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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Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

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of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

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

receive free reports

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

See full listing
of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

 

Call AIS's Customer Service Department at 800-521-4323

Call AIS's Customer Service Department at 800-521-4323

 

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

receive free reports

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

See full listing
of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

Call AIS's Customer Service Department at 800-521-4323

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

See full listing
of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

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

receive free reports

Call AIS's Customer Service Department at 800-521-4323

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

See full listing
of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

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

receive free reports

Hot Products

New
2008 Managed Medicare & Medicaid Factbook

2008 Directory of Health Plans

Pharmacy Benefit Survey Results

Best Sellers
2000-2007 Pharmacy Benefit Trends & Data

HCCA-AIS Medicaid Compliance News

Health Plan Facts Trends and Data 2007-2008

Medicare Part D: Analysis of CMS Rules

PBM Contracting & Transparency Issues and Models

See full listing
of products at
AIS Marketplace

New on AISHealth.com: Upcoming Health Business Meetings & Health Business Job Openings

Call AIS's Customer Service Department at 800-521-4323

 

AIS MarketPlace

Newsletters

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.

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.
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DRUG BENEFIT NEWS, unique information gathered in AIS's own surveys of HMOs and pharmacy benefit management companies. Timely news and data on the business of pharmaceuticals ... and practical cost management strategies from experts throughout the industry. Includes data on high-cost drug categories, inside info on what HMOs and PBMs are doing, and information that will help you benchmark results and experiences. 24 issues annually ($537 per year) or 2-month intro ($86 for 4 issues); both include print copy and e-mail delivery.
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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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INSIDE CONSUMER-DIRECTED CARE brings you timely news and insightful analysis on how the trend toward consumer-directed health plans will affect utilization of medical services, insurance premiums, and your bottom line. You'll get concise details on topics like who's getting what contracts, how plans are being structured, how to get employees to buy in, critical factors for plan success, whether incentives will foster use of cost-effective care, and how plans and employers will educate and communicate with beneficiaries. Get reliable intelligence on what's working and what's not and why. 24 issues annually ($446 per year) or 2-month intro ($82 for 4 issues); both include print copy and e-mail delivery.
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The HCCA-AIS MEDICAID COMPLIANCE NEWS, monthly news and valuable how-to strategies for identifying and reducing the top Medicaid compliance risks. Co-published by the Health Care Compliance Association (HCCA) and AIS. 12 issues annually ($417 per year; HCCA member discount available); subscriptions include print copy and e-mail delivery of the newsletter.
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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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MEDICARE PART D COMPLIANCE NEWS, news and strategies on implementation and compliance with the Medicare drug benefit — marketing, enrollment, formularies, rebates, claims pricing, and fraud, waste and abuse. 12 issues annually ($467 per year) or 2-month intro ($71 for 2 issues); subscriptions include print copy and e-mail delivery of the newsletter, biweekly "Part D E-Letters" and access to a special Part D Web site for easy access to all original documents.
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REPORT ON MEDICARE COMPLIANCE, the industry's top source of news and analysis on Medicare compliance, fraud and abuse, billing errors, and a range of complex compliance issues. Includes unique strategic guidance not available anywhere else ... from the desk of veteran compliance reporter Nina Youngstrom, who has written this newsletter since 1992. 45 issues annually ($628 per year) or 2-month intro ($92 for 8 issues); both include print copy and e-mail delivery.
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REPORT ON PATIENT PRIVACY, practical guidance on the confidentiality of patient information and a wide range of complex issues in your HIPAA compliance. Includes how-to news about risk assessments, the use and disclosure of protected health information, safeguarding PHI, business associates, education and training, audits and compliance reviews, recordkeeping and reporting. 12 issues annually ($403 per year) or 2-month intro ($61); both include print copy and e-mail delivery.
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REPORT ON RESEARCH COMPLIANCE, co-published by the National Council of University Research Administrators (NCURA) and AIS, provides the best information there is to help institutions avoid the negative publicity, financial setbacks, and management problems that compliance requirements can create. 12 issues annually, plus weekly e-mail newletters and unlimited access to a password-protected Web site. ($368 for NCURA members, $468 for non-members.)
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SPECIALTY PHARMACY NEWS, a monthly newsletter with news and strategies for managing high-cost biotech and injectable products, designed to help health plans, PBMs, providers and employers manage costs more aggressively and deliver biotechs and injectables more effectively. Contains information on benefit design, provider contracting, reimbursement, network building, claims management, formulary decisions, and other pharmacy management issues. 12 issues annually ($495 per year) or 2-month intro ($84 for 2 issues); both include print copy and e-mail delivery.
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Looseleaf Guides

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.

