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Health Care Payment Reform: Considerations for Global Payments in MedicaidEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Payment reform is an integral part of national and state-based health reform efforts. Indeed, payment reform is essential to moving from quantity-based reimbursement to a performance-based health care system. That is, moving from fee-for-service to fee-for-value. Payment innovations, such as global payment, are designed to reward efficiency and higher quality, while supporting providers as they invest in patient-centered models... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 19, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

American Health and Drug Benefits: September - October 2009 IssueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: Predictive and Prognostic Models: Implications for Healthcare Decision-Making in a Modern Recession: F. Randy Vogenberg, RPh, PhD examines the role of predictive modeling in the healthcare... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 8, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Stroke Prevention and Management: New Artices from Leading ExpertsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A series of new articles from the journal American Health and Drug Benefits address key issues in stroke prevention and management, with a special focus on transient ischemic attacks. A transient ischemic attack (TIA), a transient stroke that lasts only a few minutes, can be a warning sign that a person is at risk for a more serious, debilitating, and... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 7, 2009 Category: Pharmaceuticals Tags: Access to Care Source Type: info

Legislative Process for Health Care ReformEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The legislative process for health care reform bills is complex, involving a series of unique steps needed in the House and Senate. My friends at Sellers Dorsey have prepared a concise, helpful outline of the next steps required for passage of a health reform bill. This includes the specific steps required by the House, Senate, House-Senate conference committee, and the... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 3, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicare Reimbursement: Primers on Medicare Payment Methods for Providers, Health Plans, and Drug PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Medicare Payment Advisory Commission (MedPAC) has updated its excellent series of reader-friendly primers on Medicare payment methodologies for hospitals, physicians, Medicare Advantage plans, prescription drug plans, and other health care providers. MedPAC is an advisory agency to Congress and is highly influential, particlarly on payment methods, delivery systems, and Medicare reforms. Medicare Part A Reimbursement of Hospitals: Medicare Inpatient... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 2, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Pharmaceutical Research & Development in a Value-Based Healthcare SystemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
At the last annual meeting of the Academy of Managed Care Pharmacy, several of us spoke on pharmaceutical research and development in the quickly emerging value-driven healthcare system. Topics focused on the impact of value-based benefit designs, comparative effectiveness research, and government policies on the development of new drugs and biologics: Research and Development in the Current Healthcare System: An... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 9, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Comparative Effectiveness Research: AHRQ Plan for $300 million in New Research, Patient Registries, Infrastructure, and DisseminationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The HHS Agency for Healthcare Research and Quality (AHRQ) has announced plans for spending its $300 million share of the $1.1 billion Congress appropriated for comparative effectiveness research (CER) under the American Recovery and Reinvestment Act of 2009 (ARRA or Recovery Act for short). AHRQ plans to solicit grant applications this fall and award grants and contracts by spring 2010.... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 9, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

American Health & Drug Benefits: June-July 2009 IssueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Here are articles from the latest issue of American Health & Drug Benefits. AHDB is a peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: June - July 2009 Issue: Applying Evidence for Medical Technologies: Closing the Gap between R&D and Decision Maker Need Interview with Sean R. Tunis, MD, MSc... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - July 30, 2009 Category: Pharmaceuticals Tags: Providers Source Type: info

Medicaid and CHIP Payment and Access Commission: Primer on MACPACEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) created the Medicaid and CHIP Payment and Access Commission (MACPAC) to advise Congress on a wide range of Medicaid and CHIP issues. MACPAC will start operating in early 2010. MACPAC Membership and Staff: Modeled closely after the long standing and highly influential Medicare Payment Advisory Commission (MedPAC), MACPAC will be... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - July 28, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Comparative Effectiveness Research: Definition, Prioritization Criteria, and Implementation Plans for Federal Comparative Effectiveness ResearchEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Federal agencies are busy implementing the new program for comparative effectiveness research. The Federal Coordinating Council for Comparative Effectiveness Research (CER) has released, for public comment, a draft definition of CER and draft prioritization criteria for making research selections. The definition and criteria are intended to help guide, albeit at a high level, federal use of the $1.1 billion appropriated... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - May 28, 2009 Category: Pharmaceuticals Tags: Comparative Effectiveness Source Type: info

