Never-Event Payment Policies - How Health Plans Are Getting Tough on Preventable Hospital Errors; Implementing 'Medical Homes' to Improve Patient Care and the Bottom Line


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Senators Rockefeller, Hatch and Wyden, and Congressmen Stark, Waxman, Camp and Rangel to Speak at Health Reform Conference July 10-11

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Senators Rockefeller, Hatch and Wyden, and Congressmen Stark, Waxman, Camp and Rangel to Speak at Health Reform Conference July 10-11

receive free reports

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Senators Rockefeller, Hatch and Wyden, and Congressmen Stark, Waxman, Camp and Rangel to Speak at Health Reform Conference July 10-11

receive free reports

 

 

 

 

 

 

 

 

 

 

 

 

AIS Health Plans Marketplace

Scroll down to read short descriptions of AIS's Health Plan products.

Newsletters Listing
Books, Directories & Reports Listing
Live Meetings & Audioconferences Listing

More Health Plan products are available at the AIS Pharmacy Benefit MarketPlace and the AIS Consumer-Directed Care MarketPlace

AIS's Directory of Health Plans
The AIS Report on Blue Cross and Blue Shield Plans
Disease Management: Outcomes, Strategies, Outlooks
Expanding Market Share: A Guide to Blues Plan Strategies and Alliances
Guide to Medicare Reform Law

Health Plan Facts, Trends and Data
Health Plan Pay-for-Performance Programs: The Next Generation

 

Health Plan Week
Health Plans and Disease Management: The New Environment
Managed Medicare and Medicaid Factbook
Medicare Advantage News
Medicare Private-Fee-for-Service: Health Plan Strategies for a Booming But Controversial Product
The New Spectrum of Blues Products
Special Needs Plans: Market Strategies and Data

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

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 BlueCross BlueShield Association or any of the independent Blue Cross and Blue Shield companies.) 12 issues annually ($464 per year) or 2-month intro ($72 for 2 issues); both include print copy and e-mail delivery.
HEALTH PLAN WEEK (formerly Managed Care Week), timely business, financial and regulatory news of the health insurance industry — with the inside news, targeted data and expert analysis that will help improve your organization's bottom line. Since 1991, this newsletter has been the industry's most respected and widely read news source.Written by insightful managed care writer/analyst Jill Brown. 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 ($454 per year) or 2-month intro ($69 for 4 issues); both include print copy and e-mail delivery.
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Books, Directories & Reports

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. ($622)


EXPANDING MARKET SHARE: A GUIDE TO BLUES PLAN STRATEGIES AND ALLIANCES is a report on the latest strategies and techniques used by Blue Cross and Blue Shield plans to develop and market insurance products — and how these benefit designs are helping to keep Blues plans among the nation’s most recognized and competitive insurers. It includes details of Blues plans in individual, small-group, middle-market and national accounts; expansion efforts in market segments at state, multi-state and national levels; Blues’ strategies for state health reform efforts; and alliances created to capitalize on federal programs like TRICARE, Medicare and Medicaid. ($84) PDF version also available.
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GUIDE TO MEDICARE REFORM LAW: OVERVIEW AND HIGHLIGHTS FOR HEALTH PLANS, HOSPITALS AND PROVIDERS, summaries and explanations of the Medicare Prescription Drug, Improvement and Modernization Act of 2003 — in an easy-to-read format with a detailed table of contents for each of the 12 titles of the Act. ($84)
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HEALTH PLANS AND DISEASE MANAGEMENT: THE NEW ENVIRONMENT examines current disease management strategies and programs used by health insurers to improve outcomes and contain costs. The report evaluates programs that target specific diseases and conditions, and gives you a chapter outlining chronic disease programs aimed at Medicare populations. It also reviews the implications of new consumer-directed product designs on disease management programs, and assesses the link between specialty pharmacy and disease management programs. ($69) PDF version also available via e-mail.
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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. ($348)
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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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MANAGED MEDICARE AND MEDICAID FACTBOOK, a valuable resource packed with rates, benefit designs, directories, trends and strategies on the Medicare Advantage (MA) program and managed Medicaid. Features coverage of the overhauled Medicare program, including new payment rates, and practical information on the Part D drug benefit, Special Needs Plans, MA private fee-for-service, and much more. Written and organized by AIS's experienced health reporting staff. ($418) CD version also available.
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MEDICARE PRIVATE-FEE-FOR-SERVICE: HEALTH PLAN STRATEGIES FOR A BOOMING BUT CONTROVERSIAL PRODUCT is designed to help health plans and their partners design PFFS products that meet the goals of beneficiaries and providers, while avoiding investigations and enforcement actions by regulatory authorities. Based on an AIS audioconference, this report shares strategies from two of the nation's top Medicare managed care experts that will help you seize the current and future opportunities in PFFS. ($137) PDF version also available.
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THE NEW SPECTRUM OF BLUES PRODUCTS, a report on the flow of traditional, consumer-directed, Medicare Advantage and other products that Blue Cross and Blue Shield plans continue to bring to their markets. Includes details on how Blues plans have increased membership through new products for underserved markets, federally funded programs — including the Medicare Part D drug benefit, and more. ($69) PDF version also available via e-mail.
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SPECIAL NEEDS PLANS: MARKET STRATEGIES AND DATA follows the evolution and growth of Medicare Special Needs Plans (SNPs) from their introduction in 2004 to their current boom — and questions about their future. The report features a comprehensive directory of SNPs with enrollment data, plus insight into health plans' decisions to expand their SNP operations, and their subsequent successes or roadblocks — including cost, compliance and marketing strategies. ($69) PDF version available.
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Live Meetings & Audioconferences

