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November 12-13, 2009 | New York Marriott Downtown, New York City American Conference Institute’s 4th Annual
Drug Pricing Boot Camp Intensive training in essential pricing concepts, methodologies, and strategies relative to key government payor programs • Medicare • Medicaid • PHS • VA • DOD • FSS Industry insights from: Abbott Abraxis Genzyme Graceway Pharmaceuticals NCPDP Taro
“Valuable to both new and experienced pricing professionals.”
Paul LeCompte, Director Contracting, Pfizer (2008 Delegate)
“Content and topics were excellent and the pace of covering material was ideal.”
Dottie Caplan, Manager, Pricing and Contract Strategy, sanofi-aventis (2008 Delegate)
“Everyone provided clear and concise information that will most certainly be delivered to my organization.”
Leaders in government pricing and reimbursement will drill you in the core competencies of prescription drug pricing related to government payor programs and help you: • UNDERSTAND how government prices are established and how the rebate system works • MASTER implementation of the final Medicaid rebate rule • DEFINE key pricing terms • MAKE SENSE of confusing pricing calculations • MASTER key pricing concepts and learn how one price may affect another: - AMP, AWP, WAC, BP, WAMP, CPIU, ASP, FCP and non-FAMP
Danielle Pezzella, Senior Contract Administrator, Taro Pharmaceuticals (2008 Delegate)
Supporting Publication & Valued Media Partner:
As a subscriber of Mostly Medicaid you are entitled to a $500 discount off of the standard price when referencing discount code “MOSTLY MEDICAID Register Now • 888-224-2480 • AmericanConference.com/RxPricingBootCamp
More news over at the Mostly Medicaid Blogs recent entries Dental Services for Medicaid Recipients: A Rotten Arrangement Health Reform – Let’s Cut the Crap
Your Ad Here Email us for more info firstname.lastname@example.org
In Hospital News….
Mayo stops taking Medicaid patients
Rates continue to drop (examples from Michigan and Vermont)
Louisiana gets a past due notice on a debt to CMS from the 1990s ‐MM Staff
Enough is enough Get mad all you want, but the Mayo clinic has finally said enough is enough when it comes to losing money on Medicaid patients. The main campus will not accept Medicaid patients from NE or MT, and other facilities are starting to close the door to Medicare patients. If you are a Medicare member in AZ or FL and you want to go to Mayo, you will be hit with an annual fee of $250 and a surcharge of up to $400 per visit. Mayo reps are on the record as against government run health care. 1 Another example of a hospital saying enough is enough when it comes to Medicaid ‐‐ Chester Co Hospital in Pennsylvania will no longer be accepting Medicaid members covered under one of the states Medicaid plans (Keystone Mercy). The plan is cutting provider rates by 30%, and ‐ imagine this ‐ the hospital decided to not lose 30% of its revenue on plan members. Between this example and Mayo no longer accepting losing revenue on Medicare members, you have to wonder if this is the canary in the coal‐mine for the grand public healthcare illusion.
Hospital reimbursement continues to take a hit Vermont hospitals were hoping to see a 6.4% bump in their Medicaid rates this year, but only got 5.9%. Vermont hospitals face an unusual situation in which the state insurance commission sets their rates (as opposed to the state Medicaid agency). The VT hospitals will take in almost $2B next year, but some still face losses. Central VT Medical Center lost about $750,000, Rutland Regional lost $1.1M (both 3
compared to budget needs). VT hospitals enjoyed a 9.5% increase in 2009.
Hospitals in Michigan are staring down an 8‐12% chop to their Medicaid revenues. The General Assembly needs to cut nearly $3B out of the state budget and the huge hospital spend is looking pretty
Long Term Care News attractive. A much as $34B in cuts is being considered to the
Medicaid program. The hospital cut is estimated to take about
Good news for nursing home residents ‐
$200M from Michigan providers. Nursing homes are slotted to lose
34% of nursing home execs think new CMS
as much as $114M under the proposal. While providers always cry
quality surveys will improve care. The bad
"end of the world" with any rate cut, in Michigan the effect of cuts on the Medicaid participation rate has been palpable. In 1999 nearly 90% of providers took Medicaid patients. In 2005 that was down to 64%. Some are saying it could drop to less than half if these
news ‐ they don't know when. CMS is releasing a new Quality Indicator Survey (QIS) to 14 states. Many hope the survey will build a "year‐round" approach to
cuts go through.
