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Thursday, July 29, 2010
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Welcome to ChatterSmart
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Welcome to ChatterSmart
ChatterSmart is a short format news blog. Comments are the thoughts and opinions of our users. We welcome different viewpoints.
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Add your comment today. It's as easy as 1-2-3!
1. Make sure you're logged in. (There's no fee to register on this site.)
2. Click on the "new content" button. (If not displayed, click on "article list" to view.)
3. Write your thoughts.
Keep your submission to 400 words or less. We'll take care of formatting and do basic editing. Not every submission will be published. Questions? Please contact us here.
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Article List
Technology, Productivity & Health Care
Contributed by Sydney Williams on 10/26/2009
"...[A]s far as healthcare is concerned, new technology tends to decrease productivity i.e. drive up the cost of delivering goods and/or services to the end-user, the healthcare consumer. In fact, there’s only one way to actually decrease the cost of healthcare..." Denying coverage.
Read article here. [International Business Times]
Without payment reform–a move away from fee-for-service–and tort reform, the same economic profile that applies to technological innovation in other industries won't apply to health care.
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"...When President Obama designated $19.5 billion to expand the use of electronic medical records, former House speaker Newt Gingrich (R-Ga.) said it was one of only "two good things" in February's stimulus package.
"But such bipartisan enthusiasm has obscured questions about the effectiveness of health information technology products, critics say. Interviews with more than two dozen doctors, academics, patients and computer programmers suggest that computer systems can increase errors, add hours to doctors' workloads and compromise patient care.."
Read article here. [Washington Post]
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This Lyceum User Agreement (the "Agreement") between you (“You” or "User") and Lyceum Associates, Inc. ("Lyceum") states the terms and conditions governing Your use of the Publications (the “Publications”) and Services (the “Services”) to which You are subscribing from Lyceum. By subscribing to the Publications and/or Services, You agree to the terms of this Agreement. If You do not agree to be bound by the terms of this Agreement, do not subscribe to the Publications and/or Services. YOU SHOULD PRINT OUT A COPY OF THIS AGREEMENT FOR YOUR RECORDS. (Download PDF version here.)
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This Lyceum User Agreement (the "Agreement") between you (“You” or "User") and Lyceum Associates, Inc. ("Lyceum") states the terms and conditions governing Your use of the Publications (the “Publications”) and Services (the “Services”) to which You are subscribing from Lyceum. By subscribing to the Publications and/or Services, You agree to the terms of this Agreement. If You do not agree to be bound by the terms of this Agreement, do not subscribe to the Publications and/or Services. YOU SHOULD PRINT OUT A COPY OF THIS AGREEMENT FOR YOUR RECORDS. (Download PDF version here.)
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13. Termination. Lyceum may discontinue or change this Service, or its availability to You, at any time.
14. Survival of Terms. The provisions of Paragraphs 3 ("Disclaimer and Limitation of Liability"), 3 ("Further Disclaimer and Limitation of Liability"), 4 ("Indemnification"), 5 (“Intellectual Property”), 6 ("Rights Reserved"), 7 (“Third-Party Sites”), 8 ("User Content"), 9 ("Restrictions on Use"), 10 ("Subscription, Service, Use Fees"), 11 ("Further Subscription, Service and Use Fees"), 13 ("Termination"), 15 (“Governing Law”) and will survive the termination of this Agreement.
15. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Connecticut.
16. Miscellaneous. You accept that Lyceum has the right to change the content or technical specifications of any aspect of the Service at any time at Lyceum's sole discretion. You further accept that such changes may result in your being unable to access the Service.
17. Amendments to Agreement. From time to time, Lyceum Associates, Inc. may modify these terms and conditions. Accordingly, please continue to review these terms and conditions of service whenever accessing or using this site. Your use of the site after the posting of modifications to these terms and conditions of service will constitute YOUR ACCEPTANCE OF THE TERMS AND CONDITIONS OF SERVICE, as modified. If, at any time, you do not wish to accept the terms and conditions of service, you may not use this Site.
