Managed Healthcare Executive - January 2009 - (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. 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. VOLUME 19 | NUMBER 1 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 PUBLISHING 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 Paula Sauer is vice president of care management at Medical Mutual of Ohio. She has made contributions in medical review, network management and health promotion. Ron Zant is a practice management consultant with CPA rm VangerLugt, Mulder, DeVries and Elders. With 20 years’ experience, he has expertise in administration, managedcare contracting and pay for performance. 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. 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 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 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. RUSTY HAILEY, PHARMD, DPH, MBA, FAMCP 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. 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. CENTRALIZED CONTENT GROUP CHIEF EDITOR James Sweeney CLINICAL MANAGING EDITOR Maude Campbell SENIOR EDITORS Heide Aungst, Jeff Bendix, David Bennett, Barb Bower, Amanda Brower MARKETING SERVICES PETER M. PENNA, PHARMD DANIEL J. HILFERTY 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 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. 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. 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. REPRINTS Dave Beroisa (800) 225-4569 x 2704 (440) 891-2704 MULTIMEDIA PRODUCER/REPORTER fax (440) 826-2865 Leigh Brattain dberoisa@advanstar.com ASSOCIATE MULTIMEDIA PRODUCER DIRECT MAIL LISTS Dustin Lee Tamara Phillips (440) 891-2773 PRODUCTION fax (440) 891-2740 tphillips@advanstar.com PRODUCTION DIRECTOR Debi Harmer PERMISSIONS/INTERNATIONAL LICENSING CIRCULATION DIRECTOR Barry Gilbert Mark Rosen (440) 891-2707 bgilbert@advanstar.com Advanstar Communications 131 West First Street Send editorial materials to: Duluth, MN 55802 Managed Healthcare Executive (218) 723-9493 24950 Country Club Blvd. fax (218) 740-6381 Suite 200 North Olmsted, OH 44070 All color separations and proofs produced (800) 225-4569 by Advanstar’s Scanning and Digital Prepress departments fax (440) 891-2735 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. 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. 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, GENERAL COUNSEL Ward D. Hewins VICE PRESIDENT, ELECTRONIC MEDIA GROUP Mike Alic EXECUTIVE VICE PRESIDENT Georgiann DeCenzo VICE PRESIDENT, HUMAN RESOURCES Nancy Nugent VICE PRESIDENT, TREASURER & CONTROLLER Shelbie O’Brien VICE PRESIDENT, INFORMATION TECHNOLOGY J. Vaughn Managed Healthcare Executive’s Editorial Advisory Board contributes article ideas, commentary and analysis from the front lines of managed care. MANAGED HEALTHCARE EXECUTIVE (ISSN 15339300) is published monthly by Advanstar Communications Inc., 131 W First St., Duluth MN 55802-2065. Subscription rates: 1 year $89.25, 2 years $131.25 in the United States & Possessions; 1 year $110.25, 2 years $157.50 in Canada and Mexico; 1 year $173.25, 2 years $267.75 in all other countries. For air-expedited service, include an additional $78.75 per order annually. Single copies (prepaid only): $7.35 in the United States, $19.95 all other countries. Back issues, if available: $12.55 in the U.S.; $14.75 all other countries. Include $6.85 per order plus $2 per additional copy for U.S. postage and handling. If shipping outside the U.S., include an additional $10 per order plus $3 per additional copy. Periodicals postage paid at Duluth MN 55806 and additional mailing of ces. POSTMASTER: Please send address changes to Managed Healthcare Executive, P.O. Box 6178, Duluth, MN 55806-6178. Canadian GST number: R-124213133RT001, Publications Mail Agreement No. 40612608. Return Undeliverable Canadian Addresses to: Bleuchip of the advertisements contained in the publicaInternational, P. O. Box 25542, London, ON N6C tion, and cannot take any responsibility for any 6B2, CANADA losses or other damages incurred by readers © 2009 Advanstar Communications Inc. All rights in reliance on such content. reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical including by photocopy, recording, or information storage and retrieval without permission in writing from the publisher. Authorization to photocopy items for internal/educational or personal use, or the internal/educational or personal use of speci c clients is granted by Advanstar Communications Inc. for libraries and other users registered with the Copyright Clearance Center, 222 Rosewood Dr. Danvers, MA 01923, 978750-8400 fax 978-646-8700. For uses beyond those listed above, please direct your written request to Permission Dept. fax 440-891-2650 or email: bgilbert@advanstar.com. MANAGED HEALTHCARE EXECUTIVE welcomes unsolicited articles, manuscripts, photographs, illustrations and other materials but cannot be held responsible for their safekeeping or return. Advanstar Communications provides certain customer contact data (such as customers’ names, addresses, phone numbers and email addresses) to third parties who wish to promote relevant products, services and other opportunities which may be of interest to you. If you do not want Advanstar Communications to make your contact information available to third parties for marketing purposes, simply call toll-free 888-527-7008 between the hours of 7:30 am and 5 pm CT and a customer service representative will assist you in removing your MANAGED HEALTHCARE EXECUTIVE does not verify name from Advanstar’s lists. Outside the U.S., any claims or other information appearing in any please phone 218-723-9477. VICE PRESIDENT OF OPERATIONS AND PRIMARY CARE Laura Wagner CHIEF MEDICAL AND COMPLIANCE OFFICER John C. Marlow, MD JANUARY 2009 MANAGED HEALTHCARE EXECUTIVE

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - January 2009

Managed Healthcare Executive - January 2009 Contents Editorial Advisors For Your Benefit News Analysis Politics & Policy Letter of the Law Managed Care Outlook New Day 5 New Realities of Disease Management Pharmacy Best Practices Health Management Technology State Report: Hawaii MHE Resource Ad/Edit Index

Managed Healthcare Executive - January 2009

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.