American Health & Drug Benefits: May 2009 IssueEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Here are articles from the latest issue of American Health & Drug Benefits. AHDB is the peer-reviewed journal for 30,000 decision makers in health plans, PBMs, Medicare, Medicaid, and the pharma and biotech industries: May 2009 Issue: The Paradox of Public Policy Reform: Change or Continuum? By Robert E. Henry Are You Kidding Me? Clinical Comparative Effectiveness or Evidence-Based Medicine... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - May 24, 2009 Category: Pharmaceuticals Tags: American Health & Drug Benefits Source Type: info

State Health Access Grant Program: New Federal Grants for State Health Reform ImplementationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
As part of the FY 2009 Omnibus Appropriations Act, Congress created the State Health Access Grant Program. On a competitive basis, states may receive grants of $2 million to $10 million each year for five years to improve access to health insurance coverage. Grant funds will help cover the cost of staff, actuarial work, etc. to design and implement major... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - April 14, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicare, Medicare Advantage, and Part D: Likely Policy Changes in 2009 and 2010Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
As the new Obama Administration and the 112th Congress focus on health care issues, here is a quick list of some of the Medicare policy changes Democrats will likely seek in 2009-2010: Likely Changes in Medicare Advantage: 1. Phase-out of difference between Medicare Advantage plan rates and Medicare fee-for-service: Some Medicare Advantage (MA) plans will see lower annual increase. Others... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 17, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Management Challenges at Department of Health and Human Services: Implications for CMS and FDA AppointmentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The incoming leadership at the U.S. Department of Health and Human Services (HHS) face a number of serious management challenges. These challenges, recently identified by the Office of the Inspector General (OIG), will require close, sustained attention by the Secretary's Office and the agency heads, particularly at CMS and FDA. The nominees for Secretary and Deputy Secretary - Tom Daschle... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - January 14, 2009 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicare Part D: Comparing Prescription Drug Use in Special Needs Plans and Other Medicare Advantage PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Medicare beneficiaries in Special Needs Plans (SNPs) have higher Part D prescription drug utilization and costs than enrollees in other Medicare Advantage Prescription Drug Plans (MA-PDs) do. This is no surprise since, by design, Special Needs Plans serve higher-risk Medicare patients, including many dual eligibles. However, despite higher drug utilization rates in SNPs, SNP enrollees and other MA-PD enrollees... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 23, 2008 Category: Pharmaceuticals Tags: Medicare Drug Benefit Source Type: info

Health Indicators: 20 Key Indicators of U.S. Health CareEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Institute of Medicine (IOM) has identified 20 key indicators that together "reflect the overall health of the nation and the efficiency and efficacy of U.S. health systems." Each of the 20 indicators can be readily measured over time using existing, publicly collected, reasonably high quality data. In addition to supporting nationwide snapshots, they permit drill-down views based on geography,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 22, 2008 Category: Pharmaceuticals Tags: Access to Care Source Type: info

Hospital Quality: Adverse Event Reporting by HospitalsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Historically, traditional payment policies - coupled with lax oversight by regulators, weak leadership from many corners of the hospital and physician communities, and an uninformed, reverential public - have served to perpetuate (sometimes even reward) the use of unsafe practices and antiquated technologies in the hospital industry. This, in turn, resulted in a frightening number of adverse events - instances... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 21, 2008 Category: Pharmaceuticals Tags: Hospitals Source Type: info

National Health Reform: Federal Budget Options for 115 Health Reforms ProposalsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
To aid the incoming 111th Congress and Obama Administration, the Congressional Budget Office (CBO) released a 235-page report outlining 115 budget options for health care reform. The report catalogs most of the hottest legislative ideas on Capitol Hill, with useful background information and scores of costs and savings. Here's the list of reform ideas in the report: The Private Health... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 18, 2008 Category: Pharmaceuticals Tags: National Health Reform Source Type: info