18. Contact Information. Any notice or other communication required or permitted to be given hereunder shall be in writing and shall be given to Lyceum Associates, Inc. at 69 Orchard Place, Greenwich, CT 06830, Attention: President.
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These and other organizations have recently participated in Lyceum roundtables and events.
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AARP
Academy of Managed Care Pharmacy
Aetna
Altos Solutions
American Benefits Council
American Enterprise Institute
Amgen
Athenahealth
Beth Israel Hospital
Biotechnology Industry Organzation
BioCentury
Blue Cross & Blue Shield Illinois
Blue Cross & Blue Shield Massachusetts
Blue Shield of California
Cancer Care Northwest
Cardinal Health
Carol
Carnegie Mellon University
Caterpillar
CBS Corp
Centers for Medicare & Medicaid Services
Children's Hospital Boston
Centura
Colgate Palmolive
Colorado Business Group on Health
Colorado Health Foundation
Connecticut Oncology Association
Consortium Health Plans
CVS Caremark
Deloitte Consulting
EMC
Empire Blue Cross Blue Shield
Employee Benefit Research Institute
Engel & Novitt , LLP
Exigo
Foot Locker
Foundation for Managed Care Pharmacy
GE Company
General Mills
Harmony Pharmacy
Harvard Business School
Harvard Kennedy School
Harvard Medical School
Harvard School of Public Health
Hassard Bonnington
Health Care Service Corp.
Health Pass
Health Strategy LLC
Heritage Foundatioin
Hewitt Associates
HLM Venture Partners
Hogan & Hartson
HomePort
Horizon Blue Cross
Hospira
Hospitals Without Borders
HR Policy Assocation
Hyde RX
Imerica
Inspire
Intellogy Health Designs
ITA Partners
Kaiser Permanente
Manatt Health Solutions
Marriott International
Med Adherence
Medical Oncology Association of Southern California
Medsphere
Merrill Lynch Health Care Services
Microsoft Corporation
Milliman
MinuteClinic
Midwest Business Group on Health
Muir Medical Group IPA
National Business Coalition on Health
NaviNet
Neighborhood Diabetes
New Media Strategies
New York Business Group on Health
New York Clinical Informaton Exchange (NYCLIX)
Novartis Pharmaceutical Corporation
New York Presbyterian Hospital
NovoLogix
NPS Pharmaceuticals
Oncology Metrics
Oncure Medical Corp.
OneOncology
Park Avenue Health Care Management
Practice Fusion
Protein Sciences
Ready Consultant
Rx Vitality
Salix Ventures
Sandoz
Sanofi Aventis
Silverlink
State of Colorado
SustainAbility
TIAA-CREF
United States Senate
UnitedHealth Group
University of Colorado
University of Pittsburgh
US Chamber of Commerce
Vantage Oncology
Volo Healthcare
Watson Wyatt
Weill Cornell Medical Center
WellPoint
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Drug Pricing Methodologies
Average Wholesale Price (“AWP”): The most commonly used price index in pharmaceutical transactions, AWP operates as a suggested list price. Buyers, typically, negotiate lower prices through the inclusion of discounts, rebates or free goods. Medicare uses it to calculate the cost of drug products administered in a physician’s office. PBMs, insurance carriers, and other managed care organizations use AWP to calculate payments to retail pharmacies for providing drug products to patients. Pharmacies often use AWP as a cost basis for pricing prescriptions.
Average Sales Price (“ASP”): The Medicare Modernization Act of 2003 established ASP as a drug payment system. The methodology uses quarterly drug pricing data, which drug manufacturers submit to the CMS. In calculating the ASP, the manufacturer must deduct various discounts, including prompt payment discounts. Like AWP, it serves as a baseline to determine Medicare reimbursement rates.
Average Acquisition Cost (“AAC”): The retailer’s cost to buy drugs from wholesalers: the final cost of the drug to the pharmacy after all discounts are subtracted.
Average Manufacturer’s Price (“AMP”): The average price retail pharmacies or wholesalers pay manufacturers. It is based on sales to the retail sector, which generally pays higher prices than other purchasing sectors. The federal government currently uses AMP to calculate rebates in the Medicaid outpatient prescription drug rebate program.
