SECOND HALF OF 2010, a 90-minute Webinar first held on July 15, 2010. Hear the specifics of what Wall Street expects from health plans during the next six months and how your strategies for the rest of 2010 and 2011 should be adjusted accordingly — from Carl McDonald, a director and senior analyst covering the managed care industry at Citi Investment Research, Joseph Marinucci, a director and health sector specialist for the S&P Financial Institutions Group, and Matthew Coffina, an equity analyst with Morningstar, Inc. CD or On-Demand Recording available. ($329)
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GRANDFATHERING UNDER HEALTH REFORM: STRATEGIES FOR HEALTH PLANS AND EMPLOYERS, a 90-minute Webinar first held on July 8, 2010. Learn how the regulations on grandfathering provisions in the health reform law will impact health plans and employers. Get insider perspectives on key questions about the new rules from Chantel Sheaks, a principal of Government Affairs in the National Technical Resources Group of Buck Consultants, and Kathryn Bakich, a senior vice president and national director of health care compliance at The Segal Company. CD or On-Demand Recording available. ($329)
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MEDICARE PLAN MARKETING FOR FALL 2010: STRATEGIES TO FIT THE HUGE CHANGES AHEAD, a 90-minute Webinar first held on June 23, 2010. Find out what Medicare Advantage and Part D marketing strategies your plan should consider to prepare for the upcoming enrollment season, amid the most challenging and complicated Medicare marketing environment in history. Speakers are: Dennis Barnes, founder and president of Marketing Direct, Inc. (MDI), and Jeff White, vice president, marketing and development of Physicians Health Choice. CD or On-Demand Recording available. ($329)
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MEDICARE DATA VALIDATION: PREPARING YOUR DATA FOR UPCOMING CMS AUDITS, a 90-minute Webinar first held on June 22, 2010. Learn best practices for examining and testing your reporting systems — and correcting any deficiencies — to make sure your 2010 datasets are ready to be audited in 2011. Dorothy DeAngelis, Richard Merino and Tim Nugent of FTI Consulting detail the steps plans need to take to avoid future financial and enforcement risks. CD or On-Demand Recording available. ($329)
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THE IMPACT OF REFORM ON BROKERS AND AGENTS, a 90-minute Webinar first held on June 10, 2010. Learn how reform provisions such as the MLR floor and insurance exchanges will affect future business for brokers and agents. Scott Leavitt, owner of Scott Leavitt Insurance & Financial Services, Donald Garlitz, a benefit consultant with FirstWest Benefit Solutions, and John Prible, vice president of federal government affairs at the Independent Insurance Agents and Brokers of America, Inc. (IIABA), will provide perspectives on strategies agents and brokers should employ to protect their bottom line and job security. CD or On-Demand Recording available. ($329)
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THE REGULATION OF MEDICAL LOSS RATIOS: MAJOR CHANGES HEALTH PLANS SHOULD DESIGN NOW, a 90-minute Webinar first held on May 25, 2010. Learn what federal MLR rules are likely to include, the impact these rules have had in states such as New Jersey that already require MLR floors and rebates to consumers, and steps insurers should take to prepare for this major change in how they will need to operate soon. Speakers are: Thomas A. Carroll, a managing director at Stifel Nicolaus, and Robert Meehan, vice president of consumer and senior markets at Horizon Blue Cross Blue Shield of New Jersey. CD or On-Demand Recording available. ($329)
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HEALTH REFORM’S IMPACT ON MEDICARE ADVANTAGE AND PART D: STRATEGIES TO IMPLEMENT NOW, a 90-minute Webinar first held on April 26, 2010. Find out how MA reform will impact plans and their partners, and what steps you should take now and in the future to deal with the huge changes ahead — from two experts on the reform law and its implications for health plan business strategies, Bruce Merlin Fried, a partner in the national Health Care and Public Law & Policy Strategies groups at law firm Sonnenschein Nath & Rosenthal LLP, and John Gorman, founder and CEO of Gorman Health Group, LLC. CD or On-Demand recording available.($329)
