August 2011

One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation
Joseph Burns
When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental Disorders means even more coverage decisions.
John Carroll
The resulting company could control 40 percent of the PBM market, but would any savings be passed on to insurers?
Frank Diamond
Some insurers are taking these health care professionals from the front lines and putting them into leadership positions
Frank Diamond
The comparison found that maintenance therapy with fluticasone propionate-salmeterol combination was associated with a 14% reduction in risk of severe exacerbation, less health care utilization, and 25% lower COPD-related medical costs
Anand A. Dalal, PhD
Sean D. Candrilli, PhD
Keith L. Davis, MA
The field of personalized medicine has made significant progress with key discoveries like single nucleotide polymorphism and microarray/biochips. These advances will benefit plans, patients, the pharmaceutical industry, and society.
Daniel Pucheril
Smiriti Sharma

Thanks to the fragmented compensation system, we are already paying more. The new payment system must elicit cooperation and coordination.
Sanjaya Kumar, MD, MSc, MPH, and David B. Nash, MD, MBA
Legislation & Regulation
It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour?
John Carroll
Medication Management
Automatic interchange at the hospital can disrupt medication therapy and affect outcomes in a suboptimal way
Thomas Reinke
Plan Watch
Anthem Blue Cross & Blue Shield of Indiana focuses on improving communications between minorities and their physicians
Frank Diamond