House Votes to Drain Prevention Fund to Pay for Student-Loan ReliefFrom AIS's Health Reform Week - The latest political skirmish on Capitol Hill has again put the health reform law’s prevention fund at risk, with the Republican-led House approving a bill April 26 that drains the $15 billion fund in order to pay for maintaining college-student loan interest rates at current levels. The vote has left health care policy observers scratching their heads on what happens next, given the prevention fund’s ascension from a relatively obscure part of the reform law to its new status as a possible money pot for more popular, voter-friendly issues like student loans. The reform law created the P Read more
Insurers Increased Advertising Budgets in 2011, but Are Keeping a Close Eye on MLR (with Chart: Health Insurer Advertising…From Health Plan Week - It’s no surprise that health insurers are becoming more consumer-centric as 2014 and the launch of state health exchanges near. But an analysis performed exclusively for HPW of advertising spend shows that insurers not only are boosting their overall advertising budgets, but also are shifting their messaging to the Internet and television with less emphasis on outdoor and radio. Five of the nation’s largest publicly traded health insurers collectively spent $366.8… Read more
MSSP’s Initial 27 Applicants Draw Cautious Optimism, Show Variety of ApproachesFrom ACO Business News - CMS’s selection of 27 initial participants in the Medicare Shared Savings Program (MSSP) on April 10 drew cautious optimism from the health care industry. As one consultant says, the agency was careful to pick organizations that have a good chance of success in the first round of this program. “They certainly want to show a successful launch to this program. I also think that’s why there were only 27 selected,”… Read more
GAO Blasts CMS Stars Bonus Demo, But No Moves Are Seen to End ItFrom Medicare Advantage News - The Government Accountability Office (GAO), in an April 23 report that drew support from two prominent Republican congressmen, slammed CMS’s star quality bonus demonstration, alleging that it is wasting billions of dollars and is unlikely to yield useful results. Read more
New Express Scripts Boosts Bargaining Clout, but Deal May Help Smaller Firms TooFrom Specialty Pharmacy News - When the Federal Trade Commission (FTC) allowed Express Scripts, Inc.’s acquisition of Medco Health Solutions, Inc. to go through April 2 after an eight-month investigation, it created not only the biggest PBM in history but also the biggest specialty pharmacy. And although the new company has considerable bargaining power, the deal also may benefit smaller specialty pharmacies that can offer more high-touch services, which in turn benefits health plans looking… Read more
Former Top Enforcer Now Doubts Some Compliance-Program TenetsFrom Report on Medicare Compliance - Now that he is a compliance officer, James Sheehan — former federal prosecutor and New York state Medicaid inspector general — has found that the job is not playing out like he expected. Through the looking glass, Sheehan sees that the reality of operating a compliance program often has nothing to do with the perceptions of people on the other side. After blazing many trails in the U.S. Read more
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