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

HEALTH REFORM & THE 2008 ELECTIONS: WHAT’S AHEAD FOR HEALTH CARE ACCESS, DELIVERY AND FINANCING? a two-day conference on Capitol Hill, July 10-11, 2008. Hear directly from key policy makers on potential health reforms that could have implications for everyone from patient to payer. Featuring Senators Jay Rockefeller, Orrin Hatch and Ron Wyden, and Congressmen Dave Camp, Charles Rangel, Pete Stark and Henry Waxman; plus panels of: top health aides for Senators Clinton, McCain and Obama; leaders of influential health care organizations; experts from four Washington think tanks; and health policy advisors from California, Indiana, Massachusetts, Minnesota and Vermont. ($1,150)
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IMPLEMENTING ‘MEDICAL HOMES’ TO IMPROVE PATIENT CARE AND THE BOTTOM LINE: STEPS THAT HEALTH PLANS AND PROVIDERS SHOULD TAKE, a 90-minute audioconference on May 21, 2008. Hear 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 90-minute audioconference 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)
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2009 MEDICARE ADVANTAGE RATES: IMMEDIATE STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on April 29, 2008. Find out how to revise your product and pricing strategies to prepare the best possible bids before the submission deadline — in light of the 2009 MA payment rates. Speakers are: Pat Dunks, principal and consulting actuary with the Milwaukee office of Milliman, and Brian Weible, president of Wakely Consulting Group. ($329)
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PERSONAL HEALTH RECORDS (PHRs): NEW STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on April 23, 2008. Learn effective strategies for effectively developing and deploying a PHR to serve the needs of stakeholders — from two of the country’s top PHR experts: Jan Oldenburg, practice leader, health portfolio for the Internet Services Group within Kaiser Permanente, and Scott Heimes, senior vice president of consumer solutions for OptumHealth’s direct-to-consumer efforts. ($329)
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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 Solutions and Steve Arbaugh, principal with ATTAC Consulting Group, LLC. ($329)
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THE DEC. 29, 2007 MEDICARE LAW: IMMEDIATE STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on January 29, 2008. Two of the nation’s top Medicare Advantage experts — Gorman Health Group’s John Gorman and Jean LeMasurier  — explain what the changes created by the new law actually mean for you and your partners’ product strategies, benefit designs and application filings, and what you should do in light of this. ($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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WALL STREET’S 2008 HEALTH PLAN OUTLOOK: WHICH PLANS WILL PERFORM THE BEST AND WHY? a CD of a 90-minute audioconference held on January 16, 2008. Carl McDonald, an executive director and senior analyst at CIBC World Markets, Brian Wright, a vice president and senior analyst at Jefferies & Company, Inc., and Shellie Stoddard, a director in Corporate & Government Services at Standard & Poor's, discuss news events in the industry and how they could impact prices and profits in 2008. ($329)
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STRATEGIES FOR IMPROVING THE ACCURACY OF PART D BIDS ... AND AVOIDING MULTI-MILLION-DOLLAR PDE RECONCILIATIONS, a CD of a 90-minute audioconference held on December 13, 2007. Get the specifics of winning strategies for PDE data tracking and reconciliation, in time to prepare more accurate bids in the spring — from Jana Furda, president of product development for Plan Data Management, 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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T
HE RETURN OF MEDICARE LOCAL PPOs: IMPLICATIONS FOR MA PLANS AND MEDIGAP INSURERS, a CD of a 90-minute audioconference held on October 31, 2007. Find out how Medicare plan sponsors and their partners can prepare for, and capitalize on, the market changes likely in 2008 with the re-emergence of local PPOs — from Gorman Health Group’s John Gorman and Tom Anderson. ($322)
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UPCOMING PART D AUDITS AND ENFORCEMENT: STRATEGIES FOR PREPARING YOUR PLAN AND PBM,
a CD of a 90-minute audioconference held on September 20, 2007. Hear the details of urgent new compliance challenges Part D plans and PBMs face, and learn practical steps you can take to prepare for inevitable CMS audits and aggressive government enforcement — from ATTAC Consulting Group’s Steve Arbaugh and Susan Roberts. ($322)
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NEW HEALTH PLAN STRATEGIES FOR DISEASE MANAGEMENT: LESSONS LEARNED FROM THE MEDICARE HEALTH SUPPORT PILOT, a CD of a 90-minute audioconference held on August 21, 2007. Discover how to operate cost-effective DM programs for patients with multiple comorbidities, and the lessons health insurers, DM programs and others can learn from early Medicare pilot results. Speakers are: Christobel Selecky of LifeMasters Supported SelfCare, Inc., Vince Kuraitis of Better Health Technologies, LLC, and Jean Bisio of Green Ribbon Health LLC. ($322)