A GUIDE TO AUDITING HEALTH CARE BILLING PRACTICES, step-by-step guidance on one of the most challenging problems in Medicare compliance. The guide addresses how to recognize problems, auditing components of your billing process, auditing your IS billing systems, dealing with special billing problems, and much more. Comprehensive looseleaf with quarterly updates and monthly news summaries. ($397 annually).
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A GUIDE TO COMPLYING WITH STARK PHYSICIAN SELF-REFERRAL RULES is a comprehensive looseleaf service written by a team of experienced health care attorneys. It features easy-to-follow explanations of the prohibitions and exceptions under the Stark rules, chapters devoted to the special Stark interests of different stakeholders, summaries of Stark Advisory Opinions issued by the OIG, and copies of regulations and other formal documents. Subscription includes quarterly updates and news summaries (in print and CD formats). ($511 annually).
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HIPAA PATIENT PRIVACY COMPLIANCE GUIDE contains practical guidance and how-to tools from many of the nation’s top HIPAA advisers and practitioners. This looseleaf guide identifies 14 of the most complex and troublesome areas of your HIPAA compliance and addresses each with easy-to-understand summaries of HIPAA requirements and mounds of practical tools – sample forms, notices, waivers, checklists, decision trees, procedures, contract language, timelines, and other practical tools. Comprehensive looseleaf with quarterly updates. ($467 annually).
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Books, Directories & Reports


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35 EMPLOYER CASE STUDIES IN CONSUMER-DIRECTED CARE: Tips and Strategies From Employers that Are Pioneering HSA- and HRA-Based Health Plans profiles dozens of large and small employers that have introduced an account-based consumer-directed health plan. These profiles include enrollment results and detailed plan design information (e.g., annual deductibles, HSA and HRA contributions, coinsurance, preventive care coverage, out-of-pocket maximums), and are based on interviews with the benefits consultants and human resources executives who developed the plans and educated employees about how they work. ($69)PDF version also available.
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49 STEPS TO IMPLEMENT SARBANES-OXLEY BEST PRACTICES IN PRIVATE AND NONPROFIT HEALTH CARE ENTITIES, a highly practical book — written by experienced compliance experts at Strategic Management Systems, Inc., led by former HHS Inspector General Richard P. Kusserow — that identifies and describes steps your organization can take to adopt what have become consensus best practice standards for adhering to this landmark corporate responsibility law. Includes a companion CD with templates that can be customized by your organization. ($385)
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63 BILLING AND CODING STRATEGIES FOR AVOIDING MEDICARE FALSE CLAIMS is a comprehensive collection of highly practical articles on false claims cases, government billing and coding investigations, and a wide range of Medicare billing and coding problems to avoid. This report will guide you around many of the most common pitfalls in Medicare billing and coding, cost report errors, bad documentation, DRG upcoding, and other problems that can result in enormous fines and penalties against your organization. ($69)PDF version also available.
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2000-2007 SURVEY RESULTS: PHARMACY BENEFIT TRENDS & DATA,
a valuable book and CD resource that features the complete results — plus analyses — of AIS’s quarterly survey of pharmacy benefit management companies, from the first quarter of 2000 to the second quarter of 2007. It contains hundreds of charts, tables and graphs on costs, benefit design, utilization and PBM market share, plus a complete directory of PBMs, PBAs, SPPs and related companies. An accompanying CD contains all of the raw survey data in spreadsheet form. ($1,175)
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2007 HSA COMPLIANCE GUIDE: A PRIMER ON THE MOST CRITICAL TREASURY, IRS AND DOL GUIDANCE covers seven rounds of guidance issued by the Treasury Dept., Labor Dept. and the IRS between early 2005 and early 2007. Includes in-depth analysis — plus the actual government guidance(s) — on the rules that clarify how HSAs are to be treated, and offers a sneak peek at some of the questions and answers that will likely be included in the soon-to-be-released “HSA Grab-Bag” guidance. ($69) PDF version also available.
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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)
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AIS’s PHARMACY BENEFIT SURVEY RESULTS, a unique resource containing the raw data from AIS’s quarterly survey of PBMs — that tracks growth and consolidation in the industry, and trends in costs, utilization and benefit design. Every four months, a new Excel spreadsheet is available to download, and includes data such as contact information, annual gross revenues, number of clients, number of prescriptions filled per year, and much more. ($150 per quarter)
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CONSUMER-DIRECTED HEALTH CARE: FACTS, TRENDS AND DATA is a comprehensive resource providing timely, reliable intelligence on rapidly changing market conditions — and what's working and what's not — in consumer-directed health (CDH) plans. It features case studies, results, plan designs, strategies, directories … and other practical information, including in-depth coverage of HSAs, and enrollment and trend information. It summarizes the liability and legal concerns raised by CDH care, strategies for incorporating the pharmacy benefit into CDH care, and much more. ($364)
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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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GENETIC TESTING AND DIAGNOSTIC TOOLS IN THE PHARMACY BENEFIT examines the evolving presence and impact of genetic testing on health plans and the pharmacy benefit industry. It provides insight on coverage implications, pending legislation and government regulation, and some of the science behind the tests. ($84) PDF version available.