quality metric reporting.1
Washington hospitals sued the federal government over uncompensated care fund calculations that they say did not include
all the right patients ‐ and lost. According to the decision, the
CMS has created a list of 136 nursing
hospitals got some money by WA Medicaid and are not owed the
homes that really need improvement, but
higher reimbursement rates they sought. According to the
GAO is saying it should be nearly 600
hospitals, they got shorted $31M.
facilities. Examples of problem facilities
really dropping of the radar include those
That’s gotta hurt
in Indiana. There are 52 IN nursing homes
Talk about getting kicked when you're down. According to CMS, the
classified as "worst performing" by GAO,
state of LA owes as much as $800M back to CMS for overpayments
but only 4 made it to the CMS "special
that happened in the 1990s. Given the current low value of the
focus" list. According to GAO, for profit
dollar, I guess maybe they could actually make money by paying it back ten years later ‐ but it’s still a bitter pill. CMS alerted the state to this a long time ago, but the official "invoice" was sent in September. The letter alleges that $362M was overpaid by LA Medicaid due to incorrect hospital cost reports. State officials are
nursing home chains have the highest probability of making it on the worst performing list.1
hoping to appeal and run the clock out on this one. Medicaid Directors ‐ you may want to do a self‐audit and make sure you don’t 6
have a similar outstanding balance on your books.
Provider taxes are popping up again as states see new opportunities to take stimulus magic money and double or triple their investment. Hospitals in CA are "begging" Gov Terminator to sign a law into effect that would assess them new fees, run those fees through the magic money pot that gets federal matching and then give them back a hefty return on their 5 fees. The fees could generate as much as $2B in stimulus payments for CA hospitals. Michigan passed a 3% fee on physicians that will generate another $300M dollars in cash for the Michigan docs.
Physician Reimbursement News ‐MM Staff
Run more tests – get paid less The US Senate is looking to cut costs by hitting docs who run more tests. Outlier physicians in the 90th percentile (in terms of tests run) would see their Medicare payments reduced by 5%. The same bill would require reporting of compliance with basic quality protocols. Non‐compliance would result in up to 2% reductions in payments. Docs are saying it will hurt care. Funny ‐ we can all agree that costs needs 7
to go down, but every single idea that would make that happen seems to get shot down.
Give better care – Get paid more (sorry tried to rhyme it like the last heading, but failed) Need a no‐brainer on how to up your Medicaid physician participation rate? Paying docs a bonus for treating the poor is one way to do it. Illinois is shelling out an additional $5M in sugar money to docs who treat public‐aid patients and rate high enough on certain quality metrics (like screenings and vaccination rates). If a doc did well on the metrics, they get an extra $20 each time a patient walks in the door. United Health is helping the state track performance. All the money is being channeled through Illinois' version of a medical home for 1.6M of its Medicaid patients ("Health Connect").
NEWS FROM ACROSS THE STATES
Revising the expected surges in Medicaid enrollment
Pork and Health Reform
Governors still concerned
How states are cutting
Did we say 4% growth when we were setting budgets? We meant 7%. Yeah, let’s go with 7% this next year Enrollment grew about 5.4% across state Medicaid programs in FY 2009. This was a high since FY 2003. Medicaid directors had forecast 3.6% for an uptick, to the budget asks across the nation were way off (under). They're not so timid in their
New York alone has $5B of red ink on the books
projections this year, almost doubling the forecast to 6.6% growth in the Medicaid rolls. Medicaid spending grew 7.9%, a high not seen since FY 2004. A lot of that spending was subsidized with stimulus money in 38 states. But the spending orgy may not be able to continue next year as the debts are just too large ‐ New York alone has $5B of red ink on the books. On the other hand, if any one of the current reform bills goes through, states may be adding up to 11 9
And the 3Q 2009 Pork‐Slinging Awards Goes to…Harry Reid hypocritically raises Medicaid costs for all states but his? Did you really expect anything different? According to the NYT, the Senate majority leader has rigged the current health care bill to give Nevada 100% of its Medicaid costs for 5 years. No such luck to other states feeling the same crunch. Reid called his home state a "high‐need" state, and lumped in Michigan, Oregon and Rhode Island in that grouping. Not sure why those 4 made it, but there's a money trail there for some investigative reporter to follow for sure. Abuse of power at its best 10
Dems may feel good about health reform this month, but the Governors are still worried The Governors are still standing up to fight health reform because it will place the costs on their states via Medicaid. Democratic and Republican Governors alike are opposed. Gov Riley of Alabama says the impact on Alabama will be "dire." Tennessee Governor Bredesen warns that Tennesseans will have to cough up another $735M if the health reform package remains focused on Medicaid expansion. Governor Stricklan (Ohio) reminded everyone that states are in no position to have the hat passed around to them this year (or the foreseeable future). Ohio faces almost a billion dollar budget gap under one health reform plan. West VA Governor Joe Manchin is all for reform, saying the focus on preventive 11
care will actually reduce costs.