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HEALTH REFORM MEASURES FOR 2010: URGENT CHALLENGES FOR INSURERS AND EMPLOYERS, a 90-minute Webinar first held on April 20, 2010. Find out what steps to take to prepare for health reform’s September deadlines, avoid the many administrative pitfalls ahead and position yourself for the great opportunities that will soon emerge. Chantel Sheaks, a principal of Government Affairs in the National Technical Resources Group of Buck Consultants, Fred Karutz, general manager of health plan solutions at Silverlink Communications, and Dave Tuomala, a director of actuarial consulting at Ingenix Consulting, will walk you through critical pieces of the reform law that become effective this fall. CD or On-Demand Recording available. ($329)
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NEW MEDICARE ADVANTAGE RATES: HEALTH PLAN STRATEGIES FOR BIDS DUE IN JUNE, a 90-minute Webinar first held on April 8, 2010. Get insider guidance on how to quickly incorporate the final 2011 MA rates into your product-development and bidding strategy. William A. MacBain, senior vice president, finance of Gorman Health Group, LLC, will address how your organization can prepare for the major changes facing MA sponsors. CD or On-Demand Recording available. ($329)
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BENEFIT DESIGN DEMANDS FROM EMPLOYERS: HEALTH PLAN CHALLENGES FOR FALL 2010, a 90-minute Webinar first held on March 9, 2010. Learn about new cost-containment strategies that large employers want, as well as programs that can successfully improve the health and productivity of their employees — from Jorge Font, a principal at Buck Consultants, and Alexander “Sander” Domaszewicz, a principal and senior consultant with Mercer Health & Benefits Services. CD or On-Demand Recording available. ($329)
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MENTAL HEALTH PARITY: HOW TO COMPLY WITH NEW FINAL REGS, a 90-minute Webinar first held on February 25, 2010. Get strategic insights on steps your organization must take to fully comply with the new parity regulations, and specific actions you can take to control costs while ensuring the availability of behavioral health care benefits – from two experts on the legislation, Rhonda Robinson Beale, M.D., chief medical officer for UnitedHealth Group subsidiary OptumHealth Behavioral Solutions, and John Hickman, Esq., head of Health & Welfare Benefits in the Employee Benefits and Executive Compensation Group at the law firm Alston & Bird, LLP in Atlanta. CD or On-Demand Recording available. ($329)
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INDIVIDUAL AND SMALL-GROUP INSURANCE: HOW TO GRAB MARKET SHARE BEFORE REFORM, a recording of a 90-minute audioconference held on December 16, 2009. Get an overview of the rapidly changing sales and marketing landscape for small-group and individual products, and learn practical steps for reaching these key customer groups in 2010 — from Mark Carroll, a founding partner of Small Business Insurance Solutions (SBIS), C. Steven Tucker, founder and principal broker of Small Business Insurance Services, and Scott Leavitt, owner of Scott Leavitt Insurance & Financial Services. ($329)
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COMPETITIVE BIDDING UNDER MEDICARE ADVANTAGE: SURVIVAL STRATEGIES FOR PLAN SPONSORS, a recording of a 90-minute audioconference held on December 3, 2009. Get vital insights on how to plan for and succeed in an MA environment based on competitive bidding, from two experts at Ingenix Consulting — Stephen P. Wood, senior vice president, and Kirk Twiss, vice president, actuarial consulting. ($329)
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HOW TO COMPLY WITH NEW GENETIC-TESTING REGS WITHOUT GUTTING DM AND WELLNESS PROGRAMS, a recording of a 90-minute audioconference held on November 19, 2009. Get reliable information on strategies health plans can adopt now to comply with and prevent damage from the new GINA rules, while preserving the value of your disease management and health risk initiatives — from John Hickman, Esq., head of Health & Welfare Benefits in the Employee Benefits and Executive Compensation Group at Alston & Bird, LLP, Joanne Hustead, Esq., senior health compliance specialist in the National Compliance Practice at The Segal Co., and Cheryl Risley Hughes, Esq., of counsel to the Groom Law Group. ($329)
