Managed Care



March 2014

Medicare considers going beyond palliative care, and Aetna finds that allowing curative treatment and loosening admission criteria reduce costs and improve quality of life

Susan Worley
Insured patients are liable for ever greater out-of-pocket payments, and providers will have to evaluate their creditworthiness and act accordingly
Peter Boland, PhD ; David Gibson, MD

Health plans required not to discriminate against members with mental disorders find that many providers have modernized their methods

Thomas Reinke
Santosh J. Agarwal, BPharm, MS ; Gary V. Delhougne, JD, MHA ; Levi Citrin, JD ; Jill E. Sackman, DVM, PhD ; Anthony J. Senagore, MD, MS, MBA

Insurers and ACOs should be able to work together to tackle a problem that wastes as much as $42 billion a year

Thomas Reinke

Editor's Memo
John Marcille

The author reviewed and rejected all four options offered by his ENT and lived to tell about it

Al Lewis
Legislation & Regulation

Fewer than half of the 137 groups reported spending below Medicare’s benchmark, with total savings of $401 million

John Carroll
Medication Management

Analysis of data from claims is uncovering opportunities to advise prescribers and, through them, to improve outcomes

Thomas Reinke
The Formulary Files
Krishna Rutvij Patel, PharmD
Tomorrow's Medicine

The key is measuring chemotherapy agents’ efficacy based on aptosis — cell death — as reflected by cells’ changing optical density

Thomas Morrow, MD
Managed Care Outlook


4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium 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
HealthIMPACT Southeast Tampa, FL January 23, 2015