Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are.
When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a price
As expensive products increase their share of the medication market, expect these methods to be employed widely
When 32 million or more new members, courtesy of the Accountable Care Act, are just not enough
Even though accountable care organizations have not lived up to their promise, some will ultimately succeed
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
Legislation & Regulation
Plans will compete for new enrollees, including people with major health problems
Also called observational research, these studies dig down to the provider and patient level rather than analyzing only population-level data
The Formulary Files
Young women on Medicaid tend to skip physicals because of child care concerns. One insurer thinks it might have an answer.
This screening tool is less invasive than a colonoscopy, with a specificity approaching 99 percent as risk increases
Thomas Morrow, MD
Managed Care Outlook