Managed Healthcare Executive - October 2008 - (Page 2)

EDITORIAL ADVISORY BOARD DISEASE/CARE MANAGEMENT JOEL V. BRILL, MD Dr. Brill is chief medical of cer of Predictive Health LLC, which performs predictive modeling analysis and implements care management solutions. As a CPT and RBRVS Update Committee advisor, Dr. Brill has worked extensively with CMS. He has held positions with several managed care companies including Blue Shield of California and Prudential Health Care. RON ZANT Ron Zant is a practice management consultant with CPA rm VangerLugt, Mulder, DeVries and Elders. With 20 years’ experience, he has expertise in administration, managed-care contracting and pay for performance. VOLUME 18 | NUMBER 10 EDITORIAL EDITOR IN CHIEF PUBLISHING GROUP PUBLISHER John Grasha (440) 891-2712 jgrasha@advanstar.com DIRECTOR OF SALES, FORMULARY AND MANAGED HEALTHCARE EXECUTIVE James MacDonald (201) 690-5379 jmacdonald@advanstar.com DIRECTOR OF CUSTOM PROGRAMS Scott Handschuch (201) 690-5545 scotth@advanstar.com Advanstar Healthcare Communications 123 Tice Blvd. Suite 300 Woodcliff Lake, NJ 07677 Julie Miller INTERNATIONAL BRUCE POLLACK, MBA Bruce Pollack is president of the Academy for International Health Studies, which arranges foreign trade/study missions for senior U.S. healthcare executives. He is also a principal in the consulting rm Global Health Advisors LLC, specializing in business development, strategy and planning. (440) 891-2723 julie.miller@advanstar.com SENIOR EDITOR Tracey L. Walker (440) 891-2732 twalker@advanstar.com EXECUTIVE EDITORIAL DIRECTOR OF PRIMARY CARE Tara Stultz (440) 891-2689 tstultz@advanstar.com ART DIRECTOR Laura Chadwick (440) 891-2738 SENIOR ART DIRECTOR Peter Seltzer WASHINGTON BUREAU CHIEF Jill Wechsler CONTRIBUTING EDITORS Mari Edlin Shelly Reese Elaine Zablocki NEWS EDITOR Barbara Bower EDITORIAL ASSISTANT Kathleen Cohn SEND EDITORIAL MATERIAL TO: 24950 Country Club Blvd. Suite 200 North Olmsted, OH 44070 PAULA M. SAUER Paula Sauer is vice president of care management at Medical Mutual of Ohio. She is responsible for the company’s care management department, which ensures appropriate utilization of healthcare services and a match between patient needs and the level of care delivered. Since joining Medical Mutual in 1986, Sauer has made contributions in utilization management, medical review, network development, health promotion and care management. PHARMACY PERRY COHEN, PHARMD Dr. Cohen is a president of The Pharmacy Group LLC in Glastonbury, Conn., where he is responsible for administration and marketing of a healthcare consulting company that provides services to companies to grow revenue and improve the nancial performance of their products and services. CLASSIFIEDS CAREER CLASSIFIED & RECRUITMENT / RESOURCE DIRECTORY (800) 993-3113 CLASSIFIEDS Karen Eckenwiler (800) 225-4569 x2670 (440) 891-2670 RECRUITMENT Scott Eigenbrod (800) 225-4569 x 2671 (440) 891-2671 SUBSCRIPTION SERVICES (888) 527-7008 (218) 723-9477 AL LEWIS Al Lewis is executive director of the Boston-based Disease Management Purchasing Consortium LLC, which assists health plans with their disease management outsourcing strategies, vendor selection/evaluation and contracting. He also is past president of the Disease Management Association of America. RUSTY HAILEY, PHARMD, DPH, MBA, FAMCP EMPLOYERS SEAN SULLIVAN Sean Sullivan is president and CEO of the Institute for Health and Productivity Management. Sullivan was president and CEO of the National Business Coalition on Health from October 1992 until September 1997. Dr. Hailey is chief pharmacy of cer and senior vice president of pharmacy services at Coventry Health Care and executive vice president of Coventry Prescription Management Services. Dr. Hailey also serves as a member of the board for Coventry Prescription Management Services, Inc. and as past president of the Academy of Managed Care Pharmacy. MANAGED HEALTHCARE EXECUTIVE TERRANCE A. KILLILEA, PHARMD PRODUCTION Advanstar Communications 131 West First Street Duluth, MN 55802 (218) 723-9493 fax (218) 740-6381 PRODUCTION MANAGER Renee Marthe PRODUCTION DIRECTOR Debi Harmer CIRCULATION MANAGER Joe Martin CIRCULATION DIRECTOR Mark Rosen All color separations and proofs produced by Advanstar’s Scanning and Digital Prepress departments HEALTH PLANS/PAYERS DOUGLAS L. CHAET Doug Chaet is senior vice president of contracting and provider networks for Independence Blue Cross in Philadelphia. He is also