Mcol Blog - Welcome

Welcome to the MCOL Blog

Please join the discussion with our panel of experts, as we cover a wide range of important topics shaping the business and future of health care.

Last week HHS released new guidance on their approaches for health insurance exchanges, as well as announcing $181 million in exchange establishment grants. This brings the exchange grants to $1 billion over the last two years. Among the states, only Alaska did not apply even for a planning grant. (For detail on state activity, see here).

HHS has bent over backwards to give states options for their exchanges.............Click to continue

What’s Happening at MCOL – Webinar events on Wednesday and Thursday this week

By Claire Thayer, May 21, 2012

Last year, CMS unveiled the Pioneer ACO program to spur growth of Accountable Care Organizations prior to the full implementation of the Medicare Shared Savings program. These organizations are pioneers in the sense that they have already embarked on organized care practices and have some of the needed infrastructure in place and are therefore leading the way for others. Please join Milliman's Jill Van Den Bos on Wednesday this week as she addresses the elements of the Pioneer ACO model, the components of financial risk and cost drivers involved and strategies to identify interventions and opportunities.

On Thursday this week, our webinar explores the future of California’s healthcare districts.............Click to continue

Contracting Web Summit e-Poll Results

By Clive Riddle, May 18, 2012

Survey results are now available from the Contracting e-poll held in conjunction with HealthcareWebSummit’s 2012 Contracting Web Summit, which provide a measure of stakeholder contracting views and priorities, with comparisons to previous year’s answers.............Click to continue

What’s Happening at MCOL – New Silver Companion e-newsletter subscription for MCOL Silver and Gold members

By Claire Thayer, May 14, 2012

MCOL Silver and Gold members now have the option to designate a Silver Companion e-newsletter subscriber who will also receive the entire package of e-newsletters sent to MCOL paid members.

The MCOL Silver Companion e-newsletter subscription may be offered to a valued colleague, favorite client, or even.............Click to continue

Guy D'Andrea on Pitfalls and Practical Solutions with Shared Savings

By Clive Riddle, May 10, 2012

Guy D’ Andrea, Managing Partner at Discern Consulting, was one of the featured speakers in this week’s Contracting Web Summit 2012, and spoke on Shared Savings: Pitfalls and Practical Solutions.............Click to continue

What’s Happening at MCOL – HealthcareWebSummit events hosting two Webinars

By Claire Thayer, May 7, 2012

Concerned about hospital readmissions? On Wednesday this week, Drs. Joe Gifford and Robert Herr from Regence Group and Dr. Brian Wolf from BCBS Rhode Island provide a Medical Director's perspective on aspects of their current approaches to drive accountability by reducing unnecessary hospital readmissions. Understand the critical need to develop the expertise and repository of attributed data tracking for re-hospitalization rates by hospital and provider groups.

On Thursday this week, we’re pleased to host The Third Annual Health Plan Contracting Web Summit which will address how contracting stakeholders should position themselves for 2012 and beyond.............Click to continue

A Practical Roadmap for the Perilous Journey from a Culture of Entitlement to a Culture of Accountability

By Nate Kaufman, May 4, 2012

In a culture of entitlement there is the belief that one deserves certain rewards, rights and privileges based on tradition or past achievements. In contrast, in a culture of accountability rewards, rights and privileges are only earned based on the merits of one’s current behaviors and actions. The transition from a culture of entitlement to a culture of accountability is a perilous journey for rights and privileges are no longer automatic, the ‘entitled party’ usually feels disappointed, angry, or mistreated.............Click to continue

What’s Happening at MCOL – May 2012 edition of MCOL Monthly

By Claire Thayer, May 1, 2012

The May 2012 edition of MCOL Monthly is now available for MCOL paid members. MCOL Monthly is an e-magazine in Adobe Acrobat format with easy to print and read MCOL authored articles and features from the past month's e-newsletters and web site. The table of contents for the May edition of MCOL Monthly is provided below for a quick peek at this months’ edition:.............Click to continue

Guest Blog from Sander Domaszewicz on Decline in Utilization Metrics

By Clive Riddle, April 30, 2012

Sander Domaszewicz is a Principal with Mercer well-versed in employer and employee health benefit issues, and is a noted national speaker on topics related to this arena. Recently, MCOL’s ThoughtLeaders publication asked it’s panel about the recently observed trends regarding a dip in various utilization metrics.............Click to continue

The Price Is (Not) Right

By Kim Bellard, April 25, 2012

I noticed several recent articles and studies about some of the problems caused by the crazy ways we price care in our health system. If they made a reality show about it, it’d be less The Price Is Right than it would be Survivor.............Click to continue

What’s Happening at MCOL – New ACO Directory 2012 and Business of Clinical Integration

By Claire Thayer April 23, 2012

This week we’ve released a new directory on ACOs: The Accountable Care Organization Directory 2012 and will be hosting a webinar event focused on the business of clinical integration.

