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GLG News by Managed Care Experts

Analysis of: Cigna reaches deal on doctors' rankings (news.yahoo.com)
    Entities that simplify ranking of hospitals and physicians will move market share and revenue.  More importantly, these providers will attract the educated and well informed (80,000,000 soon to arrive Medicare), and commercially well insured commercial customers. ...
Analysis of: Government Raid Snares WellCare Directors (blogs.wsj.com)
1. Although government entities have many activities, the role of "cop" is very much a favorite. As more government dollars roll into health care, we can expect more policing by the government, especially at the Federal level, over how those dollars are handled. 2. Disgruntled ex-staff provide a number...
Richard Baland, Partner
Richard Baland, Partner
B2B CFO
Analysis of: Nonpayment for Performance? Medicare's New Reimbursement Rule (content.nejm.org)
Infection Rates and Quality Indicators now impact reimbursement. The Revenue Cycle Team at a hospital must incorporate both features into any work plan.
Frederic Goldstein, President and Chief Operating Officer
Frederic Goldstein, President and Chief Operating Officer
U.S. Preventive Medicine, Inc.
Analysis of: Cigna reaches deal on doctors' rankings (news.yahoo.com)
CIGNA has received the okay from the NY Attorney General to publish its system for ranking physicians. Aetna is also moving forward with establishing a deal with the Attorney General. This process will proceed rapidly throughout the country and will change consumer behavior.
Analysis of: Pfizer Abandons Exubera, Posts 77% Earnings Decline (online.wsj.com)
Pfizers failure on Exubera were not of safety issues, or complicated device, or even consumer marketing problems.  Their biggest issue that brought failure was the lack of payer coverage.  Almost no payer in the US added Exubera to their formulary or saw any value over injectable insulin...
Frederic Goldstein, President and Chief Operating Officer
Frederic Goldstein, President and Chief Operating Officer
U.S. Preventive Medicine, Inc.
Analysis of: Government Raid Snares WellCare Directors (blogs.wsj.com)
Wellcare' stock has dropped like a rock since the FBI, Health and Human Services (HHS) and the Florida Attorney General's office raided the facility earlier this week. Initial speculation was on marketing activities, or billing issues.  It now appears that it may be based upon their use of...
Analysis of: E-discovery law a boon for lawyers (www.washingtonpost.com)
1. Although computers are a manstay in every business setting, it must be remembered that this has only become widespread in the last 10-20 years. Thus, the long term effects of them are only now becoming clear. 2. Electronic records are quite different from paper. They are easier to create so there...
Analysis of: N.Y. Giving Big Brokers Green Light To Accept Service Fees From Insurers (www.propertyandcasualtyinsurancenews.com)
Savvy CLients will rarely pay for underwriting help from their broker.  Additional service fees above the disclosed commission for underwriting analysis that some agents are looking to capitalize on will be a tough sell to most policy holders who feel the commission already compensates the...
Analysis of: IBM to Help Pay for Plans To Curb Childhood Obesity (online.wsj.com)
1. The article puts a focus on a very serious health problem, childhood obesity, and serves an example of good corporate citizenship that other should follow. 2. The article does not present evidence that prvention and wellness programs actually save money for the health care system. There is actually...
Frederic Goldstein, President and Chief Operating Officer
Frederic Goldstein, President and Chief Operating Officer
U.S. Preventive Medicine, Inc.
Analysis of: IBM to Help Pay for Plans To Curb Childhood Obesity (online.wsj.com)
The country spends an inordinate amount on health care for people who experience conditions and illnesses that could have been prevented.  IBM recognizes the importance of Prevention as a mainstay of their health program. Prevention and Wellness companies are the future of health care delivery

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