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Managed Care

 

 

October 2010

Though this innovation focuses mainly on the provider’s role, only health plans have the assets, such as claims data, to make it succeed
Peter Boland, PhD ; Phil Polakoff, MD ; Ted Schwab, MBA
Because specialty drug expenditures will grow, P&T committees may become more involved with drugs provided under the medical benefit
Sarah Collins, MBA
CFS is one of a number of diseases with an uncertain etiology and a substantial effect on patients but with few or no verified treatments
William Atkinson
A consultant urges plans to streamline Web sites and devise new contracting strategies to prepare for an influx of individual customers
Its new branding campaign may be a ‘right mistake’
Thomas Reinke
A new system set to start in 2012 will tie allocations to how well insurers hit quality benchmarks. There’s a curve, too.
Frank Diamond
A straightforward method of identifying potentially non-urgent ED visits from administrative data can be employed to calculate population-based rates, which might be applied in the development of managed care programs
James W. Davis, PhD ; Ronald Y. Fujimoto, DO ; Henry Chan, BS ; Deborah T. Juarez, Sc.D



Departments
Editor's Memo
John Marcille
Legislation & Regulation
Federal auditors tell CMS it has been deficient in monitoring whether states are treating plans fairly
John Carroll
Tomorrow's Medicine
For cosmetic reasons, this type of hearing system is desirable, but how much does it cost and who are the best candidates?
Thomas Morrow, MD