The Accountable Care Directory 2012, compiled by MCOL’s HealthQuest Publishers, offers a unique resource for Accountable Care stakeholders and others monitoring the industry. The Accountable Care Organization Directory includes 100 selected ACOs, as well as a listing of over 400 key persons with leadership or operational involvement with the ACO.

Join us on Wednesday, April 18^th at 1PM Eastern for a healthcarewebsummit event as nationally renowned experts Doug Hastings, Chairman of Epstein, Becker & Green, and Dr. Mark Browne, Principal of Pershing Yoakley & Associates, construct the foundation of business considerations for health care organizations in pursuit of clinical integration. This session will address payment models, structures, governance, strategic issues and more.

DME: A Modest Proposal

By Laurie Gelb, April 18, 2012

What's a "convenience item?"

For most plans, it's anything from the elevation feature of a wheelchair seat to a motorized patient lift to a track to move a shower chair into a traditional stall. In other words, it's features, equipment or supplies that you don't want to reimburse..............Click to continue

What’s Happening at MCOL – Changes to HealthQuest Publications and HQ Online

By Claire Thayer, April 16, 2012

This week we’ve launched the new HealthQuest Publishers web site and renamed the online subscription HQ Online!

HealthQuest Publishers offers critical market intelligence for those doing business with the managed care and other health care business sectors.............Click to continue

Three ‘Brutal Facts’ That Provide Strategic Direction for Healthcare Delivery Systems- Preparing for the End of the Healthcare Bubble

By Nate Kaufman, April 10, 2012

In August 2005, David Lereah, chief economist of the National Association of Realtors stated “All of the doom-and-gloom forecasts of a housing debacle are not only irresponsible, but downright wrong” Lereah was not alone, economists from Goldman Sachs, National Association of Home Builders and the Mortgage Bankers Association all stated similar opinions. Wall Street firms such as Lehman Brothers and Bear Sterns bet their companies on the strength of the housing market. Eventually the lack of financial sustainability inherent in sub-prime mortgages burst the housing bubble and the industry collapsed.............Click to continue

A Different Way to Fix Medicare

By Kim Bellard, April 5, 2012

Two recent public statements made me both smile and despair about saving Medicare.

The first was President Obama’s recent attack on the budget proposal put forth by Rep. Ryan and passed by the House. The President has no shortage of issues with that budget, but one of his specific attacks was the way Ryan proposes to reform Medicare.............Click to continue

What’s Happening at MCOL – Predictive Analytics, MSSP & Star Webinar

By Claire Thayer, April 3, 2012

On Thursday this week…we’re hosting a webinar event that explores how the Medicare Shared Savings Program and the Medicare Advantage Part C “Star” rating program relate to one another. During the session, we’ll look at what types of Medicare members are less likely to be compliant under these programs and therefore require more targeted communication or intervention.

Did you see the Zombie lists on healthsprocket? On April 1st, several selections were added:

Impact of Zombie Apocalypse or Supreme Court Decision on Affordable Care Act
Proposed Outsourced Regulatory Oversight of Key Healthcare Components
Meaningful Use Requirements in 4,000 BC
Provider Time-Travel Provisions to Negotiate in Value Based Purchasing
Top Five Dental Coverage Concerns for Vampires
Out of Network Coverage Issues for Extra-Terrestrials
Strategies to Minimize Zombie Coverage under Health Plan
Secret Individual Broccoli Mandate Provisions Included in Affordable Care Act

Read all the selections at: http://healthsprocket.com/

Changing Economics in an Era of Healthcare Reform

By Nate Kaufman, April 2, 2012

Health systems are beginning to prepare for healthcare reform. Significant resources are being focused on developing Accountable Care Organizations, medical homes, and preparing for bundled payments and population-based reimbursement. However, current economic trends combined with an analysis of the impact of key healthcare reform initiatives, will require health systems to take significant cost out of their system in order to maintain positive financial performance. Few organizations have the culture or the expertise to implement a cost reduction effort of this magnitude.............Click to continue

Is There Life After Mandates?

