Managed Care
Disease
Management

 

November 2011

The size of the essential benefits package may determine whether insurers can operate in the highly regulated exchange market. Expect strong lobbying from health care interest groups.
Michael D. Dalzell
Clinical executives at health plans want to see how providers react to draft recommendation against procedure
Frank Diamond
Discrimination persists in many areas, but slow progress is being made
Joseph Burns
With national attention on health care reform and new models of care, the NCQA’s VP for performance measurement looks at how quality improvement can stay at the forefront
John Marcille
Determining return on investment and improvement of outcomes is essential when new programs are being tried, but the research method must be chosen carefully
Andrew Kolbasovsky, PsyD, MBA



Departments
Legislation & Regulation
The gray market, where medications can be repriced, is becoming unmanageable
John Carroll
Medication Management
Decision support tools provide new options for oncologists and health plans
Thomas Reinke
Plan Watch
Holding physicians to best-practice guidelines with the threat of refusing to pay for unnecessary tests reaps dividends
Frank Diamond
Tomorrow's Medicine
Managed care once again faces the all-too-familiar debate about cost and benefit
Thomas Morrow, MD
Managed Care Outlook
Lipitor led the way, and other blockbusters are following