Managed Healthcare Executive - December 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. 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. VOLUME 18 | NUMBER 12 EDITORIAL EDITOR IN CHIEF Julie Miller (440) 891-2723 julie.miller@advanstar.com SENIOR EDITOR Tracey L. Walker (440) 891-2732 twalker@advanstar.com ART DIRECTOR Laura Chadwick (440) 891-2738 lchadwick@advanstar.com WASHINGTON BUREAU CHIEF Jill Wechsler EXECUTIVE EDITORIAL DIRECTOR OF PRIMARY CARE Tara Stultz SENIOR ART DIRECTOR Peter Seltzer EDITORIAL ASSISTANT Kathleen Cohn PUBLISHING GROUP PUBLISHER John Grasha (440) 891-2712 jgrasha@advanstar.com DIRECTOR OF CUSTOM PROGRAMS Scott Handschuch (201) 690-5545 scotth@advanstar.com Advanstar Communications 123 Tice Blvd. Suite 300 Woodcliff Lake, NJ 07677 (201) 690-5300 fax (201) 690-5400 PAULA M. SAUER 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. 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. CLASSIFIEDS CAREER CLASSIFIED & RECRUITMENT/RESOURCE DIRECTORY (800) 993-3113 CLASSIFIEDS Carla Kastanis (800) 225-4569 x 2711 (440) 891-2711 RECRUITMENT Scott Eigenbrod (800) 225-4569 x 2671 (440) 891-2671 SUBSCRIPTION SERVICES (888) 527-7008 (218) 723-9477 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. AL LEWIS Al Lewis is executive director of the Bostonbased 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. CENTRALIZED CONTENT GROUP CLINICAL MANAGING EDITOR Maude Campbell SENIOR EDITORS Heide Aungst, Jeff Bendix, David Bennett, Barb Bower, Amanda Brower 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. MARKETING SERVICES MULTIMEDIA PRODUCER/REPORTER REPRINTS Nick Thome Leigh Brattain (800) 225-4569 x 2761 ASSOCIATE MULTIMEDIA PRODUCER (440) 891-2761 Dustin Lee fax (440) 826-2865 nthome@advanstar.com PETER M. PENNA, PHARMD PRODUCTION 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. 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. PRODUCTION MANAGER Renee Marthe PRODUCTION DIRECTOR Debi Harmer CIRCULATION MANAGER Joe Martin CIRCULATION DIRECTOR Mark Rosen Advanstar Communications 131 West First Street Duluth, MN 55802 (218) 723-9493 fax (218) 740-6381 All color separations and proofs produced by Advanstar’s Scanning and Digital Prepress departments 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 Send editorial materials to: Managed Healthcare Executive 24950 Country Club Blvd. Suite 200 North Olmsted, OH 44070 (800) 225-4569 fax (440) 891-2735 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 “nonpro 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. DANIEL J. HILFERTY Daniel J. Hilferty is president and CEO of the AmeriHealth Mercy Family of Companies, the largest organization of Medicaid managed care plans in the United States, touching the lives of more than 6.2 million individuals nationally. Hilferty is active in national managed care organizations such as Medicaid Health Plans of America and AHIP and is an advocate for improving access and quality for publicly funded healthcare. 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. 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. 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 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). 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. Managed Healthcare Executive’s Editorial Advisory Board contributes article ideas, commentary and analysis from the front lines of managed care. CHIEF MEDICAL AND COMPLIANCE OFFICER John C. Marlow, MD DECEMBER 2008 MANAGED HEALTHCARE EXECUTIVE

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Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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