Content about Managed care

February 5, 2013

Money is a powerful motivator. Look no further than the sports world for validation. The PGA’s FedEx Cup encourages golfers to earn “points” towards participation in playoffs that offer a big season-ending payoff. Tennis has a similar format with the U.S. Open Series where performance in a series of events equates to a huge prize purse. Both instances use hefty prize money to help ensure the top performers participate and at high levels. The Centers for Medicare and Medicaid Services (CMS) have applied this sports theory to its rankings system of Medicare Advantage (MA) and Prescription Drug Plans (PDP) plans. And there’s billions of dollars up-for-grabs for healthcare plans.

Money is a powerful motivator. Look no further than the sports world for validation. The PGA’s FedEx Cup encourages golfers to earn “points” towards participation in playoffs that offer a big season-ending payoff. Tennis has a similar format with the U.S. Open Series where performance in a series of events equates to a huge prize purse. Both instances use hefty prize money to help ensure the top performers participate and at high levels.

March 24, 2014

A new analysis from Avalere Health released Monday found that consumers purchasing insurance through exchanges are twice as likely to face utilization management controls on prescription medications compared with people enrolled in employer-sponsored insurance plans.

WASHINGTON — A new analysis from Avalere Health released Monday found that consumers purchasing insurance through exchanges are twice as likely to face utilization management controls on prescription medications compared with people enrolled in employer-sponsored insurance plans. Utilization management controls, including prior authorization and step therapy, are administrative steps that patients and their physicians must complete to demonstrate appropriate use of the drugs.

February 18, 2014

The federal agency in charge of Medicare is pushing for a major overhaul of its Medicare Part D drug benefit program for seniors.

The federal agency in charge of Medicare is pushing for a major overhaul of its Medicare Part D drug benefit program for seniors. Those changes, if adopted, could help level the competitive playing field for pharmacy retailers in Part D plan networks, reduce competitive advantages for preferred pharmacy networks and mail-order pharmacies, and put a tighter squeeze on pharmacy benefit managers.

Thus, the proposals by the Centers for Medicare and Medicaid Services for the 2015 federal fiscal year could spell big changes for retail pharmacies. Among the most far-reaching are:

January 30, 2014

Walgreens announced that it is expanding its relationship with technology company Inovalon to implement its patient assessment tool and technology platform to support improvements in care, quality and risk score accuracy programs across more than 400 Healthcare Clinics at select Walgreens locations.

DEERFIELD, Ill. — Walgreens announced on Thursday that it is expanding its relationship with technology company Inovalon to implement its patient assessment tool and technology platform to support improvements in care, quality and risk score accuracy programs across more than 400 Healthcare Clinic at select Walgreens locations.

January 9, 2014

Administering high-touch, expensive and complex medications to patients intravenously in their homes — or in a setting other than a hospital — is essentially a large-scale bid to “reduce costs by transferring non-self-administered drugs to the most cost-effective and clinically appropriate site of care,” said pharmacist Michael Einodshofer, senior director of specialty strategy and innovation at Walgreens Specialty Pharmacy.

Administering high-touch, expensive and complex medications to patients intravenously in their homes — or in a setting other than a hospital — is essentially a large-scale bid to “reduce costs by transferring non-self-administered drugs to the most cost-effective and clinically appropriate site of care,” said pharmacist Michael Einodshofer, senior director of specialty strategy and innovation at Walgreens Specialty Pharmacy.

January 7, 2014

Employees will benefit from better coordination between their wellness programs and accountable care organization networks, according to as many as 92% of HR professionals recently surveyed by BioIQ.

SANTA BARBARA, Calif. — Employees will benefit from better coordination between their wellness programs and accountable care organization networks, according to as many as 92% of HR professionals recently surveyed by BioIQ. 

BioIQ's fourth annual Wellness Trends survey, released Tuesday, also found that one-in-five HR professionals encourage their employees to engage with an ACO. 

January 6, 2014

The ability of most accountable care organizations to promote optimal use of medications has not yet been developed, according to a new study.

WASHINGTON — The ability of accountable care organizations to promote optimal use of medications has not yet been fully developed, according to a new study.

October 23, 2013

A privately owned pharmacy benefit manager has named BioPlus Specialty Pharmacy as one of its top providers, BioPlus said Wednesday.

ALTAMONTE SPRINGS, Fla. — A privately owned pharmacy benefit manager has named BioPlus Specialty Pharmacy as one of its top providers, BioPlus said Wednesday.

The specialty pharmacy said MedImpact Healthcare Systems had named it a ChoiceSpecialty provider and one of the preferred pharmacy providers of hepatitis C medications to MedImpact members.

