Kareen Zimmer

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Last Wednesday, September 18, 2013, Walgreen Company (“Walgreen”) announced its plan to move approximately 160,000 employees to Aon Hewitt’s private health exchange (the “Aon Exchange”) in 2014. This move marks a significant decrease in risk for Walgreen as the company will shift to a defined contribution model for funding its employees’ health insurance. Under the Aon Exchange defined contribution model, Walgreen will provide its employees a fixed amount of money to be used in purchasing…
The June 2013 edition of Managed HealthCare Executive magazine includes an article authored by Squire Sanders partner Lisa Han and associate David Kopans entitled, “Highmark Buy Continues National Insurer Trend.” The article focuses on the trend of insurer and provider integration, which blurs the line between the two. With the Highmark Inc. and West Penn Allegheny Health System affiliation as the backdrop example, Han and Kopans dig deeper into this continuing trend, as well as…
Fasken Martineau released today the results of a survey of senior M&A executives primarily based in the United States that lead to some compelling observations about the growing use of social media platforms such as LinkedIn and Facebook. Key Findings Entrepreneurs looking for an exit should not ignore the quality of their social profiles: 36% of respondents used social media platforms to research potential acquisition targets in the last year. 48% used social platforms to…
The Affordable Care Act requires the assignment of Medicare beneficiaries based on which physician provides a beneficiary’s primary care services, and delegates the task of prescribing the assignment methodology to the Secretary of Health and Human Services. After considering a majority rule and a plurality rule, CMS believes that the latter should be the governing rule.  CMS believes, correctly so, that the majority rule would be too strict and likely hinder the development and stability…
CMS has considered two basic options for assigning beneficiaries to an ACO to calculate eligibility for shared savings.  The first option is that beneficiary assignment would occur at the beginning of the performance year on a prospective basis.  The second option is for beneficiary assignment to occur on a retrospective basis based on the actual utilization of primary care services provided by ACO physicians during the performance year. CMS is proposing the combined approach of…
Although the Affordable Care Act allows hospitals employing physicians and other non-physician professionals such as advance practice nurses, physician assistants and nurse practitioners, to be eligible providers for an ACO, only primary care services provided by primary care physicians matter in determining the beneficiaries that would be assigned to an ACO. And only those ACOs that have been assigned at least 5,000 beneficiaries are allowed to participate in the Medicare Shared Savings Program. The definition…