How to Secure a PBM Contract That Meets Your Goals

Debra Devereaux

At the beginning, it all sounds great…the PowerPoint presentation was informative, and the staff who came to present all seemed very competent and caring with a lot of integrity. Then the negotiations begin, and there’s a lot of back and forth and he-said/she-said, and you give up. That is not a great strategy for getting a Pharmacy Benefit Manager (PBM) contract that meets your financial, compliance, and Star Ratings goals. You must have a letter of agreement if you are implementing a new plan, but the contract negotiation may stretch into the latter part of third or fourth quarter. You are better off taking your time, getting your own legal counsel review, and staying true to your plan goals.

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Go-to-Market Strategy: Bringing It All Together

Nilsa Lennig

Go-to-market strategy is truly fantastic as it is literally aligning the entire organization to drive profitable growth supported by a governance structure that helps more effectively manage.

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Global Warming Comes to Healthcare

David Sayen

On June 7, the Health Subcommittee of the House Ways and Means Committee heard and responded to testimony about Medicare Advantage (MA) and, in particular, how the program can be an instrument to advance care coordination and integration. The tenor of this hearing, combined with the recent unanimous passage of the bipartisan Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act by the Senate Finance Committee tells this reader ice isn’t just melting at the North Pole. There is a thaw in the chill that seemed to blanket parts of the healthcare industry since the election.

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One in Three People in Medicare Now Enrolled in Medicare Advantage

Olga Walther

For the first time, one in three people in Medicare are now enrolled in Medicare Advantage (MA), according to a new analysis from Kaiser Family Foundation. The new analysis, “Medicare Advantage 2017 Spotlight: Enrollment Market Update,” examines trends in the MA market, including cost sharing and premiums, market penetration, and market share of the top three MA firms by state.

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Three Compliance-Minded Steps to Take for 2018 Marketing and Sales

Regan Pennypacker

Is it me, or is time flying by? Applications are done, bids are in, new plans are in planning stages, and existing plans are getting ready for the launch of the next benefit year.

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Final Benefit Submission Is Done. Top 5 Items To Focus on Now!

Diane Hollie

Benefits were submitted on June 5, 2017. Too many times we see health plans wait until the last minute to complete important information. This tends to lead to incorrect mailings and advertising getting into the marketplace with costly errata mailings occurring. Gorman Health Group recommends you start with a strong work plan in place to get the following documents completed, starting now:

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GAO Recommends Use of Disenrollment Data to Strengthen Oversight in MA Program

Olga Walther

In a newly released report, the Government Accountability Office (GAO) recommended the Centers for Medicare & Medicaid Services (CMS) examine data on disenrollment by health status and the reasons beneficiaries disenroll to strengthen oversight of the Medicare Advantage program. The Department of Health & Human Services concurred with GAO’s recommendation.

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