By Kim Bellard, March 29 2012

This week the health policy, legal, and political worlds have been focused on the Supreme Court hearing oral arguments about the constitutionality of the Affordable Care Act (ACA). If the passage of ACA was a once-in-a-generation piece of legislation, the Supreme Court review has been the inevitable sword of Damocles hanging over it.............Click to continue

Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics

By Claire Thayer, March 28, 2012

MCOL’s Healthcare Web Summit announces a complimentary webinar event, co-sponsored by Elsevier/MEDai: Managing Medicaid Patients with Physical and Behavioral Health Dual Diagnoses through Advanced Analytics, scheduled for Tuesday, May 1st, 2012 at 1PM Eastern. This webinar will provide a high-level briefing on how using a combination of analytical tools can be used to improve clinical and financial outcomes in state Medicaid programs, particularly for high-cost, high-risk Medicaid beneficiaries with dual medical and behavioral diagnoses.

More information: www.healthwebsummit.com/medai050112.htm

Fail to Prepare, Prepare to Fail

By Lindsay Resnick, March 27, 2012

For health plans looking at the period leading up to the Affordable Care Act’s 2014 big launch, it’s a critical time. We’re about to see the most jarring market reforms ever. Even with the uncertainty of the Supreme Court decision and 2012 election, can Plan’s really afford to sit on the sidelines and watch valuable time tick away? The retailization of healthcare is coming, and preparation is key..............Click to continue

The 3^rd Annual Contracting Web Summit

By Claire Thayer, March 23, 2012

MCOL’s Healthcare Web Summit announces The 3^rd Annual Contracting Web Summit, scheduled for Thursday, May 10th, 2012 at 1PM Eastern. The Third Annual Health Plan Contracting Web Summit will address value based contracting, bundled payments, readmissions financial incentives and more.............Click to continue

Celebrating an Anniversary Under Threat of Divorce

By Clive Riddle, March 23^rd , 2012

The Affordable Care Act turned two today. If we consider this a birthday, some would say the Act is entering its terrible twos, but DHHS and other are referring to this as an anniversary, which in this context is bittersweet as the Act now sits under a Supreme Court cloud starting next week, with plenty of partisan positioning from both sides. Will the Anniversary result in Divorce, Annulment, Trial Separation, a Second Honeymoon or settle in a routine marriage with ups and downs?Walgreens – Express Scripts saga.............Click to continue

Health Plan Readmission Strategies: Contracting and Care Management Approaches

By Claire Thayer March 17, 2012

MCOL’s Healthcare Web Summit announces Health Plan Readmission Strategies: Contracting and Care Management Approaches, scheduled for Wednesday, May 9th, 2012 at 1PM Eastern. Health plan readmissions management encompasses a variety of approaches that often incorporate new provider payment structures, data tracking, education and engagement. Some initiatives are designed for specific care delivery settings, while others are system-wide programs. Please join Drs. Joe Gifford and Robert Herr from Regence, and Dr. Brian Wolf from BCBSRI as they provide a Medical Director's perspective on aspects of their organization's current approaches to drive accountability by reducing unnecessary readmissions.

More information: http://www.healthwebsummit.com/readmissions050912.htm

Walgreens and Express Scripts: The PBM-Pharmacy Feud

By Clive Riddle, March 16, 2012

Once upon a time, pharmacies and PBMs seemed like one happy family – experiencing minimal conflict in the health benefits arena while hospitals and health plans duked it out. But as the marketplace pressures matured, a full blown family feud - or pharmacy feud – has erupted in the form of the ongoing Walgreens – Express Scripts saga.............Click to continue

The Current Facts on Alzheimer's

By Clive Riddle, March 8, 2012

The Alzheimer's Association this week released their 2012 Alzheimer's Disease Facts and Figures, with the full report available from their web site.

