Managed Care



February 2011

Health insurers will soon find themselves working with provider organizations that have vastly improved utilization management skills
John Carroll
The information that many plans use needs to be open to physicians for review, and the formulas need considerable improvement
Advocates say that what’s lost in lowered copayments is more than made up by lowered downstream costs, but skeptics find the data unpersuasive
Richard Mark Kirkner
Just because Medicare is hobbled in what it can do with comparative effectiveness research, doesn’t mean that MCOs cannot use the information for both quality improvement and cost control
Sarah Collins, MBA
Atrial fibrillation patients are often noncompliant with warfarin but newer drugs have better safety and side effect profiles
Bob Kirsch
Amy K. O'Sullivan, PhD ; Jane Sullivan, MPH ; Keiko Higuchi, MPH ; A. Bruce Montgomery, MD

Legislation & Regulation
In addition to the 85 percent rule, the department is applying a ‘reasonableness’ criterion. But it’s all bark, no bite.
John Carroll
Medication Management
In an effort to make the best use of specialty drugs, everybody gets into the act at Independence Blue Cross
Thomas Reinke
Plan Watch
BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers
Frank Diamond
Tomorrow's Medicine
NuView Life Sciences fuses molecular biology with imaging technology using the radioactive nuclide Copper 64
Thomas Morrow, MD


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
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium 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
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015