Wholesale Acquisition Cost (“WAC”): A manufacturer’s list price established for sales to wholesalers, and a basis for calculating rebates.
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MANUFACTURER TO PHARMACY (VIA WHOLESALER)
1. MANUFACTURER
↓ Wholesale Acquisition Cost (WAC) or ↓ Average Manufacturer's Price (AMP)
2. WHOLESALER
↓ Actual Acquisition Price (AAP)
3. PHARMACY
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MANUFACTURER TO PHARMACY
1. MANUFACTURER
↓ Average Manufacturer's Price (AMP)
2. PHARMACY
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PAYER TO PHARMACY
1. PAYER
↓ Reimbursement: Average Wholesale Price + Discount
2. PHARMACY
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PHARMACY TO PATIENT
1. PHARMACY
↓ Retail or Usual & Customary Price (U & C)
2. PATIENT/END-USER
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Drug Coding Procedures
Vendors use both the Health Care Common Procedure Coding System (“HCPCS”), devised by CMS, and Current Procedural Terminology (“CPT”), an AMA creation, to bill for drugs/products that are utilized in the physician’s office, clinic or home setting. These include drugs that are injected subcutaneously, intramuscularly, or intravenously, and drugs administered via nebulizers or other DME equipment.
The National Drug Code (“NDC”) serves as a universal product identifier for drugs and biologics. Although similar to NDC, J Codes contain less information, such as the name of the drug manufacturer. J Codes are administered under the HCPCS.
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The newsletter Perspectives features commentary and opinion on economic transition and business innovation across health care, financial systems and consumer business. Many contributions come from our participants, and reflect front-line experience.
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Maureen Bailey "Silent Epidemic" (volume 5, issue 2), "Nudging Temptation Aside: Behavioral Economics and Diabetes" (volume 5, issue 5)
Ms. Bailey is the author of the forthcoming book "The Diabetic Diva", a cookbook for diabetics with a foreword by Ron Rosedale, MD. Dr. Rosedale developed a nutritional protocol that has helped thousands of people reverse type 2 diabetes. Her work has also appeared in Barron's and The Economist. Read more here.
Tom Cronin "A Better Model for Disease Management" (volume 5, issue 11)
Mr. Cronin is CEO of Neighborhood Diabetes, where he and his partners on the Management Team have grown the company tenfold in the last five years. Prior to involvement in the acquisition of Neighborhood, Tom took a sabbatical from business and was a math teacher at an urban high school and high school varsity soccer coach. Prior to teaching, Tom was CEO and owner of CranBarry, Inc., an established manufacturer and distributor of women's sporting goods. Earlier, Tom was a consultant at Bain & Company, the international strategy consulting firm headquartered in Boston. Read more here.
Bruce Cutter, MD "A New Oncology Business Model" (volume 5, issue 1)
Dr. Cutter is a practicing medical oncologist/hematologist at Cancer Care Northwest, a large integrated oncology group in Spokane, WA. As president and CEO from 2000 to 2007, Bruce lead the development of a comprehensive quality initiative called Foundations of Quality ("FOQ"). FOQ was developed six years ago, in close collaboration with Premera Blue Cross. This program, which includes a pay-for-performance contractual relationship, was founded on the quality principles promulgated by the Institute of Medicine, is physician-driven and collaborative, and based on a commitment by the practice to measurable quality and accountability. Read more here.
Steve Hyde "Personal Choice and Breast Cancer Screening" (volume 5, issue 12)
Mr. Hyde is the author two books: most recently, “Cured! An Insider's Handbook for Health Care Reform” (June 2009, Hobnob Publishing; read review) and, previously, “Prescription Drugs for Half Price or Less,” (2006, Bantam-Dell Division of Random House). He has been a public company CEO and chairman or board member of numerous companies. The former federal chief HMO financial regulator and a certified actuary, he started and grew Peak Health Care, Inc., into a highly successful public managed care company, recognized by Business Week Magazine as one of America’s Best Small Companies. He has extensive experience in managed care operations and strategy, health insurance, managed care regulation, consumer-driven health care, pharmacy benefits, disease management, medical information technology, medical group management, medical network and PPO operations, health benefit design & pricing, health insurance underwriting, community rating, and health service product development and marketing. Steve is CEO of Hyde Rx Services Corp., a health care management consultancy. Read more here.
