Even though total remuneration was relatively unchanged from 2008 to 2009, one expert thinks chief medical officers (CMOs) will be seeing more responsibility and will be “crucial in helping insurers meet their bottom lines,” says C. J. Bolster, a vice president and national director of health care practice at Hay Group, a global management consulting company.

He says CMOs are executives involved in setting business strategies for the insurer or health plan. Bolster describes the CMO as a supervisory position, with medical directors reporting to him.

“One of the real issues coming out of reform is going to be how insurers can demonstrate value,” says Bolster, “and a lot of that value is going to be driven by the policies that come out of the chief medical officer’s domain — in terms of safety and the types of programs that keep people healthy.”

That’s good news for CMOs.

“I think the role of a chief medical officer is going to continue to evolve in these types of organizations, and it’s probably going to become a bigger job,” says Bolster.

“It would not surprise me to see the duties of the traditional chief operating officer get smaller and be focused on the transactional part of the insurance business. I also see the CMO position becoming more important because that’s where you’re going to drive membership satisfaction and costs,” he says.

Breakdown of remuneration components, 2008-2009

Cheryl Mikuls, a vice president at Hay Group, expects the compensation mix for these executives to shift more toward base salary, with less compensation falling into the short- and long-term incentives for compensation paid in 2010.

Source: The Hay Group. 2009 Industry Insights: Health Insurance 2009.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.