Medicare Reimbursement: Primers on Medicare Payment Policies for Providers, Health Plans, and Drug PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Medicare reimbursement policies are highly complex. Yes, that could be the litotes of the decade. Thankfully, the outstanding staff at the Medicare Payment Advisory Commission (MedPAC) produce and routinely update a series of basic primers on Medicare payment methodologies for hospitals, physicians, other providers, Medicare Advantage plans, and Part D prescription drug plans. MedPAC's primers are reader friendly and crafted... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 16, 2008 Category: Pharmaceuticals Tags: Medicare Source Type: info

State Medicaid Budgets: Fiscal Survey of the StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Comprising 21% of state budgets and growing faster than revenues, Medicaid continues to be a serious challenge for governors, state legislatures, and state Medicaid directors. The National Association of State Budget Officers (NASBO) has released its latest Fiscal Survey of the States. Every six months, NASBO provides a crisp, informative snapshot on the revenue and spending situation in every state.... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 15, 2008 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Presidential Appointees: HHS, CMS, FDA, and OMB in Obama AdministrationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
A new Administration in the White House also means an array of new political appointees. The aptly named Plum Book, a quadrennial publication, identifies 7,000 senior-level policy making positions in the Executive and Legislative Branches. It includes all the well-know top positions - such as HHS Secretary, CMS Administrator, FDA Commissioner, and OMB Director - as well as their deputies,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 12, 2008 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Federal Budget and Health Reform: Budgeting for Health ReformEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The budgetary impact of proposed health reform initiatives - whether through legislation, rules, or waivers - significantly affects the likelihood of success. The following provides a concise briefing on some key players and processes affecting cost estimates of federal health care initiatives. Congressional Budget Office (CBO): The Congressional Budget Office (CBO), a nonpartisan agency of Congress, provides Congressional committees with... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - December 10, 2008 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicaid Managed Care: Requirements for Medicaid Health PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Medicaid managed care is a complex business, far more complex than commercial, employer-sponsored health plans or Medicare Advantage plans. Medicaid health plans must meet a range of competitive, financial, clinical, operational, compliance, and political challenges. However, in smart hands, Medicaid managed care organizations (MMCO's) can and often do delivery positive results for beneficiaries (better access and higher quality), taxpayers (lower... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - November 5, 2008 Category: Pharmaceuticals Tags: Medicaid Health Plans Source Type: info

Medicare Policy Making: Quick Primer on Federal Medicare Statutes, Rules, and WaiversEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The next President and Congress will face many fiscal and policy challenges from the $436 billion Medicare program. Following my earlier quick primers on Medicaid policy making and Medicare and Medicaid waivers, here is a similar briefing on the primary vehicles of Medicare policy making. As a federal health program operating nationwide, Medicare policies are made through: Federal Medicare Statutes:... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 27, 2008 Category: Pharmaceuticals Tags: Medicare Source Type: info

Medicaid Policy Making: A Primer on the Mechanisms for Federal and State Medicaid PoliciesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Many of my clients ask me how Medicaid policy is made, particularly for coverage, reimbursement, and managed care and other delivery systems. The $360 billion Medicaid program is highly complex and there are many nuances and exceptions, but here is a high-level primer on the basics. Given the Medicaid program's shared federal-state funding and governance, underlying complexity, and variability across... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 18, 2008 Category: Pharmaceuticals Tags: Medicaid Source Type: info

Medicare and Medicaid Demonstration Waivers: PrimerEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Federal waivers are powerful tools to demonstrate Medicare or Medicaid reforms, including new payment methods, benefit packages, and delivery systems. The business and policy opportunities are considerable. Here's a quick primer. Demonstration Waivers: Historically, federal policymakers have understood the need to test new ideas in the complex Medicare and Medicaid programs. Research and demonstrations projects - whether initiated by states,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 13, 2008 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicaid Financing and Waivers: Podcasts on Medicaid Financing 101 and Federal Section 1115 Health Reform WaiversEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Are you curious or mystified by the intricucies and vagaries of Medicaid financing or federal Medicaid waivers? If so, please check out my new podcasts courtesy of Sellers Dorsey, the influential Medicaid and health reform consultancy. Medicaid Financing 101: Concise review of Medicaid financing and the many opportunities available to find solutions to Medicaid budget needs. To listen, click here... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - June 8, 2008 Category: Pharmaceuticals Tags: Medicaid Source Type: info