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A GUIDE TO AUDITING AND MONITORING HIPAA PRIVACY COMPLIANCE, how-to-do-it guidance on installing effective HIPAA auditing and monitoring systems including practical templates, tools and documents on a companion CD. ($285)
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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 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 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.
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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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HSA DIRECTORY AND RESOURCE GUIDE, a comprehensive directory of HSA firms containing up-to-date information on more than 400 HSA administrators and custodians — with names, titles and mailing addresses for more than 1,200 HSA executives. Also features information on fees, geographic area, number of accounts, deposits, product descriptions and more. ($447, includes companion CD-ROM)
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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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MANAGING CANCER CARE: STRATEGIES TO IMPROVE OUTCOMES AND LOWER COSTS examines recent developments from companies leading the way in the complex oncology management field. This valuable report takes a look at some of the management strategies and pricing methodologies that health plans have been instituting in hopes of reining in costs, as well as the federal government’s role in reimbursement. ($69) PDF version also available.
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MEDICAID FRAUD CRACKDOWNS AND COMPLIANCE is packed with case studies that will show you what health organizations should expect under the federal Deficit Reduction Act (DRA).This report explains what sparked the Medicaid enforcement push, how it affects providers and what actions your organization should take now. ($69) PDF 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 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.
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ONCOLOGY DRUG MANAGEMENT: A WHITE PAPER ON MARKETPLACE CHALLENGES, OPPORTUNITIES AND STRATEGIES,
a white paper by pharmacy benefit expert Chris Nee. Filled with data and illustrations that clearly explain the oncology drug management industry’s history and current climate, this white paper includes case studies of various reimbursement scenarios and practical advice on how to design a cost-effective oncology drug program. ($156) PDF version also available.
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PART D APPEALS & GRIEVANCES: STRATEGIES FOR MINIMIZING COMPLIANCE RISKS examines key issues surrounding Part D appeals and grievances. This report, based on a January 25, 2007, audioconference, shares expert advice on how to structure an effective appeals and grievances procedure — one that will help you avoid becoming a target of CMS enforcement. ($137) PDF version also available.
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PBM CONTRACTING AND TRANSPARENCY ISSUES AND MODELS examines which contracting strategies have been successful, and which have failed or have contributed to confusion among pharmacy benefit clients. It details the decisions that factored into many contract negotiations, both in the public and private sectors, and pays particular attention to the role of transparency in these negotiations. ($84) PDF version also available.
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PBM FORMULARY STRATEGIES AND THEIR IMPACT ON PAYERS provides payers and interested parties with insight into the formulary management tools and practices offered by some of the nation's leading PBMs. PBM practices surrounding formulary management have come under intense scrutiny in recent months. How PBMs collect rebates on formulary products is a topic of much discussion and speculation, even as PBMs continue to hold confidential many details on rebate collection from pharmaceutical manufacturers. This book gives you the basic ingredients you need to conduct detailed formulary comparisons between PBM vendors. Written by Tim Watson, Pharm.D., M.B.A. ($84) PDF version also available.
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PBM TRANSPARENCY: WHAT RECENT NEWS EVENTS MEAN FOR PAYERS, PBMs AND OTHER STAKEHOLDERS
examines key developments and issues surrounding the PBM industry’s march toward greater transparency. Based on an AIS audioconference, this report shares advice from three experts with different perspectives on the industry, on how you can make sense of, prepare for and take advantage of recent trends in PBM transparency. ($137) PDF version also available.
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PRESCRIPTION DRUG REBATES AND EVOLVING REIMBURSEMENT METHODOLOGIES is a primer on the basics of drug rebates — how they have evolved over the years and continue to change. It examines how the health care industry has reacted to new reimbursement methodologies, and details strategies that have been successful, as well as ones that have increased confusion or conflict. ($84) PDF version available.
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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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SPECIALTY PHARMACY: STAKEHOLDERS, STRATEGIES AND MARKETS, a comprehensive picture of the specialty pharmacy marketplace. Includes hard data and statistics on the vendors serving this health care sector, the products involved, and the strategies employed by payers for managing and delivering these products to members. ($312) CD version also available.
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STATUS OF 104 DRUGS ON 30 HMO FORMULARIES provides information on some of the most widely prescribed pharmaceutical products (including some of the most popular injectables that are beginning to be covered under the pharmacy benefit) on 30 different HMO formularies as of February/March 2005. It will give you valuable insights you can put to use in establishing or modifying your own formulary. ($69) PDF version also available.
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Live Meetings & Audioconferences

