When we plan an issue, we try to assign a variety of topics that will appeal to most of our readers. Since nearly all of these readers work in managed care organizations, be they health plans or integrated systems or the large practices that do business with hospitals and insurers, it isn’t particularly hard to do.
This month’s cover story should have something to say to nearly every reader. It’s a bird’s eye view of two approaches to health care management that seem, from their names, to be very much at odds with each other. What we found out is that yes, there can be problems, but more and more the care-for-populations approach and the patient-centered approach are not enemies, and in fact, the latter depends on the achievements of the former.
For everyone in health care, the cost of drugs is a problem. Everyone except pharmaceutical companies, that is. I had been interested in the burgeoning practice of pharma companies giving health plan members coupons to lower their out-of-pocket costs so as to keep them from going generic or seeking a prescription for a tier 2 drug instead of, perhaps, a tier 3 drug with a high copayment. This practice raises costs for employers, health plans, and patients in general. So I asked my friend Linda Cahn, a lawyer/consultant who has written some wonderful, highly specific articles on contracting with PBMs (all available free on our Web site, www.managedcaremag.com), to advise our readers on how to tackle the coupon problem, and as usual, she came through.
Still seeking variety so that there will be something, if not many things, to interest each reader, I came up with a piece about four trends in managing specialty pharmacy that the author, Ira Studin, tells us will assume major roles in dealing with these costly drugs. And there are a dozen or so other stories, long and short, on the clinical and business sides of managed care.