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MAJOR NEW REPORTING RULES FOR MA AND PART D PLANS: WHAT SPONSORS NEED TO KNOW NOW, a recording of a 90-minute audioconference held on November 17, 2009. Learn the details and implications for Medicare Advantage and Part D programs of CMS’s proposed new regs. Steve Arbaugh of ATTAC Consulting Group and Wendy Krasner of Manatt, Phelps & Phillips, LLC, provide practical guidance on what plans need to start doing immediately to avoid sanctions and penalties, and limit the significant administrative burdens ahead. ($329)
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PREPARING YOUR MA PLAN FOR THIS FALL’S RISK ADJUSTMENT AUDITS: STRATEGIES TO REDUCE YOUR COMPLIANCE AND FINANCIAL RISKS, a recording of a 90-minute audioconference held on October 28, 2009. Get valuable information on how to prepare for imminent and potentially very costly MA RADV audits. Anne Crawford, compliance officer of Medicare Parts C and D for Highmark Blue Cross Blue Shield, provides details on strategies you need to design and implement immediately to ensure that your processes meet CMS’s submission requirements. ($329)
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MEDICARE MEMBER RETENTION: STRATEGIES TO COUNTER ‘SWITCHER’ CAMPAIGNS FROM COMPETITORS, a recording of a 90-minute audioconference held on October 22, 2009. Gorman Health Group’s chief marketing officer, Lindsay Resnick, details how you can build a member-centric program to retain as many of your Medicare Advantage and Part D enrollees as possible before the upcoming the annual election period. ($329)
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HEALTH REFORM’S NEW REQUIRED BENEFIT DESIGN FOR INDIVIDUAL PLANS: IMPLICATIONS FOR INSURERS, a recording of a 90-minute audioconference held on September 24, 2009. Find out what requirements Congress likely will mandate for individual products. How will health insurers need to overhaul benefit designs, underwriting and premiums in order to meet the standards? What should they do now to prepare for this? Speakers are: Dave Tuomala, a director of actuarial consulting at Ingenix Consulting, and Scott Leavitt, owner of Scott Leavitt Insurance & Financial Services and the former president of the National Association of Health Underwriters. ($329)
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WHAT HEALTH INSURANCE COOPERATIVES WOULD MEAN FOR HEALTH PLANS, a recording of a 90-minute audioconference held on August 12, 2009. Get practical intelligence on the health insurance co-op model and how it would affect the health insurance market. Speakers James O’Connor, a principal and consulting actuary at Milliman Inc., and Allan Wearing, sales and marketing director at Group Health Cooperative of South Central Wisconsin, answer questions about how co-ops would work and what steps private insurers should take to prepare for the possible inclusion of co-ops in health reform legislation. ($329)
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MEDICARE PART D REFORM: STRATEGIES TO PREPARE FOR POTENTIALLY ENORMOUS CHANGES IN 2010, a recording of a 90-minute audioconference held on August 6, 2009. With Medicare Part D a major focus of pending health care reform legislation, there is an urgent need for Part D plan sponsors to work with their PBMs and other first-tier entities to prepare for possible changes. Susan Hayes of Pharmacy Outcome Specialists and Steve Arbaugh of ATTAC Consulting Group provide details of what to do now to prepare for the potential impact of various health care reform proposals on Part D. ($329)
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UCR RATE LITIGATION: HEALTH PLAN STRATEGIES FOR MINIMIZING FINANCIAL AND LEGAL RISKS, a recording of a 90-minute audioconference held on July 29, 2009. Find out what to do to minimize your risk of facing Ingenix-based UCR and prompt-pay lawsuits — from Edward Kaplan, senior vice president, national health practice leader in The Segal Company’s New York office, and Matthew Katz, executive vice president of the Connecticut State Medical Society. ($329)
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WHAT A ‘PUBLIC OPTION’ WOULD MEAN FOR HEALTH PLANS, a recording of a 90-minute audioconference held on June 30, 2009. Get an inside view of what a public health insurance option might look like, what impact it would likely have on health plan operations, enrollments and revenues, and what private carriers can do to survive — from Scott Keefer, vice president of policy development for the Center for Policy and Research at America’s Health Insurance Plans (AHIP), and Diane Archer, an attorney and co-director of the Health Care for All Project at the Institute for America’s Future. ($329)