Upcoming Meetings
CDs/Tapes of Past Audioconferences

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

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.

Upcoming Meetings

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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CDs/Tapes of Past Audioconferences

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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VENDOR GIFTS AND RELATIONS: HOW TO REVISE YOUR HOSPITAL’S STRATEGIES AS THE FEDS CRACK DOWN, a CD of a 90-minute audioconference held on March 25, 2008. Learn how to identify and manage potential vendor gift conflicts, to avoid possible compliance minefields and ensure patient care decisions are not influenced by vendor gift-giving. Speakers are: Donald E. Koenig, Jr., vice president and assistant general counsel of corporate responsibility and enterprise risk management for Catholic Healthcare Partners (CHP) in Cincinnati, and Nickie Braxton, corporate compliance officer for Hartford (Conn.) Hospital/Hartford Health Care Corp. ($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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ORAL ONCOLOGY DRUGS: HEALTH PLAN STRATEGIES FOR AN EVOLVING MARKET, a CD of a 90-minute audioconference held on February 28, 2008. Find out what strategies plans are (or should be) using to manage oral oncology drugs, and what trends insurers should prepare for — from Lee N. Newcomer, M.D., senior vice president of oncology for UnitedHealthcare, Randy Falkenrath, senior vice president of specialty pharmacy and business development for UnitedHealth Pharmaceutical Solutions (UHPS), and Thomas McNulty, Pharm.D., chief clinical officer for Ancillary Care Management, Inc. (ACM). ($329)
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“DRUG MIX” STRATEGIES FOR HEALTH PLANS AND PBMs: WAYS TO LOWER Rx COSTS AND WIN BUSINESS, a CD of a 90-minute audioconference held on February 13, 2008. Three leading pharmacy experts — Jake Cedergreen of Express Scripts, Helen Sherman of The Regence Group's RegenceRx and Tim Watson of Pharmaceutical Strategies Group — provide strategic insights on how health plans and PBMs can develop an effective drug mix, and thereby differentiate themselves in the marketplace. ($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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HSAs AND PREVENTIVE DRUGS: HOW TO REDUCE YOUR RISKS WITH THE IRS, a CD of a 90-minute audioconference held on December 18, 2007. Get advice on how to determine whether a preventive drug can be covered outside of the deductible and ensure that the health plan remains HSA-compliant. Speakers are: John Hickman, Esq., head of Health & Welfare Benefits in the Employee Benefits and Executive Compensation Group at Alston & Bird, LLP in Atlanta, Nancy Summa, a product manager for consumer-directed products at Aetna, and Tracy Grunsfeld, Medco’s vice president of insured and emerging markets. ($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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MEDICATION THERAPY MANAGEMENT: DESIGNING PROGRAMS TO ACHIEVE BETTER OUTCOMES AND ROI, a CD of a 90-minute audioconference held on November 14, 2007. Learn specific steps you should take to implement emerging best practices for MTM programs, and produce the best results for your bottom line — from two experts on health plan and PBM strategies for MTM: Jim Langman, vice president of clinical services at Walgreens Health Services, and Edmund Pezalla, M.D., national medical director at Aetna Pharmacy Management. ($322)