Wolfgang Klietmann, MD "Understanding H1N1 as a Pandemic Threat and Public Health Service Challenge" (volume 5, issue 11)
Dr. Klietmann is a clinical pathologist and medical microbiologist and serves at Harvard Medical School faculty as an appointed Lecturer on Pathology. Prior to his immigration to the United States in 1992, Klietmann founded and was president and physician-in-chief of a major Institute of Laboratory Medicine in Germany which he built into a peerless institution in its scientific standing and innovative diagnostic reputation among private laboratories in Germany. A prolific author and guest lecturer with over 200 publications and presentations delivered to audiences across the globe, the cornerstone of Klietmann’s career has centered on infectious diseases and bringing together individuals and organizations to share information, technology and resources. His work in biodefense includes a collaboration with MIT in a project for the Department of Defense. He serves as president on the board of directors of the Harvard Business School Health Industry Alumni Association and organized as co-chairman several major conferences held on the campus of Harvard Business School. His memberships in several scientific societies include a fellow of the College of American Pathologists. Read more here.
Tom McNulty, Pharm.D "New Strategies for Specialty Pharmacy" (volume 5, issue 12)
Dr. McNulty is co-founder and chief clinical officer of NovoLogix, Inc, a performance-based health care technology company delivering electronic claims re-pricing processes, prior authorization controls, and integrated patient care and pharmaceutical programs. His expertise includes medication adherence and compliance. Tom is a frequent speaker at industry events and conferences. Read more here.
Kavita Nair, PhD "Value-Based Benefit Design: Getting It Right" (volume 5, issue 4)
Dr. Nair is an associate professor in the department of clinical pharmacy at the University of Colorado (Denver) School of Pharmacy. Her current area of research involves pharmacy benefit design in managed care and retail pharmacy including the structure, pricing and reimbursement of medications, factors affecting the reimbursement of medication in retail pharmacy, willingness to pay for retail pharmacists services and consumer attitudes regarding their pharmacy benefit plans and the impact of multi-tiered reimbursement mechanisms on medication utilization. She is currrently working with Anthem Blue Cross Blue Shield of Colorado to examine the impact of two and three tier co-pay pharmacy benefit plans on the drug utilization patterns of a commercially insured population and a Medicare managed care population. She is also working with various Pharmacy Benefit Managers to examine the impact of converting prescription Claritin to an over-the-counter status on medication utilization and reimbursement mechanisms. Read more here.
Susan Pantely "Benefit Design Strategies and Oral Anticancer Medications" (volume 6, issue 1)
Ms. Pantely is a principal and consulting actuary with Milliman. She works with a broad range of clients, including Blue Cross/Blue Shield plans, HMOs, commercial insurers, government agencies and healthcare providers. Her work includes rate development, provider contract review, reserve certification, capitation development, Medicare risk feasibility studies, HMO start-ups, HMO due diligence, and development of risk sharing and reimbursement arrangements for physician groups, PHOs, and other integrated delivery systems. In addition, Susan has extensive experience with the valuation, financial analysis, and projection of healthcare services for several state public health insurance (Medicaid) programs. Read more here.
David Rose "Smart Packaging, Better Health Care" (volume 6, issue 1)
Mr. Rose is CEO of Vitality, inc. a company focused on connected-health devices and services. He teaches at the MIT Media Lab and speaks frequently on design and product innovation at conferences and corporate retreats. Previously, he was founder and CEO of Ambient Devices where he pioneered embedding Internet information in everyday objects like umbrellas, light bulbs, bathroom mirrors, and refrigerator doors, to make the physical environment an interface to digital information. Read more here.