Results-Driven Health Care: The Five Steps to Higher Quality, Lower CostsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Serious and costly performance problems riddle U.S. health care. Because of overuse, under use, and misuse of health care, researchers at the Juran Institute and elsewhere estimate that about 30 percent of health care costs are generated by poor quality. Therefore, poor quality medical care will cost about $720 billion in 2008 (30% of $2.4 trillion). Poor quality also reduces... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - May 9, 2008 Category: Pharmaceuticals Tags: Innovations Source Type: info

Medicare Payment Policy: MedPAC Recommendations to CongressEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Medicare Payment Advisory Commission (MedPAC) - the influential independent Congressional agency charged with advising Congress on a wide range of Medicare policy issues - has released its Medicare payment policy recommendations for 2009. The 355-page report includes a weath of information for those tracking Medicare provider or health plan issues, particularly annual provider payment updates, reforms to Medicare Advantage,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - March 3, 2008 Category: Pharmaceuticals Tags: Medicare Source Type: info

Medicare Advantage: Value of Extra Benefits Offered by Medicare Advantage Health PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Enrollment in Medicare Advantage plans has jumped 63 percent since 2005. Over 22 percent of all Medicare beneficiaries - 8.8 million total - now receive their Medicare Part A and Part B benefits through a private health plan instead of the traditional fee-for-service system. About 88 percent of all Medicare Advantage plan enrollees also receive their Part D drug benefits... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 1, 2008 Category: Pharmaceuticals Tags: Medicare Advantage Source Type: info

Value-Based Drug Benefit Designs: Impact on Drug ManufacturersEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
More purchasers and payors are moving away from simplistic cost-driven drug benefit designs to formularies and cost sharing based on value. The impact of value-based drug benefit designs on manufacturers will depend on how quickly individual firms adapt their business thinking and communications strategies. Until recently, the path to success for a drug manufacturer was based largely on product novelty,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - January 29, 2008 Category: Pharmaceuticals Tags: Pharma and Biotech Source Type: info

Diabetes: Opportunities to Improve Outcomes and Reduce CostsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The latest issue of the American Journal of Managed Care has several interesting articles on diabetes, demonstrating several opportunities to improve outcomes and reduce costs: How Managed Care Organizations Contribute to Improved Diabetes Outcomes: Patricia Salber, MD, chief medical officer and SVP at Universal American, a large Medicare health and drug plan, outlines how MCOs are improving outcomes for patients... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - January 20, 2008 Category: Pharmaceuticals Tags: Quality and Patient Safety Source Type: info

Comparative Effectiveness and Safety: Emerging Methods and Tools to Compare Drugs, Devices, and TherapiesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The journal Medical Care has published series of outstanding articles on emerging methods and tools to compare the effectiveness of medical therapies, prescription drugs, and devices. The peer-reviewed articles are an outgrowth from a symposium on comparative effectiveness research sponsored by the Agency for Healthcare Research and Quality (AHRQ). Here are links to the individual articles in PDF format: Emerging... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - October 10, 2007 Category: Pharmaceuticals Tags: Innovations Source Type: info

Medicare Payment Policy: MedPAC Primers on Medicare ReimbursementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Medicare Payment Advisory Commission (MedPAC), the savvy nonpartisan shop that advises Congress on Medicare program issues, has updated its excellent series of primers. Extremely complex and changing constantly, Medicare payment policy will drive $479 billion in health spending in 2008. MedPAC's primers, typically four crisply-written pages, explain the basic steps and methodologies Medicare uses to reimburse fee-for-service providers, Medicare... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - October 7, 2007 Category: Pharmaceuticals Tags: Medicare Source Type: info

