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August 2011

One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation
Joseph Burns
When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental Disorders means even more coverage decisions.
John Carroll
The resulting company could control 40 percent of the PBM market, but would any savings be passed on to insurers?
Frank Diamond
Some insurers are taking these health care professionals from the front lines and putting them into leadership positions
Frank Diamond
The comparison found that maintenance therapy with fluticasone propionate-salmeterol combination was associated with a 14% reduction in risk of severe exacerbation, less health care utilization, and 25% lower COPD-related medical costs
Anand A. Dalal, PhD ; Sean D. Candrilli, PhD ; Keith L. Davis, MA

The field of personalized medicine has made significant progress with key discoveries like single nucleotide polymorphism and microarray/biochips. These advances will benefit plans, patients, the pharmaceutical industry, and society.

Daniel Pucheril ; Smiriti Sharma



Departments
Viewpoint
Thanks to the fragmented compensation system, we are already paying more. The new payment system must elicit cooperation and coordination.
Sanjaya Kumar, MD, MSc, MPH, and David B. Nash, MD, MBA
Legislation & Regulation
It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour?
John Carroll
Medication Management
Automatic interchange at the hospital can disrupt medication therapy and affect outcomes in a suboptimal way
Thomas Reinke
Plan Watch
Anthem Blue Cross & Blue Shield of Indiana focuses on improving communications between minorities and their physicians
By Frank Diamond

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014