Harry Johns, President and CEO of the Alzheimer's Association, tells us "Alzheimer's is already a crisis and it's growing worse with every year. While lives affected and care costs soar, the cost of doing nothing is far greater than acting now.............Click to continue

Pioneer ACOs: Quantifying Risks & Identifying Opportunities

By Claire Thayer, March 5, 2012

MCOL’s Healthcare Web Summit announces Pioneer ACOs: Quantifying Risks & Identifying Opportunities, scheduled for Wednesday, May 23, 2012 at 1PM Eastern. This session discusses the elements of risk associated with Pioneer ACOs as well as potential strategies for controlling costs and identifying opportunities for savings. Organizations not participating in the Pioneer ACO program but either wishing to monitor Pioneer ACO issues and activities, or wishing to adapt applicable risk and cost control strategies discussed to other populations, can also benefit from this session.

More information: http://www.healthwebsummit.com/milliman052312.htm

Midwest Business Group on Health’s Quest to Reduce Elective Preterm Deliveries

By Clive Riddle, March 2, 2012

Last week, Larry S. Boress, President & CEO of the Midwest Business Group on Health was one of three featured speakers in the HealthcareWebSummit event: Managing an Increasing Trend of Elective Preterm Deliveries.

MBGH has taken a keen interest in facilitating a reduction in elective preterm deliveries, and Larry shared why purchasers have gotten involved, and what they are doing about it..............Click to continue

The Business of Clinical Integration: Payment Models, Structures, Governance, Strategic Issues and More

By Claire Thayer, March 2, 2012

MCOL’s Healthcare Web Summit announces The Business of Clinical Integration: Payment Models, Structures, Governance, Strategic Issues and More, scheduled for Wednesday, April 18, 2012 at 1PM Eastern. Join nationally renowned experts Doug Hastings, Chairman of Epstein, Becker & Green, and Dr. Mark Browne, Principal of Pershing Yoakley & Associates, as they construct the foundation of business considerations for health care organizations in pursuit of clinical integration. This session will address payment models, structures, governance, strategic issues and more, for organizations seeking: to manage populations and patients based on a culture of patient focused “Clinical Teaming”; utilizing systems and data which enable seamless coordination and continuity-of-care; and optimization of applicable incentives.

More information: http://www.healthwebsummit.com/integration041812.htm

Medicare: Predictive Analytics, MSSP & Star – Hidden Compliance & Enrollment Patterns

By Claire Thayer, March 1, 2012

MCOL’s Healthcare Web Summit announces Medicare: Predictive Analytics, MSSP & Star – Hidden Compliance & Enrollment Patterns, scheduled for Thursday, April 5, 2012 at 1PM Eastern. The Medicare Shared Savings Program and the Medicare Advantage Part C "Star" rating program both provide significant potential financial rewards if participating organizations meet applicable criteria. Join Milliman's Rong Yi and Bruce Pyenson as they explore how the two sets of quality measures relate to each other, and discuss what types of these Medicare members are less likely to be compliant and therefore require more targeted communication or intervention.

More information: http://www.healthwebsummit.com/milliman040512.htm

It’s the Data, Stupid

By Kim Bellard, February 21, 2012

Two announcements by payors last week caught my eye – both relating to payors and to health care data.

Last week UnitedHealth announced that its Optum division would offer cloud services for health data, allowing health care providers and even other payors to move and access data via the cloud. They are even extending the Apple analogy further by opening up their platform to outside developers, so that those developers can develop “apps” for the Optum platform. They cite the example of an app that would make it easier for providers to structure payments in “bundles of care,” as are expected for ACOs.............Click to continue

Kaiser by the Numbers

By Clive Riddle, February 17, 2012

Kaiser Permanente, the nation’s largest integrated health care delivery system, last week released fourth quarter and year-end 2011 financial results. Here’s some highlights.............Click to continue

MCOL.com has a new fresh look!

By Claire Thayer, February 16, 2011

Check out our new web site at mcol.com! Now it’s a whole lot easier to quickly find what you’re looking for! Browse list of Topics and Offerings. View the What’s New section for upcoming webinar events along with e-learning and other announcements. Log-in to the MCOL member web site. Learn about advertising opportunities. And lots more! Take a peek today at www.mcol.com and let us know what you think!!

Just Say No

By Kim Bellard, February 9, 2012

The recent flap over the recent Obama administration decision to not exempt religious organizations over rules requiring first dollar coverage of birth control leave me either bothered or bemused -- perhaps both.

The controversy has very little to do with health policy and very much to do with the 2012 elections. Moreover, it was entirely predictable, and it is amazing that the Administration walked right into what is becoming a big pie in its face.............Click to continue