Tennesseans will have to cough up another $735M if the health reform package remains focused on Medicaid expansion
AZ Gov Jan Brewer is eyeing the impact health reform will have on her state, and says that the current Medicaid membership of 1.2M 12
would grow by 400,000 under some proposals.
Same story, different states Everybody – and we mean everybody – is facing a huge state and Medicaid deficit. So cuts and eligibility freezes are the standard script for probably the next few years. Here’s the detail of how a few states are playing this out now‐
getting docked about $40M (12%
providers will see cuts soon that are projected to be around 8%. Michigan is
New Mexico is considering dealing a
cutting payments to docs and hospitals
death blow to services like adult dental,
by 4% (again) to save $165M. Mental
vision podiatry, speech therapy and
health providers in Michigan will be
inpatient psych for kids. It really has little choice when you see the $300M
state Medicaid budget deficit. No one
who make up to 200% FPL ‐‐ but now
expects the cuts to be easy though, as
has to freeze enrollment. BadgerCare
Medicaid director Pam Hyde reminded
Plus (an expansion of the state's
state reps how controversial it was to
Medicaid program) is putting all new
cut the program 1/10th of what needs
applicants on a waiting list as of early
October. Members have a $60 sign up
to be cut now just a few years ago.
fee and some copays but no monthly
Florida is coming up about $1B short for
premium costs. Officials plan to offer a
FY 2011 and Medicaid spending is in the
"bare‐bones" plan to the 20,000 people
crosshairs. The already huge (2.7M on
expected to get wait‐listed.
the Medicaid roles) program has
increased 13% and is projected to grow
another 5.3% in 2010.
10,000 ‐ 15,000 people each month
North Carolina is slated to cut Medicaid
154,000 (9%) have been added in the
by $1.5B. Provider rates are getting
last 12 months. It has reached the point
slashed, and some programs are being
where 33% of kids and 20% of the
cut back (community mental health and
whole population is on the roll. So far
personal care services, for example).
Ohio has been able to keep it all afloat
Medicaid mental health alone is losing
using 1.1$B in federal stimulus dollars ‐
$400M next year. An expected loss of
but the clock will strike 12 at some
20,000 home health jobs is on tap due
point and people are starting to wonder
to cuts in the 2010 budget. 16 One out of
where the money will come from. One
every 6 people in North Carolina went
observer noted that "it looks like the
without health insurance in 2008, and
state is holding the budget together
the 11% unemployment rate has many
thinking the number of uninsured will
unemployment rate is near 11% ‐ one
of the highest in the USA ‐ and more job losses are expected. 3% provider cuts
Ohio is seeing its Medicaid rolls grow by
during the recession. A whopping
Wisconsin started to ramp‐up a new program that covers childless adults
have already happened, but its hard to stop a train moving this fast: Ohio's $14.7B Medicaid spend grew 14% jump
this year (compared to an 8% average 19
Medicaid increase nationally).
health reform bills proposed so far. The Texas
expansion called for in most of the
The current health bill in the US Senate
projections that show an additional
would double Nevada's already record
2.5M Texans on the rolls running up
Medicaid rolls to nearly 500,000 people
another $20.4B in costs by 2010. Part of
(according to the NV Medicaid agency).
the jump is that current enrollment
Nevada currently spends $1.5B a year
levels are held in check by limiting
on Medicaid, and is short $2.4B for FY
coverage to Low‐income adults ‐>
2011. The Medicaid roll is currently
creating a total Medicaid eligible adult
11,000 people higher than projected,
population of around 38,000 people. So
and the state is looking for another
there really is no where to go but up. If
$37M to plug the hole.
the CHIP changes in some bills happen, Texas could be covering about 768,000
more kids by 2010 as well.