State Children's Health Insurance Program: Update on SCHIP ReauthorizationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The 10-year old, extremely popular, and reasonably successful State Children's Health Insurance Program (SCHIP) expires in six weeks. Congress and the White House must agree on a reauthorization bill, and so far the parties are far apart. Here are some key resources to understand the radically different House and Senate bills. Most notably, the House bill is far more expansive... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - August 20, 2007 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Pricing of Biologics and Other Physician-Administered Drugs: The Rise of Average Sales Price in Medicare and Commercial Health PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The well-regarded industry trade journal Biotechnology Healthcare has an excellent article by Patrick Mullen on The Arrival of Average Sales Price. In it, Mr. Mullen interviews several top industry experts (yes, including me) on the rationale for and impact of Average Sales Price (ASP) and how health plans are following Medicare's lead: Health plans are beginning to adopt the average... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - July 20, 2007 Category: Pharmaceuticals Tags: Pharma and Biotech Source Type: info

Pharmaceutical Pricing: New Federal Rules on Average Manufacturer Price and Medicaid Pharmacy ReimbursementEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In the Deficit Reduction Act (DRA), Congress made major, controversial, and technically complex changes to Medicaid prescription drug pricing and pharmacy reimbursement. The policy changes, which are expected to save the feds and states $8.4 billion over the next five years, present significant challenges to both drug manufacturers and retail pharmacies. To implement the DRA changes, the Center for Medicare... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - July 19, 2007 Category: Pharmaceuticals Tags: Prescription Drug Benefits Source Type: info

CMS Administrator Nomination Hearings: Challenges Facing Kerry WeemsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Kerry Weems, Secretary Mike Leavitt's deputy chief of staff and President Bush's nominee to head the Centers for Medicare and Medicaid Services (CMS), faces tough Senate confirmation hearings in July. A savvy, career HHS insider with a wealth of experience in the fiscal and organizational mechanics of federal health programs, Mr. Weems is a good choice for an administrator to... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - June 25, 2007 Category: Pharmaceuticals Tags: Medicare Source Type: info

Medicare Advantage: Understanding Medicare Private Fee-For-Service PlansEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Of the 45 million Medicare beneficiaries, 19 percent are enrolled in a Medicare Advantage health plan. The other 81 percent choose to remain in traditional fee-for-service Medicare for Part A and Part B services. Governed under Part C of Medicare, Medicare Advantage health plans come in several flavors, most notably HMOs, PPOs, special needs plans (SNPs), and private fee-for-service plans.... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - June 20, 2007 Category: Pharmaceuticals Tags: Medicare Advantage Source Type: info

Health Care Innovation: Medicaid, State Health Reform, and Diffusion of Innovation Among StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
When it comes to innovation in health coverage, finance, and purchasing, states are the most likely innovators. The role states can play as laboratories of reform is a key advantage of our Federalist system of government. Right now, as many states find themselves in a strong fiscal condition, states are taking the lead in expanding health coverage, reforming market dynamics,... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - June 15, 2007 Category: Pharmaceuticals Tags: Innovations Source Type: info

Comparative Effectiveness of Medical Treatments, Drug Therapies, and Clinical Practices: AHRQ's Effective Health Care ProgramEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Normally, $15 million a year doesn't buy you much in the federal government. A notable exception is the Effective Health Care Program at the Agency for Healthcare Research and Quality (AHRQ). Drug manufacturers, device makers, health plans, state Medicaid agencies, Wall Street analysts, physicians, and patient groups should all follow it closely. The Medicare Modernization Act of 2003 (MMA) authorized... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - April 1, 2007 Category: Pharmaceuticals Tags: Research Source Type: info

Enhancing Drug Safety and Innovation Act of 2007Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The Enhancing Drug Safety and Innovation Act of 2007 (reintroduced as Senate Bill 484), sponsored by Senator Mike Enzi (R-WY) and co-sponsored by Senator Ted Kennedy (D-MA), is worth watching as the new Congress contemplates pharmaceutical industry legislation. As proposed, The Enhancing Drug Safety and Innovation Act of 2007 has five components: 1. Amends the Federal Food, Drug, and Cosmetic... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - March 22, 2007 Category: Pharmaceuticals Tags: Pharma and Biotech Source Type: info