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MEDICAL TOURISM: STRUCTURING A PROGRAM THAT BENEFITS THE HEALTH PLAN AND PATIENT, a CD of a 90-minute audioconference held on August 7, 2007. Find out how to set up or access a medical-tourism program that satisfies the needs of patients and health plans alike, and develop strategies to take advantage of this growing trend. Speakers are: Wouter Hoeberechts, CEO of WorldMed Assist, and David Boucher, assistant vice president for health care services at Blue Cross and Blue Shield of South Carolina. ($322)
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PREPARING FOR MEDICARE OPEN-ENROLLMENT MARKETING: STEPS HEALTH PLANS SHOULD TAKE NOW, a CD of a 90-minute audioconference held on July 12, 2007 — with Gorman Health Group experts Jeff Fox and Joe Aggazio. Get the practical advice you need to make sure your Medicare marketing and sales strategies are effective and in full compliance with new CMS requirements, before the highly competitive Medicare open-enrollment season begins. ($322)
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VALUE-BASED INSURANCE DESIGN STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on April 24, 2007. Mark Fendrick, M.D., co-director of University of Michigan’s Center for Value-Based Insurance Design and Lonny Reisman, M.D., CEO of ActiveHealth Management, Inc. share valuable strategies for implementing the value-based insurance design concept, and overcoming the challenges that can hinder its widespread use. ($322)
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MEDICARE PRIVATE-FEE-FOR-SERVICE: HEALTH PLAN STRATEGIES FOR A BOOMING BUT CONTROVERSIAL PRODUCT, a CD of a 90-minute audioconference held on April 19, 2007. Get an inside look at the factors triggering the current PFFS boom and controversies, from two of the nation's top Medicare managed care experts. John Gorman and Jean LeMasurier of Gorman Health Group outline details of strategies that will help you seize the opportunities in PFFS while guarding against the major pitfalls. ($322)
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NEW OPPORTUNITIES FOR HEALTH PLANS IN LONG-TERM CARE, a CD of a 90-minute audioconference held on February 8, 2007. Michael Quilty, president and CEO of Matrix Management Services, Holly Michaels Fisher, a senior consultant with Reden & Anders, and Tom Coble, founder and CEO of HealthCare Management Company of Oklahoma (HMC), detail the specifics of the opportunities — and the pitfalls — for health plans in serving long-term care populations. ($322)
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NATIONAL PROVIDER IDENTIFIERS: HEALTH PLAN CONTINGENCIES TO AVERT A SPRING DISASTER, a CD of a 90-minute audioconference held on December 13, 2006. Two health plan NPI experts — Chris Apgar, a consultant with Apgar and Associates, and Beth Cox, compliance director for regulatory assurance at WellPoint, Inc. — share effective approaches to making a smooth transition to NPIs, before the May 23 deadline for using new 10-digit NPIs for all standard electronic transactions. ($292)
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MEDICARE SPECIAL NEEDS PLANS: STRATEGIES FOR SUCCESS IN 2007 AND BEYOND
, a CD of a two-hour audioconference held on November 2, 2006. Two experts from Gorman Health Group — John Gorman, president and CEO, and Rick Bowles, Special Needs Plan Practice leader — provide you with the tools you need to improve patient outcomes and your bottom line in the difficult and increasingly competitive SNP market. ($292)
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MEDICARE RISK ADJUSTMENT STRATEGIES: JANUARY DEADLINE LOOMS TO CORRECT CODING ERRORS, a CD of a two-hour audioconference held on September 27, 2006. John Gorman, president and CEO of Gorman Health Group, and David Bach, M.D., CEO of Leprechaun, will provide "best practices" you can use to make sure you get the maximum amount of risk-adjusted payments you're entitled to — and implement effective programs to reduce incorrect coding so you can thrive in the new Medicare environment. ($292)
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MEDICARE PART D DIAGNOSTICS: TROUBLESHOOTING YOUR DRUG PLAN, a CD of a two-hour audioconference held on July 20, 2006. Three experts from Gorman Health Group, LLC — Babette Edgar, Michael Flagstad and Jeff Fox — guide you through an analysis of your Part D operations, enabling you to identify trouble spots in your plan and design effective corrective steps. ($292)
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INSURER STRATEGIES FOR THE NEW MEDIGAP MARKET,
a CD of a 90-minute audioconference held on June 28, 2006. John Gorman, president and CEO of Gorman Health Group LLC, dispenses reliable how-to advice about what to do to succeed in the rapidly changing Medigap environment. ($292)