Everything is big in Texas ‐ especially the tab for the level of Medicaid
And finally (we didn’t know where else to put this) . . . Wally World may be soon forced to chip into the state healthcare pot in Ohio. (Many may remember other states ‐ like MD‐ who successfully forced Walmart to cover healthcare for thousands of workers). According to Ohio officials, more than 100,000 people work in retail in Ohio are getting their healthcare paid for by Medicaid. 15,000 of them work at Walmart. 22
Will e‐prescribing ever take off? Pharma sues states (yes, you read that right) States sue pharma (back to normal!) America writes Pfizer a letter
E‐prescribing increases (ever so slowly) About 25% of docs are e‐prescribing, but only a small fraction of prescriptions are prescribed electronically. About 110 M scripts were written using an e‐prescribing tool ‐ out of a total of nearly 4B scripts (2009 YTD). The WSJ is predicting that the number of docs using the technology will double in 2010. It doesn't hurt that Medicare started paying docs to use it in Jan of this year ‐ you get 2% increases if you start doing it now. 23 CMS just approved a $2.36 increase in the dispensing fee that TX Medicaid can pay to pharmacists (for a total of $7.50 per script now). Texas has been paying for the increase since 24
2007 with $42M in unmatched state funds.
Weird Lawsuits The tables have turned. Although states sue pharmacy companies all the time (they need to open up dedicated
Pharmacies in the states could lose $200M each year that the Medicaid programs don't get up to speed with the new AWP
agencies for this given the prevalence we've seen), this is a
case of the pharma company suing a state. The National Association of Chain Drug Stores is fighting back against California, Washington and New York in litigation that charges the states with failing to use the new AWP established on September 26. According to the suit, pharmacies in the states could lose $200M each year that the Medicaid programs don't get up to speed with the new AWP. 25
Ok back to the normal kind of pharma lawsuits Iowa's AG is taking some of the winnings from a recent settlement against big pharma and funding a rx subsidy for citizens. $420,000 will be used to pay for up to 50,000 scripts for Iowans under the program. 26
$13M is coming back Idaho from Eli Lilly. The AG used the Idaho Consumer Protection Act to sue Lilly over "deceptive marketing" for Zyprexa. Medicaid costs skyrocketed as a result, and ID wanted its money back. Similar to other lawsuits, Lilly was charged with marketing to kids and failing to disclose side effects. After the feds take back their share, ID will have a take home pay of about $7M from the suit. 27
Dear Pfizer, Dang, Pfizer. You just paid $58.2M to Florida due to kickbacks and off‐labeling marketing practices that you allegedly engaged in. We know you paid all that money for that one little word (allegedly), so we made sure to include it in our letter to you. Overall, you're paying $1B to various states and the feds. Why did you (allegedly) market Bextra and Lyrica for things you knew it was not approved for? Why did you pay (allegedly) kickbacks to doctors is they prescribed Aricept, Celebrex, Lipitor, Norvasc, Relpax, Viagra, Zithromax, Zoloft and Zyrtec? We were already hooked with the nifty Zyrtec commercials and did not need you (allegedly) screwing us over behind our backs with our doctors that we (allegedly) trusted. A‐L‐L‐E‐G‐E‐D‐E‐ L‐Y that’s 10 letters that cost you $1B (that's a $100M a piece, people). Dang, Pfizer. 28 Sincerely, America
Winter 2009 Crossword It’s Back!
Across 2. 60 ___. CBS show that reported on Medicare fraud SWAT team 3 months after Mostly Medicaid did. 5. Percentile at which you would get hit with a penalty for running too many tests under a new CMS rule. 11. Word that is generally seen at end of pharma suits instead of "convicted" 12. Quality _____ Survey. New survey used by CMS to improve quality at long term care facilities 13. One ___. The fraction of doctors that are e‐prescribing in 2009 14. ____ hundred million $. the amount LA owes to CMS for overpayments in the 1990s.