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THE 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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OPTIMIZING SPECIALTY PHARMACY BENEFITS: STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on October 17, 2007. Learn strategies health plans are using to give members the best benefits possible — and to rein in specialty drug spending. Speakers are: Robert Giles, Jr., Pharm.D., senior manager of formularies and specialty pharmacy at BlueCross BlueShield of Tennessee (BCBST); F. Michael White, Pharm.D., manager of pharmacy care management at BCBST; Al Heaton, Pharm.D., director of pharmacy at Blue Cross Blue Shield of Minnesota; and Debbie Stern, R.Ph., vice president of Rxperts. ($322)
EFFECTIVE HEALTH PLAN STRATEGIES FOR MANAGING EPOETIN PRODUCTS, a CD of a 90-minute audioconference held on September 27, 2007. Find out how health plans are managing drugs like Epogen and Procrit to assure best health outcomes for patients, and best financial outcomes for their own bottom lines. Speakers are: Helen Sherman, R.Ph., Pharm.D., senior director of pharmacy services and chief pharmacy officer at The Regence Group's RegenceRx, and Michael Joslin, chief operating officer of CareCore Oncology and executive vice president of CareCore National, LLC. ($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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HSA LANDMINES: SOLVING TRICKY COMPLIANCE PROBLEMS BEFORE OPEN ENROLLMENT BEGINS, a CD of a 90-minute audioconference held on July 26, 2007. Get reliable intelligence about what you can do to better inform employers and employees about HSAs, and avoid compliance landmines, before the open-enrollment period — from Alston & Bird, LLP’s John Hickman, Esq., and Deere & Company’s Duane Olson. ($322)
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SPECIALTY INFUSION MANAGEMENT: EFFECTIVE STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on July 18, 2007. Find out how health plans are managing infusibles, and how new drugs in the pipeline and proposed federal legislation could severely impact the bottom lines of commercial and Medicare health plans. Speakers are: David Willcutts, chief executive officer at Ancillary Care Management, Inc., and Bruce Rodman, M.B.A., vice president, health information policy for the National Home Infusion Association. ($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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THE RETAIL CLINIC BOOM: BOTTOM-LINE OPPORTUNITIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on June 28, 2007. Learn how health plans can take advantage of financial and clinical benefits resulting from the growing proliferation of walk-in clinics — from Louise Clyde, director of allied network management at Blue Cross and Blue Shield of Minnesota, Christopher W. Kersey, M.D., chief business development officer and chief medical officer of RediClinic, and Mary Kate Scott, CEO of consulting firm Scott & Company. ($322)