CMS Leadership Changes: Likely New Leadership at Centers for Medicare and Medicaid ServicesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
My sources in the Bush Administration tell me that the President will nominate Kerry Weems as the next administrator of the Centers for Medicare and Medicaid Services (CMS). Mr. Weems, a savvy finance expert with a long career at HHS, is well-liked by HHS Secretary Mike Leavitt, former Secretary Tommy Thompson, and the White House Office of Management and Budget... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - March 19, 2007 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

White House Oversight of CMS and FDA: Office of Management and Budget Gets Expanded Role in Medicare, Medicaid, and Drug Industry PolicyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Under a new Executive Order, President Bush has significantly expanded the authority of the White House Office of Management and Budget (OMB) over policymaking by the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA). Specifically, OMB now has the authority to review and approve a vast array of written guidance issued day-to-day by CMS... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - March 3, 2007 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Health Insurance Regulation and Debate Over Medical Loss Ratios in CaliforniaEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In health policy, bad ideas never go away. Case in point is the proposal in California to require that health plans spend at least 85% of premium revenue on provider payments. Specifically, as part of his $12 billion Stay Healthy California package of reforms, Governor Arnold Schwarzenegger proposes to set a new minimum medical loss ratio for health plans. In... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 20, 2007 Category: Pharmaceuticals Tags: Health Plans Source Type: info

Understanding Pharma and Biotech: Best Books on Pharmaceutical Industry IssuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Science Business: The Promise, the Reality, and the Future of Biotech Summary: Why has the biotechnology industry failed to perform up to expectations - despite all its promise? In Science Business, Gary P. Pisano, Ph.D. answers this question by providing an incisive critique of the industry. Dr. Pisano not only reveals the underlying causes of biotech's problems; he offers the... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 18, 2007 Category: Pharmaceuticals Tags: Book Reviews Source Type: info

State Children's Health Insurance Program: Understanding SCHIP and the Reauthorization DebateEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The $7 billion State Children's Health Insurance Program (SCHIP) is up for reauthorization in Congress this year. SCHIP, which began in October 1997, now covers over four million Americans, primarily children in families with incomes too high to qualify for Medicaid but too low to afford commercial health insurance coverage. Popular with both Democrats and Republicans, SCHIP is certain to... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 13, 2007 Category: Pharmaceuticals Tags: Access to Care Source Type: info

State Health Care Reform: Health Coverage Expansion Initiatives Across the U.S.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In health care, states serve as the nation's laboratories of reform - able to test innovations in financing, coverage, regulation, and care delivery. In 2007, states are leading the way on health insurance coverage expansion, leveraging a mix of policies including universal coverage, individual mandates, tax credits and Section 125 plans, and insurance "exchanges" or "connectors" to facilitate buying of... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - February 10, 2007 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Bush Health Reform Proposals: Tax Deductibility of Health Insurance and New Grants, Flexibility for StatesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
President Bush has joined the health reform debate with a proposal of his own. The Bush approach is as intriguing as it is controversial. First, the Administration seeks to reform the federal tax code to change the tax treatment of health insurance premiums and offer new tax deductions to help make coverage more affordable. Second, the White House wants to... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - January 25, 2007 Category: Pharmaceuticals Tags: Health Care Policy Source Type: info

Medicare Prospective Payment System: Role in Changing U.S. Health Care SystemEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
When asked about health care innovations, especially practices directed at controlling costs, most policymakers and wonks point to private sector solutions, such as the cost-constraining effects of HMOs in the 1990's or today's ideation of consumer-directed health plans. But is this conventional wisdom wrong? What about public sector health policies, most notably in Medicare or Medicaid? In a fascinating... (Source: Piper Report on Health Care)
Source: Piper Report on Health Care - January 14, 2007 Category: Pharmaceuticals Tags: Book Reviews Source Type: info