Payers and providers need to play together to make accountable care organizations successful

The ACO Team
By David Ruppert September 29, 2011
Payers and providers need to play together to make accountable care organizations successful.


When the Centers for Medicare & Medicaid Services and private sector payers join in support of the accountable care organization, providers can expect big changes. "Thought-leading providers are glad to see a congruent and coherent message coming from both the private and public payers," said Scott Sarran, M.D., chief medical officer at Health Care Services Corp., the parent of nonprofit Blue Cross plans in Illinois, New Mexico, Oklahoma and Texas.

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PCMA: PBMs Will Save Nearly $2 Trillion in Prescription Drug Costs over the Next Decade

Pharmacy benefit managers (PBMs) will save consumers and payers almost $2 trillion in prescription drug costs - a 35 percent savings - over the next decade, according to new research from Visante. The research also indicates that another $550 billion could be saved if payers used the full array of savings-tools that PBMs offer. Full Article: click here

Personal Health Records and the Nurse Informaticist

By Thomas Piotrowski The nurse informaticist can lead the way in bringing the personal health record to the forefront of care. For more than 60 years, personal health records have been used to capture, store and aggregate information on individuals' health, helping them make health care decisions and allowing them to actively manage their own health and health records. PHRs vary significantly, but some of the more typical products include information related to diagnosis, medication, immunizations, allergies, test results and other aspects of personal health. Other, more sophisticated Web-based PHRs allow for additional services that are more interactive, such as setting appointments, refilling prescriptions and making payments. Access full article

Managed Care Forum November 2011

Managed Care Form
November 2011
Las Vegas

Link to access information: link

Video: Upside to an Uncertain Health Care Climate

The Upside to an Uncertain Health Care Climate
By Mary Grayson August 08, 2011
In today's chaotic health care world, opportunities abound.

Access Video

Rules Requiring Contraceptive Coverage Approved

Rules Requiring Contraceptive Coverage Approved

From Targeted News Service (August 1, 2011)
Link to article online: access

WASHINGTON, Aug. 1 -- Rep. Chellie Pingree, D-Maine (1st CD), issued the following news release:

Congresswoman Chellie Pingree welcomed a historic announcement today that the Obama Administration will require all new insurance policies to provide coverage for women's health care--including well-woman visits, breastfeeding support, domestic violence screening, and contraception--without charging a co-payment, co-insurance or a deductible.

"Out-of pocket expenses have been on the increase and basic health care services like birth control or check-ups have become unaffordable for a lot of women," Pingree said. "Giving all women access to these services allows them to take charge of their own health care."

Last summer, Pingree wrote to the Obama Administration to recommend full coverage for contraceptive services and basic health care screenings.

The guidelines will ensure women have access to a full range of recommended preventive services without cost sharing, including:

* well-woman visits;

* screening for diabetes;

* human papillomavirus (HPV) DNA testing for women 30 years and older;

* sexually-transmitted infection counseling;

* HIV screening and counseling;

* FDA-approved contraception methods and contraceptive counseling;

* breastfeeding support, supplies, and counseling; and

* domestic violence screening and counseling.

Under the health care reform law passed last year, the Obama Administration had to decide what services should be classified as "preventive." The health care reform law requires preventive procedures be covered without co-pay in all new insurance policies. The Administration's decision today followed the recommendations from the Institute of Medicine (IOM), an independent, non-profit organization affiliated with the National Academy of Sciences.

New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after August 1, 2012.

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News: Health Care Reform

A federal appeals court in Cincinnati has ruled in favor of the Obama administration, saying a key provision in the sweeping health care reform bill passed last year was constitutional. The "individual mandate" requiring nearly all Americans purchase health insurance by 2014 or face financial penalties was challenged in federal courts. The judge panel ruled the requirement was constitutional.
See: CNN.com for more info