PREDICTIVE MODELING IN UNDERWRITING: NEW HEALTH PLAN STRATEGIES, a CD of a 90-minute audioconference held on June 7, 2006. Penny Hahn, the actuarial director at Humana Inc., and Diane Laurent, a senior vice president at DxCG, Inc., discuss effective strategies for selecting and using predictive modeling tools for underwriting. They also share valuable tips and tactics that can help plans and their partners make use of these tools in premium rate-setting, benefit selection, marketing and sales. ($292)

STRATEGIES FOR THE MAY 15 MEDICARE PART D LOCK-IN, a CD of a 90-minute audioconference held on April 20, 2006. Two of the nation’s leading experts in Part D — Gorman Health Group’s John Gorman and Jeff Fox — analyze the marketing and sales challenges health plans face, and offer advice on how plan sponsors can maintain and grow their membership despite the lock-in. ($292)

HEALTH PLAN PAY-FOR-PERFORMANCE RESULTS: RECENT CLINICAL AND FINANCIAL OUTCOMES, a CD of a 90-minute audioconference held on March 16, 2006. Jeff Kamil, M.D., of WellPoint, Inc. subsidiary Blue Cross of California, and Carrie B. Frank, of Excellus Health Plan, describe the structure of their P4P programs and highlight their clinical, utilization and financial results. They share lessons learned during their program development and refinement, so you can apply their successes to your P4P plans. ($292)

NEW FORMULARY STRATEGIES FOR PART D: DECISIONS TO MAKE BY THE APRIL 17 DEADLINE, a 2-hour audioconference on March 2, 2006. Three experts from Gorman Health Group — John Gorman, president and CEO, Michael S. Flagstad, director of the pharmacy benefits practice, and Babette Edgar, former director of formulary management for CMS — will discuss emerging trends and key issues in Part D formularies for 2007, so that you can learn how best to fulfill the new formulary requirements. ($292)
PART D IMPLEMENTATION: NEW PITFALLS TO AVOID FOR HEALTH PLANS, PBMs AND PHARMA COMPANIES, a CD of a two-hour audioconference held on January 18, 2006. Two leading Medicare experts — S. Lawrence Kocot, senior advisor to the administrator at CMS, and David Ralston, JD, MPH, legal director for Schering-Plough Corp. — dispense reliable intelligence about how to deal with key implementation issues of the Medicare Part D drug benefit. ($267)

NEW HEALTH PLAN BUSINESS STRATEGIES FOR TOTAL POPULATION MANAGEMENT, a CD of a two-hour audioconference held on December 14, 2005. Dexter Shurney, M.D., vice president at American Healthways, Inc., and Dana Davies, a consultant at Blue Shield of California, discuss how to create effective total population management programs that will improve health outcomes and control medical costs. ($267)
WINNING STRATEGIES FOR MEDICARE RISK ADJUSTMENT, CD of a two-hour audioconference held on December 8, 2005. Two experts in Medicare risk adjustment — John Gorman of Gorman Health Group and Karen Van Wagner, executive director of North Texas Specialty Physicians — explain what steps