Robert Rowley, MD "Cloudburst: The New Frontier for Electronic Health Records" (volume 5, issue 11)
Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward , CA has functioned without paper charts since 2002. Read more here.
David Willcutts "Are Expectations Too High for Health IT Vendors?" (volume 6, issue 2)
Mr. Willcutts is a long time health care services executive and entrepreneur focused on managed care, specialty pharmacy and home care services. He is currently the president and founder of Ready Consultant, LLC an early stage marketplace for healthcare consulting services created in response to the unprecedented level of health care initiatives underway in the US covering areas such as EHR, HIPAA, ICD10, and more. He previously founded Ancillary Care Management (now Novologix) in 1995 growing it to over $450 million in annual revenue before leaving in 2007. Read more here.
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Selected Health Care Legislation
1965: Social Security Amendments authorized Medicare and Medicaid programs. The act created separate payment systems for in patient hospital care (Part A), and outpatient care, including home care and physician services (Part B). Read more here.
1983: Orphan Drug Act gave tax breaks, subsidies, and special exclusivity privileges to sponsors of drugs for rare diseases, defined as having fewer than two hundred thousand cases in the United States. The act implemented market exclusivity by granting protection for seven years against competition from any drug with a similar effect. Read more here.
1984: Hatch-Waxman “Generic Drug” Act required the FDA to accept bioequivalence as sufficient for approval and established the procedure for a generic drug approval called the Abbreviated New Drug Application (“ANDA”). The act extended patents for time lost during FDA review and for one-half the time lost during FDA-required clinical testing. The act capped the extension at a maximum of five years, and the total patent term at 14 years from the data of the FDA approval. Read more here.
1986: The Health Care Quality Improvement Act protected peer review bodies from private money damage liability, and prevented incompetent practitioners from moving state to state without disclosure or discovery of previous damaging or incompetent performance. Read more here.
1989: Omnibus Budget Reconciliation Act authorized resource-based, relative value scale reimbursement of physicians under Part B of Medicare. Read more here.
1990: Budget Reconciliation Act established Medi-Gap insurance regulation that limited exclusions for pre-existing conditions, requirements for uniformity in policies, civil penalties for duplicative services, mandatory rebates if policies failed to return specified percentages of each premium dollar, and rules for "simplification" and standardization of policies. The act also introduced a series of Medicare reforms that aimed to save $40 billion over five years. Read more here.
1992: Prescription Drug User Fee Act established for a five-year period a mandatory fee to be submitted by a pharmaceutical company along with its application to finance the hiring of new employees and reduce average processing time. Read more here.
1996: Health Insurance Portability and Accountability Act (“HIPAA”) allowed for the protection of health insurance coverage for workers and their families when changing jobs, and established national standards for electronic health care transactions and national identifiers for providers, insurance plans, and employers to promote electronic data interchange. The act also authorized tax-deductible medical savings accounts. Read more here.
1997: Balanced Budget Act added Part C to Medicare, which expanded options for enrollment in managed care plans. Read more here.
1997: FDA Modernization Act reauthorized user fees for another five years, and introduced new inducements to conduct pediatric studies that included granting a sponsor an additional six months of exclusive marketing privileges beyond any patent or other nonpatent rights for which the drug may already be eligible. Read more here.
2003: Medicare Modernization Act provided a new outpatient prescription drug benefit under Medicare beginning in 2006 (Part D). In the interim, it created a temporary prescription drug discount card and transitional assistance program. It also included a provision for establishing health savings accounts. Read more here.
2005: Patient Safety and Quality Improvement Act established a system of patient safety organizations and a national patient safety database, to encourage reporting and broad discussion of adverse events, near misses and dangerous conditions. The Agency for Healthcare Research and Quality oversees many of its provisions. Read more here.
2009: The American Recovery and Reinvestment Act included the Health Information Technology for Economic and Clinical Health ("HITECH") Act, which provisions $19.2 billion in incentive money for the implemention and use of electronic health records. It also legislatively mandated the Office of the National Coordinator for Health Information Technology ("HIT"), and the creation of the HIT policy and standards committees. Read more here.
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