Managed Care

 

 

May 2012

Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are.
Timothy Kelley
When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price
Linda Cahn
As expensive products increase their share of the medication market, expect these methods to be employed widely
Ira Studin, PhD, MPH
When 32 million or more new members, courtesy of the Accountable Care Act, are just not enough
John Carroll
Even though accountable care organizations have not lived up to their promise, some will ultimately succeed
Richard Stefanacci, DO, MGH, MBA, AGSF, CMD

A review of the available research identifies payment for services in the absence of high-quality scientific evidence and presents an opportunity to use evidence-based medicine to develop a clinical coverage guideline

James P. Reichmann, MBA ; Michael S. Kirkbride, BSc, Pharm D



Departments
Editor's Memo
John Marcille
Legislation & Regulation
Plans will compete for new enrollees, including people with major health problems
John Carroll
Medication Management
Also called observational research, these studies dig down to the provider and patient level rather than analyzing only population-level data
Thomas Reinke
Plan Watch
Young women on Medicaid tend to skip physicals because of child care concerns. One insurer thinks it might have an answer.
Frank Diamond
Tomorrow's Medicine
This screening tool is less invasive than a colonoscopy, with a specificity approaching 99 percent as risk increases
Thomas Morrow, MD

Meetings

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