Down 1. 3. 4.
Company coming under scrutiny for high volume of workers on Medicaid rolls in Ohio Number of jobs listed in this month's issue ___ County Hospital. Another hospital that is starting to refuse to take Medicaid as insurance coverage for some patients 6. Governor saying that the burden on states caused by current health reform bills would be "dire" 7. State where hospitals are "begging" the governor to sign a new provider tax bill 8. Hospital system that is no longer taking Medicaid patients 9. Powerful politician getting his state a pass on the Medicaid expansion tab 10. State that added another 154,000 to its Medicaid rolls in the last 12 months 15. Percent increase you get from Medicare payments if you start e‐prescribing now
Now we’re on Facebook and Twitter, too! Look us up searching “medicaid” or “mostly medicaid”
Cross the wrong people in health fraud – end up with a horse’s head in your bed
Who says you cant get Medicaid to pay for your Oxycontin fix after you die?
And other big frauds
First things first ‐ Bragging Rights Report on Medicare fraud SWAT team (HEAT) Mostly Medicaid – August 2009 CBS 60 minutes – October 2009
Now if we could just get Andy Rooney to complain about technology and clutter at the end of one of our issues.
Health fraud and the mob Never would've guessed we'd see the day ‐ but the Godfather has decided to take a piece of the Medicare fraud racket. Corleone's Cardiovascular? Miami police increasingly find a bloody scene when they raid Medicare fraud sites ‐ because the mafia has been involved. The New York Bonanno family sent a scouting expedition to Florida and 11 were arrested in a Medicare scheme in May. Fraud task forces across the country suspect organized crime involvement in several cases that have seen 100s of millions of $ lost to fraud and multiple unsolved homicides. There are actually cases where elderly people have been abducted so there Medicare numbers could be stolen, and where hackers have been paid by the mob to help execute complicated data schemes. That math is pretty easy actually. Bring in $25k a day in a Medicare scheme and get maybe 10 years if you're busted OR make way less a day and get a life sentence for selling drugs. Hmm.. 29 Now this is a cool endcap to this bit about the mob. FL Medicaid is robbing pharma to catch fraud. Well, not exactly robbing, but taking the money it won in litigation against Pfizer to pay informants who tip off Medicaid agents about fraud. Admit it you think its cool, too. A cool $1m will go to snitches who lead
officials to fraud. The ROI for FL will probably be huge though. One case against Wellcare alone this year brought back $80m due to a fraud scheme. Informants will get up to $500k per case. 30
Pills and dead people The whole save‐money‐that‐we‐know‐is‐being‐lost‐to‐fraud‐now thing still doesn’t seem to be on the radar of the health reform debate, but GAO is reporting on it. A recent audit clocks losses due to fraud around painkillers at about $65M in just 2 years. GAO reported that doctors banned from Medicaid were still getting paid for Medicaid prescriptions, some patients went to more than 40 different pharmacies to get their fix (by some we mean 65,000 instances). An oldie but goodie – drugs for dead people‐ came in around 2,000 scripts for dead patients and 1,000 scripts written by dead docs. 31
The big ones Home health is always a ripe area for fraud investigations, but there were some big ones that dropped in Texas recently. According to a federal investigation, Irene Anderson got $6.5M for services from Medicare. Problem is a lot of those services never happened. The court ordered her to pay back $2.2M. Home health in Texas is pricey for Medicare, compared to other states. It's the highest, with an average payout of $7,761 per patient (2007). LA is 9% cheaper than that. CA is almost half that. A recent GAO report points to a surge in Medicare spending on TX home health, with payments growing nearly 1.5 times since 2002. (The White House has home health on its radar, with a proposed $34B reduction by 2020).32 Another fraudster had insiders at hospitals in GA and FL. Using forged scripts for high cost meds, Varian Scott pocketed more than $1M in Medicaid funds until he was caught and convicted. He did have a little help from some trustworthy Medicaid members who were happy to sell him their ID numbers. We know we ask this all the time, but ‐ Is anyone looking out for the taxpayer? In all the brouhaha over health insurance coverage, can we get some don’t‐spend‐my‐taxes‐on‐fraud insurance coverage? 33
Your Ad Here
Reach 1,000s of Medicaid professionals Email us for more info email@example.com
CHIP News Winter 2009