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PART D DRUG REBATES: STRATEGIES FOR MINIMIZING A SERIOUS RISK OF FRAUD AND ABUSE, a CD of a 90-minute audioconference held on June 14, 2007. Learn how to identify and avoid fraud-and-abuse risks in drug-rebate negotiations, and stay in compliance with Part D requirements. Speakers are Gina M. Smith, of counsel in the Litigation Department of Ballard Spahr Andrews & Ingersoll, LLP; and Sam Rajan, R.Ph., vice president of clinical operations, and Daniel Best, director of manufacturer-trade relationships, at MemberHealth, a pharmacy benefit manager and national Medicare Part D sponsor. ($322)
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OVERCOMING SERVICE AND OPERATIONAL PITFALLS IN CONSUMER-DIRECTED HEALTH CARE: WHAT HEALTH PLANS MUST DO NOW, a CD of a 90-minute audioconference held on May 15, 2007. Get reliable intelligence about how to create and keep the customer-service capabilities that CDH demands, from Carlton Doty, a senior analyst at Forrester Research, Inc., William Thomas, co-president of The Internet Coupon Exchange, and Nathaniel Brinn, CEO of HSA Bank and executive vice president of corporate development at Webster Bank, a subsidiary of Webster Financial Corp. ($322)
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MEDICARE 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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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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EFFECTIVE ONCOLOGY MANAGEMENT STRATEGIES FOR HEALTH PLANS, a CD of a 90-minute audioconference held on March 20, 2007. Learn how to design flexible programs that manage out-of-control oncology drug costs without compromising patient outcomes — from Robin U. Smith, president of Biologics, Inc., and Al Heaton, director of pharmacy at Blue Cross Blue Shield of Minnesota. ($322)
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DEBIT/CREDIT CARDS AND CDH: HOW REMAINING PAYMENT AND PAPERWORK PROBLEMS WILL BE SOLVED, a CD of a 90-minute audioconference held on March 15, 2007. Three experts — Chris Byrd, executive vice president at Evolution Benefits, John Prince, CEO of UnitedHealth Group's Exante Financial Services, and William Fandrich, product executive for CIGNA's new HealthePass card program, — discuss the effect recently released IRS guidance will have on health card transactions, the very latest information about credit- and debit-card technology, and specific steps that remain for their successful integration into CDH plans. ($322)
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HEALTH PLAN STRATEGIES FOR MANAGING THE WAVE OF NEW DRUGS IN THE 2007 PIPELINE, a CD of a 90-minute audioconference held on February 28, 2007. Jake Nichols, Pharm.D., clinical pharmacy programming consultant to MedMetrics Health Partners, Inc., and Joseph Gifford, M.D., chief medical officer at Regence Blue Shield, analyze the 2007 Rx pipeline and offer concrete advice on how PBMs and health plans can provide access to important new therapies while exercising prudent cost controls. ($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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PART D APPEALS AND GRIEVANCES: STRATEGIES FOR MINIMIZING COMPLIANCE RISKS, a CD of a 90-minute audioconference held on January 25, 2007. Maureen Miller, an expert from Gorman Health Group and former senior policy analyst for HCFA, helps you go beyond the audit guide and learn how to structure an effective appeals and grievances procedure so that you don't become a target of CMS enforcement. ($292)
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NEW HSA LAW: WHAT HEALTH PLANS, EMPLOYERS AND BANKS NEED TO DO NOW, a CD of a 90-minute audioconference held on January 18, 2007. John Hickman, Esq., and Ashley Gillihan of Alston & Bird, LLP, and Beth Bierbower of Humana Inc., explain the provisions of newly enacted HSA legislation, and dispense advice on what you need to do to comply with — and take full advantage of — its opportunities. ($292)
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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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MANAGING RHEUMATOID ARTHRITIS: STRATEGIES FOR HEALTH PLANS,
a CD of a 90-minute audioconference held on December 7, 2006. Find out promising ways to improve outcomes and reduce costs, which should trend even higher with expensive new RA drugs in the pipeline. Speakers are Helen Sherman, R.Ph., Pharm.D., director of pharmacy services at The Regence Group's RegenceRx, and Debbie Stern, R.Ph., vice president of managed care consulting firm Rxperts. ($292)
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PBM TRANSPARENCY: WHAT RECENT NEWS EVENTS MEAN