October 22, 2013

Baroma on Tuesday announced a strategic relationship with Walgreens that will bring pharmacists and hospital staff together to help reduce re-admissions and increase medication adherence for Baroma’s accountable care organization.

MIAMI — Baroma on Tuesday announced a strategic relationship with Walgreens that will bring pharmacists and hospital staff together to help reduce re-admissions and increase medication adherence for Baroma’s accountable care organization.

October 14, 2013

More than three-quarters of Medicare beneficiaries don't compare drug prices when shopping for their health plans, according to a new study.

MOUNTAIN VIEW, Calif. — More than three-quarters of Medicare beneficiaries don't compare drug prices when shopping for their health plans, according to a new study.

The study, conducted by eHealth, found that 78% of respondents don't compare prices, but that the average beneficiary could have saved more than $600 this year on out-of-pocket prescription drug costs if he had. The study was based on an analysis of more than 450,000 unique visitor sessions during Medicare's 2013 Annual Enrollment Period.

August 8, 2013

Any specialty pharmacy provider that wants to succeed in today's healthcare arena has to align its capabilities with patients, prescribing physicians, hospitals and pharmaceutical manufacturers. But success also depends on delivering cost savings and high-touch patient care services to managed care and health plan payers that depend on it.

Any specialty pharmacy provider that wants to succeed in today's healthcare arena has to align its capabilities with patients, prescribing physicians, hospitals and pharmaceutical manufacturers. But success also depends on delivering cost savings and high-touch patient care services to managed care and health plan payers that depend on it.

August 8, 2013

There's no way to sugarcoat it. Over the past two decades, Flint, Mich., headquarters city for Diplomat Specialty Pharmacy, had become a poster child for urban decline.

There's no way to sugarcoat it. Over the past two decades, Flint, Mich., headquarters city for Diplomat Specialty Pharmacy, had become a poster child for urban decline.

Thanks to massive renewal efforts by Diplomat and many other locally based corporate citizens, however, Flint's story is far from over.

"Because of Diplomat's long-standing loyalty to and belief in the city of Flint, much of our community rebuilding initiatives are focused on outreach in the city and surrounding areas," the company noted.

June 11, 2013

Krames StayWell has introduced a set of products for accountable care organizations that includes marketing and patient-engagement tools and a new system for ACO member health management.

YARDLEY, Pa. – Krames StayWell has introduced a set of products for accountable care organizations that includes marketing and patient-engagement tools and a new system for ACO member health management.

The company announced the launch of ACO 360, saying it was designed to help ACO patients take more responsibility for their own care with a collection of health outreach, acute care and population management products that support a growing number of government quality requirements for ACOs participating in the Medicare Shared Savings Program.

April 2, 2013

Next year, for the first time since Medicare Part D's inception, the deductible for the defined standard plan will be lower than in previous years, as healthcare spending across the country has been growing, with Medicare spending per beneficiary at 0.4% in 2012.

WASHINGTON — Next year, for the first time since Medicare Part D's inception, the deductible for the defined standard plan will be lower than in previous years, as healthcare spending across the country has been growing, with Medicare spending per beneficiary at 0.4% in 2012.

March 29, 2013

Three bills that were introduced in California would recognize pharmacists as healthcare providers and would enable pharmacists, nurse practitioners and optometrists to practice to the full extent of their education and training.

The reality is that industry observers can expect to see more states considering similar measures as they all prepare a roadmap to lower costs by allowing pharmacists and NPs to practice at the top of their professions.

Three bills that were introduced in California would recognize pharmacists as healthcare providers and would enable pharmacists, nurse practitioners and optometrists to practice to the full extent of their education and training.

The reality is that industry observers can expect to see more states considering similar measures as they all prepare a roadmap to lower costs by allowing pharmacists and NPs to practice at the top of their professions.

February 22, 2013

The head of a trade organization for retail pharmacies critiqued the conclusions of an op-ed published in the Wall Street Journal that cast doubt on some of the potential benefits of accountable care organizations.

ARLINGTON, Va. — The head of a trade organization for retail pharmacies critiqued the conclusions of an op-ed published in the Wall Street Journal that cast doubt on some of the potential benefits of accountable care organizations.

February 11, 2013

Organizations representing more than 60 accountable care organizations from more than 15 states have come together to form the National Association of ACOs, a 501(c)(6) nonprofit organization that allows ACOs to work together to increase quality of care, lower costs and improve the health of their communities.

WASHINGTON — Organizations representing more than 60 accountable care organizations from more than 15 states have come together to form the National Association of ACOs, a 501(c)(6) nonprofit organization that allows ACOs to work together to increase quality of care, lower costs and improve the health of their communities. Membership is expected to exceed 100 ACOs by April, representing more than 2 million Medicare assigned beneficiaries.