CHIP Outreach Funds Starting to Be Handed Out to States Money is finally flowing from Sebelius' CHIP revival fund. More than $40M in grants is being distributed to states who are trying to signup more kids eligible for CHIP coverage. The pot was funded under the CHIP reauth act of 2009, but Sebelius has been key in getting the valve turned on. 34 LA and Mississippi just bagged a little more than $2M to enroll more kids in their CHIP programs. The cash is spread out between now and December 2011. 35 Expanding Coverage in Tough Times Not sure how they're pulling it off, but Alabama is enrolling most of its uninsured kids starting in October. All Kids (the Alabama CHIP program) will start taking kids with up to 300% FPL. The move is expected make most of the 78,000 uninsured kids in the state eligible for coverage ‐ which may be a problem since the state legislature only approved an expansion of 14,000 more kids. 36 Montana, like Alabama, is somehow finding money in this recession to cover more kids. Per a wildly popularly vote in late 2008, the Healthy Kids Montana program will be adding about 30,000 kids to the rolls at a cost of about $112M by 2012. To make the push easier, the application has been reduced and made possible online. A family of four making up to $55,000 a year can now get coverage for their kids. 37
Hey‐ We know it’s tough out there. Here’s a few Medicaid‐specific opportunities. Join our LinkedIn group for more contact info on job posters.
Mainframe Tester for long term State Healthcare(MMIS) project
We are looking for a "QA Analyst" for a long term State Healthcare(MMIS) project. We hope this project would go for long term. Required Skills: • Should have experience in testing with some healthcare experience like (MMIS, Medicaid, Claims) • Mainframe testing experience • Experience on “Rational tools”(CleaeCase, ClearQuest)
Srinivasa 636‐442‐1000(ext 225) firstname.lastname@example.org om Srinivasa 636‐442‐1000(ext 225) email@example.com om
Business Analyst" for long term State Healthcare(MMIS) project
Required Skills: • Gathering of technical/functional requirements • Working within a project team, the Business Analyst is responsible for technical project consultation, initiation, collection and documentation of client business and functional requirements, solution alternatives, functional design, testing and implementation support. • Strong oral and written communications skills. Will be required to create analysis and design documents as part of our development life‐cycle. • Should have good experience as a Business Analyst with healthcare (MMIS or Medicaid). MMIS Technical Project Location: Columbia, SC Duration: 12+ months Manager‐Columbia, SC General Duties: The MMIS Requirements Manager is responsible for elicitation and life‐ cycle management of the requirements for a replacement MMIS, a multi‐year effort that will be one of the largest IT projects in the State. Mainframe Technical Lead This is a Full time opportunity with S2Tech. Required Skills: Should have >10 yrs of exp on for 3 yrs long term State Mainframe. Should have good experience as a “Technical Lead” on “Provider Healthcare(MMIS) Project Subsystem(MMIS)” Note: This project is running based on Mainframe. So at this point in time we are looking for “Mainframe Technical Lead” with MMIS experience rather than a “Java Technical Lead” with MMIS experience. Medical Director ‐ Atlanta
PHYSICIAN EXECUTIVE, BUSINESS PERSON, CLINICAL EXPERT, COMMUNITY SUPPORTER........ In this role you’ll be leading the competition with your new and innovative disease management and patient education programs while building upon a tradition of pioneering and progressive initiative. You’ll show the company how to best ensure the highest quality of care while making new strides in cost management. And in doing so, you’ll impact this community of patients in meaningful and unparalleled ways. If you are board certified in a primary care field, licensed in Georgia (or eligible) and have
chrisd@netpolarity. com or 408‐200‐ 3203
Srinivasa 636‐442‐1000(ext 225) firstname.lastname@example.org om Pamela Ratz DeVille, CPC, CDR, CIR 866‐371‐0687 X 256
exp in disease management, UM, and worked with the underserved population, you owe it to yourself to explore this opportunity. With the use of sophisticated data analytics you will be able to make a positive impact on outcomes and improve healthcare for tens of thousands of lives. Sr Java Developer" for a State Healthcare(MMIS) Project
We are looking for a “Sr Programmer Analyst” for a State healthcare(MMIS) Project. Required Skills: • Should have strong experience >8 yrs on Java and J2ee . • Should have good experience as a “Java/J2ee developer” with MMIS(Claims). • Should have good experience on Websphere
MANAGED CARE EXECUTIVES Director of Contracting ‐ NEW position in BOSTON!