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INDIVIDUAL MANDATE AND GUARANTEED ISSUE: WHAT PLANS CAN DO TO PREPARE FOR THE POTENTIALLY ENORMOUS CHANGES AHEAD,
a recording of a 90-minute audioconference held on June 18, 2009. Two leading health policy experts — Rosemarie Day, deputy director and chief operating officer of the Commonwealth Health Insurance Connector Authority, and Kevin Wrege, president of PULSE Issues & Advocacy LLC and a consultant to the Council for Affordable Health Insurance — discuss the likely impact of guaranteed issue and individual mandate rules, and what health plans can do to prepare for their possible adoption. ($329)
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MEDICARE ADVANTAGE RATES OUTLOOK: HEALTH PLAN STRATEGIES FOR BIDS DUE ON JUNE 1, a recording of a 90-minute audioconference held on May 7, 2009. William MacBain, senior vice president, finance of Gorman Health Group, LLC, will help you develop sound strategies regarding MA payment rates in 2010 and beyond. Get answers to complex questions, including: what are the implications of the 2010 rates, what should MA plans expect for the coming year, and what should they be doing as the deadline for bids draws near? ($329)
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HEALTH PLAN MEMBER RETENTION STRATEGIES IN A TOUGH ECONOMY, a recording of a 90-minute audioconference held on April 22, 2009. Find out what group client retention strategies you can implement to minimize the impact of the economic meltdown — from Michael Taylor, a principal in the Towers Perrin Boston office, and Ingrid Lindberg, CIGNA Corp.’s customer experience officer. ($329)
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DESIGNING AND MARKETING INDIVIDUAL AND SMALL-GROUP INSURANCE PRODUCTS FOR AN ECONOMIC SLOWDOWN, a recording of a 90-minute audioconference held on January 29, 2009. Learn practical steps for designing and selling health insurance products in a recession, from three experienced health insurance brokers — Scott Leavitt, owner of Scott Leavitt Insurance & Financial Services, Mark Carroll, a founding partner of Small Business Insurance Solutions (SBIS), and Joseph Dibella, an executive vice president at Conner Strong Companies, Inc. ($329)
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NEW MENTAL HEALTH PARITY LAW: WHAT HEALTH PLANS MUST DO NOW TO COMPLY, a recording of a 90-minute audioconference held on November 19, 2008. Three experts on the new legislation — Rhonda Robinson Beale, M.D., chief medical officer for UnitedHealth Group subsidiary OptumHealth Behavioral Solutions, Kathleen Mahieu, a senior consultant in Hewitt Associates, LLC’s Health and Productivity Solutions group, and John Hickman, Esq.,  head of Health & Welfare Benefits in the Employee Benefits and Executive Compensation Group at Alston & Bird, LLP in Atlanta — share their strategic insights on specific actions that your organization can take to control costs while ensuring the availability of the newly mandated behavioral health care benefits. ($329)
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MEDICAL TOURISM: HEALTH PLAN STRATEGIES FOR INTEGRATING OVERSEAS NETWORKS INTO BENEFIT DESIGNS, a recording of a 90-minute audioconference held on November 6, 2008. Find out how to integrate medical-tourism benefits in a way that satisfies the needs of patients and payers alike — and the pitfalls that need to be avoided — from medical tourism experts Wouter Hoeberechts, CEO of WorldMed Assist, and Phil Midden, operations manager at Companion Global Healthcare, the medical tourism subsidiary of BlueCross BlueShield of South Carolina. ($329)
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FINAL MEDICARE MARKETING RULES: THE TIME TO CHANGE AND COMPLY IS NOW!, a recording of a 90-minute audioconference held on October 23, 2008. Gorman Health Group’s managed care marketing and regulatory experts Jeff Fox and Jean LeMasurier detail the steps you should be taking to ensure that your MA and Part D marketing is effective and compliant, both in the upcoming open-enrollment season and beyond. ($329)