January 10, 2013

Advocare Walgreens Well Network, Diagnostic Clinic Walgreens Well Network and Scott & White Walgreens Well Network have been selected as three of 106 new Accountable Care Organizations in Medicare, Health and Human Services Secretary Kathleen Sebelius announced.

DEERFIELD, Ill. — Advocare Walgreens Well Network, Diagnostic Clinic Walgreens Well Network and Scott & White Walgreens Well Network have been selected as three of 106 new Accountable Care Organizations in Medicare, Health and Human Services Secretary Kathleen Sebelius announced Thursday.

December 19, 2012

The changing healthcare environment and the challenges and opportunities of specialty pharmacy were the biggest themes at Acro Pharmaceutical Services' sixth annual Payer and Managed Care Symposium in Philadelphia last Thursday.

PHILADELPHIA — The changing healthcare environment and the challenges and opportunities of specialty pharmacy were the biggest themes at Acro Pharmaceutical Services' sixth annual Payer and Managed Care Symposium in Philadelphia last Thursday.

Representatives from drug makers and across the specialty pharmacy space met at the Hyatt at the Bellevue to discuss a wide variety of topics related to specialty pharmacy.

November 29, 2012

With new payment models beginning to change the way hospitals and health providers are reimbursed for their services, health plan payers scrambling to control unsustainable medical costs and health information technology linking up the patient care silos, a more integrated and patient-centric care model is emerging out of the chaos of a health system in transformation. 


With new payment models beginning to change the way hospitals and health providers are reimbursed for their services, health plan payers scrambling to control unsustainable medical costs and health information technology linking up the patient care silos, a more integrated and patient-centric care model is emerging out of the chaos of a health system in transformation. 


November 29, 2012

Recently, I had a brief conversation with a man I admire and respect very much, regarding the cover story of the Oct. 15 issue of DSN, “Building the ACO.”


Recently, I had a brief conversation with a man I admire and respect very much, regarding the cover story of the Oct. 15 issue of DSN, “Building the ACO.”


“Eder, what’s an ACO?” the man asked.


I explained that it stands for accountable care organization; basically, it means providers from different practice settings working together to spread primary care responsibility across an integrated healthcare team. 


“You think that’s good?”


November 2, 2012

More health insurers are credentialing nurse practitioners as primary care providers, but there is room for improvement, according to a recent national survey of health insurers.

PHILADELPHIA — More health insurers are credentialing nurse practitioners as primary care providers, but there is room for improvement, according to a recent national survey of health insurers.

The survey of health insurers, specifically Health Maintenance Organizations — conducted by the National Nursing Centers Consortium, a support organization for nurse-led care — found that 75% of HMOs credential with nurse practitioners as primary care providers, an increase over previous years.

October 9, 2012

New, holistic models for integrated, patient-centered care are emerging from the fog of health reform almost as fast as you can say “accountable care organization.” But pharmacy and retail clinic operators aren’t waiting for ACOs to fully ripen.

New, holistic models for integrated, patient-centered care are emerging from the fog of health reform almost as fast as you can say “accountable care organization.” But pharmacy and retail clinic operators aren’t waiting for ACOs to fully ripen; they’re forging new alliances with hospital-based health systems and building the kind of continuity-of-care networks that could be a template for the new era of evidence-based medicine and improved patient outcomes.


March 8, 2012

In January, specialty pharmacy group contracting organization Armada Health Care introduced ApproveRx, a Web-based system that it says will greatly streamline the prior authorization process and already has been adopted by Amber Pharmacy. Meanwhile, the company also is gearing up for the Armada Summit at the Wynn Las Vegas Hotel in May.

In January, specialty pharmacy group contracting organization Armada Health Care introduced ApproveRx, a Web-based system that it says will greatly streamline the prior authorization process and already has been adopted by Amber Pharmacy. Meanwhile, the company also is gearing up for the Armada Summit at the Wynn Las Vegas Hotel in May. Recently, Drug Store News spoke with Armada CEO Larry Irene about these recent developments.


DSN: How did Armada develop the ApproveRx 
system? 


January 31, 2012

California state officials tentatively are blocked from moving forward with a 10% Medi-Cal reimbursement rate cut.

SACRAMENTO, Calif. — California state officials tentatively are blocked from moving forward with a 10% Medi-Cal reimbursement rate cut.

The court decision, handed down by Judge Christina Snyder, was applauded by several organizations, including the California Medical Association, the California Dental Association, the National Association of Chain Drug Stores, the California Association of Medical Product Suppliers, the AIDS Healthcare Foundation and the American Medical Response.