GRN Cherry Hill has been retained by a nationally recognized Integrated Health System to find the following leaders for their Medicaid Managed Care Plan: ‐ Vice President of Operations ‐ Assistant Vice President of Disease Management Innovative Health Plan! This position is responsible for the development and maintenance of the contractual relationships with the provider network including hospitals, physicians and ancillary providers. Exceptional analytic support and corporate backing for expansion. Successful candidate will have min 5 yrs exp.in complex hospital negotiations on the payer side and previous exp.with providers in this area. Also Director opportunities still available in GA and MS. "QA Analyst" for one of the Required Skills: • Should have experience in testing with some healthcare experience like long term State (MMIS, Medicaid, Claims) • Mainframe testing experience • Experience on “Rational Healthcare(MMIS) Project tools”(CleaeCase, ClearQuest)
Medical Director ‐ Analytics
Contract Proposal Development Specialist
Unique Opportunity with Innovative service organization on the East Coast. Our client is focused on improving overall health and wellness through interventions that promote behavior change, improve health outcomes and reduce long‐term healthcare costs. The focus of their newest program is the state's Medicaid members. The goal is to improve quality of care while bringing state Medicaid closer to the best utilization review technology available. The program will utilize the results of sophisticated analytics with physicians and clinics to enhance their ability to improve clinical outcomes. Preference for candidate with a strong background in analytics. Position could be part‐time or fulltime role combined with provider community outreach. Experience/Education Required: MPH preferred. M.D. or D.O. Current board certification in a specialty recognized by the American Board of Medical Specialists or American Osteopathic Association is required. Minimum of 5 years postgraduate clinical experience and a solid understanding of disease management and/or utilization management. Experience working in government (Medicaid) and/or commercial sector preferred. Optimetra, a premier provider of business development consulting services to the Public Sector Healthcare industry, is currently seeking Proposal Development Specialists to work on a contract basis. A Bachelor’s degree in English, Marketing, Communications, or a health‐related field is required, and a Master’s degree is preferred. Three years of proposal development experience in a healthcare setting is required, and more than five years is preferred. Experience with public‐sector health programs, such as Medicaid, is a definite advantage. Advanced MS Word skills, and a working knowledge of all other MS Office applications, are required. Our engagements demand excellent written communications skills; excellent interviewing skills; ability to facilitate group discussions; and a working knowledge of Medicaid and/or other public‐sector healthcare programs. Advanced knowledge of publications production and in‐depth knowledge of Medicaid or other public‐ sector healthcare programs is preferred.