founder and chairman of the American Association of Integrated Healthcare Delivery Systems. Terrance Killilea is assistant vice president of pharmacy services for Regence BlueShield of Idaho and Regence BlueCross BlueShield of Utah. He also served as senior vice president and chief clinical of cer of a large national PBM. MARKETING SERVICES REPRINTS Nick Thome (800) 225-4569 x 2761 (440) 891-2761 fax (440) 826-2865 nthome@advanstar.com DIRECT MAIL LISTS Tamara Phillips (440) 891-2773 fax (440) 891-2740 tphillips@advanstar.com PERMISSIONS/INTERNATIONAL LICENSING Barry Gilbert (440) 891-2707 bgilbert@advanstar.com PETER M. PENNA, PHARMD Peter M. Penna is founding partner of Formulary Resources LLC, which assists MCOs and others in formulary processes. He formerly was vice president of managed pharmacy for CIGNA Healthcare. DANIEL J. HILFERTY Daniel J. Hilferty is president and CEO of AmeriHealth Mercy and its sister organization, Keystone Mercy Health Plan. AmeriHealth Mercy and its af liates comprise the largest family of Medicaid managed care plans in the country, touching the lives of more than 2 million members. Hilferty is active in national managed care organizations such as the Medicaid Health Plans of America and AHIP. PHARMACY BENEFIT MANAGERS DAVID CALABRESE, RPH, MHP David Calabrese is chief clinical of cer with MedMetrics Health Partners Inc., a PBM company in Worcester, Mass. Af liated with the University of Massachusetts Medical School, MedMetrics is one of only a handful of “non-pro t” PBMs in the country. There, David oversees the development of all aspects of the MedMetrics’ clinical services portfolio. He is also the assistant clinical professor, Northeastern University Bouvé College of Pharmacy and Allied Health Sciences. PRESIDENT & CHIEF EXECUTIVE OFFICER Joe Loggia EXECUTIVE VICE PRESIDENT, FINANCE & CHIEF FINANCIAL OFFICER Ted Alpert EXECUTIVE VICE PRESIDENTS Steve Morris Daniel M. Phillips EXECUTIVE VICE PRESIDENT, CORPORATE DEVELOPMENT Eric I. Lisman VICE PRESIDENT, MEDIA OPERATIONS Francis Heid VICE PRESIDENT, INFORMATION TECHNOLOGY J. Vaughn VICE PRESIDENT OF OPERATIONS AND PRIMARY CARE Laura Wagner VICE PRESIDENT, GENERAL COUNSEL Ward D. Hewins VICE PRESIDENT, ELECTRONIC MEDIA GROUP Mike Alic VICE PRESIDENT, MARKET DEVELOPMENT & LICENSING GROUP Georgiann DeCenzo VICE PRESIDENT, HUMAN RESOURCES Nancy Nugent VICE PRESIDENT, TREASURER & CONTROLLER Shelbie O’Brien INDEPENDENT THOUGHT LEADERS DON HALL Don Hall is principal of DeltaSigma LLC, a consulting practice specializing in Medicaid and Medicare Special Needs Plans. He has more than 30 years of experience and most recently served as president and CEO of a non-pro t, provider-sponsored health plan. TECHNOLOGY RANDY KILLIAN Randy Killian is executive vice president of the Medical Director’s Institute in Glen Allen, Va. He has more than 30 years of healthcare experience throughout the continuum of care, including direct patient care, and as chief operating of cer and chief nancing of cer. J.D. KLEINKE J.D. Kleinke is a medical economist, author and health IT entrepreneur. Kleinke was a founding executive of HCIA Inc., a healthcare information company. His rst book, Bleeding Edge: The Business of Health Care in the New Century, is considered a de nitive healthcare business textbook within the community and was followed by Oxymorons: The Myth of a U.S. Health Care System. DENNIS SCHMULAND, MD Dennis Schmuland, MD, health plan industry solutions director for Microsoft Corp. is responsible for its strategy and solutions for the health plan industry. He previously led Microsoft e-health, HIPAA, privacy and security strategies. Also the founder of an e-health connectivity company, Dr. Schmuland has earned degrees in medicine, psychology and chemistry, and is a fellow of the American Academy of Family Physicians (FAAFP). CHIEF MEDICAL AND COMPLIANCE OFFICER John C. Marlow, MD OCTOBER 2008

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - October 2008

Managed Healthcare Executive - October 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Healthcare Reform Trends in 2009 Cost Control Strategies Predicted Premium Increase Top Challenges in 2009 IT System Integration Technology Innovation Disease Management Health Management Pharmacy Best Practices Technology Desktop Resource Ad/Edit Index Managed Care Outlook Statement of Ownership

Managed Healthcare Executive - October 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.