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HEALTH PLAN STRATEGIES FOR USING PREDICTIVE MODELING IN UNDERWRITING, a recording of a 90-minute audioconference held on August 26, 2008. Hear two experienced health plan executives outline how their companies use predictive modeling tools to improve the accuracy and profitability of underwriting efforts. Speakers are: Swati Abbott, president of MEDai, Inc., and Sharon Howe, director of underwriting for LifeWise Health Plans in Oregon and Arizona, subsidiaries of Premera Blue Cross. ($329)
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BENEFIT DESIGN AND MARKETING FOR INDIVIDUAL HEALTH INSURANCE PRODUCTS: “LIFE STAGE” STRATEGIES FOR HEALTH PLANS, a recording of a 90-minute audioconference held on July 30, 2008. Learn practical steps toward developing products with the right price points and product designs, and marketing them with messages that are reaching their intended market — from Laurie Brubaker, COO for Aetna, Inc.’s Consumer Segment. ($329)
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IMPLEMENTING ‘MEDICAL HOMES’ TO IMPROVE PATIENT CARE AND THE BOTTOM LINE: STEPS THAT HEALTH PLANS AND PROVIDERS SHOULD TAKE, a CD of a 90-minute audioconference held on May 21, 2008. Two of the nation’s top Medical Home experts — Joe Gifford, M.D., senior medical director of The Regence Group, and Pranav Kothari, M.D., co-founder of Renaissance Health  — describe sensible first steps that health plans and providers could take to create, partner with and reward Medical Home practices. ($329)
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NEVER-EVENT PAYMENT POLICIES: HOW MAJOR HEALTH PLANS ARE GETTING TOUGH ON PREVENTABLE HOSPITAL ERRORS, a recording of a 90-minute audioconference held on May 13, 2008. Learn how to implement and enforce never-event payment methods — from Charles Cutler, M.D., Aetna’s chief medical director for national accounts, Jay Schukman, M.D., medical director of Anthem Blue Cross Blue Shield of Virginia, and Leah Binder, CEO of The Leapfrog Group. ($329) Available on CD or as an MP3 file.
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INNOVATIVE PROVIDER PAYMENT STRATEGY OR CAPITATION ALL OVER AGAIN? a CD of a 90-minute audioconference held on April 3, 2008. Hear a provocative debate about new provider-payment strategies health plans are experimenting with to replace the traditional fee-for-service model — from Robert Mandel, M.D., vice president of health care services at Blue Cross Blue Shield of Massachusetts, and François de Brantes, CEO for Bridges To Excellence. ($329)
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PART D ENFORCEMENT PITFALLS: HOW TO IDENTIFY AND ELIMINATE FRAUD AND ABUSE IN YOUR DOWNSTREAM ENTITIES, a CD of a 90-minute audioconference held on March 13, 2008. Find out urgent new compliance challenges Part D plans face in light of CMS’ recently finalized regs that increase sponsor responsibilities for downstream entities … and learn steps you can take to identify and eliminate fraud and abuse at the various contact points for beneficiaries. Hear from Susan Hayes, principal and founder of Pharmacy Outcome Specialists and Steve Arbaugh, principal with ATTAC Consulting Group, LLC. ($329)
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HEALTH PLAN PAY-FOR-PERFORMANCE PROGRAMS FOR SPECIALISTS: RECENT FINANCIAL AND CLINICAL OUTCOMES, a CD of a 90-minute audioconference held on January 24, 2008. Find out how two leading health plans developed and refined their P4P programs for specialists, and learn how their successes may be applied to your P4P plans. Speakers are Bill Hauser, M.D., regional head of medical and quality management operations for Aetna, Inc.’s Southeast and Southwest regions, and Babette Apland, senior vice president of health and care management and provider relations at HealthPartners, Inc. ($329)
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HEALTH PLAN STRATEGIES FOR HIGH-TECH IMAGING TESTS, a CD of a 90-minute audioconference held on November 29, 2007. Learn specific steps you can take to address rising costs and formulate coverage polices for advanced and emerging high-tech imaging procedures (MRIs, CT scans and PET scans, CT angiography, functional MRI’s for Alzheimers’s disease) — from Ken Patric, M.D., vice president and chief medical officer at BlueCross BlueShield of Tennessee and Diane Hayes, vice president of research and development for medical technology assessment firm, Hayes, Inc. ($329)
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