Srinivasa 636‐442‐1000(ext 225) email@example.com om pblau@grncherryhill .com Pam Ratz DeVille, CPC, CIR, CDR PamD@healthcaree rprofessionals.com 866‐371‐0687 X 256 Srinivasa 636‐442‐1000(ext 225) firstname.lastname@example.org om Pam Ratz DeVille, CPC, CIR Certified Diversity Recruiter PamD@healthcaree rprofessionals.com 866‐371‐0687 X 256
Holly R. Smith Optimetra, Inc. Phone 719‐964‐ 2323 hrsmith@optimetra. com
Winter 2009 Crossword Answers
“Mayo Clinic no longer accepting some Medicare and Medicaid patients.” October 13, Health Care Examiner. Sheila Guilloton "Insurer and hospital part ways." Kerry Grens. Whyy.org October 13th, 2009 3 “State trims hospital increases.” Louis Porter. VERMONT PRESS BUREAU ‐ September 16, 2009 4 “Michigan’s hospitals, doctors, nursing homes brace for Medicaid budget cuts.” Jay Greene. Crain's Detroit Press. Sep. 21, 2009 5 "Wash. hospitals' court bid for reimbursement fails." 10/01/2009. Associated Press 6 “La. gets $362M debt note from fed health agency.” MELINDA DESLATTE , 09.16.09 7 "Doctors Fight Penalty for Heavy Test Use." JANET ADAMY. WSJ. OCTOBER 2, 2009 8 "Illinois Doctors Who Treat the Poor Get State Bonus." Workforce.com October 1, 2009 9 "Rate of Enrollment in Medicaid Rose Rapidly, Report Says.' KEVIN SACK, NYT, September 30, 2009 10 "Majority Leader Protects Home State." Robert Pear, NYT. Sept 28, 2009 11 "States Speak Up: Medicaid Spending Among Top Issues." Medical News Today Oct 8, 2009 12 "Health‐plan ramifications worry Brewer." Howard Fischer. Capitol Media Services 10.08.2009 13 “State Budget Cuts Continue To Erode Medicaid Programs, New And Old Models Gain Traction.” Medical News Today. 01 Oct 2009 14 “State considers cutting optional Medicaid services ‐New Mexico could face a $300 million gap in the budget for low‐income health care services.” Trip Jennings. New Mexico Independent 9/17/09 15 “Medicaid shortfall looming.” LLOYD DUNKELBERGER H‐T Capital Bureau October 8, 2009 16 “Strained Medicaid in for cuts.” Lynn Bonner. Raleigh News Observer 17 "Number of N.C. uninsured grows." Richard Craver. Winston‐Salem Journal. Sept 24, 2009 18 "Gov. Jim Doyle announces suspension of Badger Care enrollment." Fox6 Now. October 5, 2009 19 "Medicaid keeps stretching. Funding concerns loom as more seek aid." Catherine Candisky. THE COLUMBUS DISPATCH. October 11, 2009 20 "PROPOSED MEDICAID EXPANSION: Plan could be costly to Nevada. Health care bill would nearly double number of recipients." ED VOGEL. Oct 2, 2009. LAS VEGAS REVIEW‐JOURNAL 21 "Texas agency: Senate health care bill could cost Texans up to $20.4B." September 22, 2009. DAVE MICHAELS / The Dallas Morning News 22 "Thousands of Ohio store workers on Medicaid. "September 29, 2009 23 "Incentives Move Doctors To E‐Prescribe; Hospitals Slow To Join HIT Exchanges." Medical News Today. Oct 6, 2009 24 "Medicaid win for state's druggists." David Rauf. San Antonio Express News. 9/18/2009 25 “UPDATE 1‐NY, California, Washington state sued over Medicaid.” Sep 30, 2009 Reuters 26 “Iowa AG Miller unveils prescription drug plan.” Mike Glover. September 22, 2009 27 "Idaho reaches $13 million settlement with Eli Lilly." KIVI Today's Channel 6 News 28 "McCollum: Florida Recovers $58.2 Million from Pfizer Inc. in Billion Dollar Medicaid Settlement." Office of the AG. September 2, 2009 29 “Mafia, violent criminals turn to Medicare fraud.” KELLI KENNEDY (AP) – Oct 6, 2009 30 "Pfizer's millions fund state's new Medicaid whistleblower plan" .LINDSAY PETERSON. The Tampa Tribune. September 17, 2009 31 “GAO report: Millions in fraud, drug abuse clogs Medicaid.” 9/29/2009 Kathy Kiely, USA TODAY 32 “Critics see home health care boom in Texas as wasteful spending, but others tout benefits. “ September 23, 2009. GREGG JONES / The Dallas Morning News 33 "Fla. Man Convicted Of Defrauding Ga. Medicaid." AP Oct 5, 2009 34 "Medicaid, CHIP initiative underway. "Wally Northway. September 30,2009 35 "La., Miss. Get Grants for Uninsured Kids.” MyFoxMemphis. 01 Oct 2009 36 “ALL Kids Expands Eligibility For Children's Health Insurance Oct. 1” Medical News Today. 03 Oct 2009 37 "Expansion Launched for Montana Children’s Health insurance Program.” Matt Gouras, Associated Press, 09‐23‐09 2
Published on Nov 2, 2009
Published on Nov 2, 2009
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