February 2011

Health insurers will soon find themselves working with provider organizations that have vastly improved utilization management skills
John Carroll
The information that many plans use needs to be open to physicians for review, and the formulas need considerable improvement
Interview by John Marcille
Advocates say that what’s lost in lowered copayments is more than made up by lowered downstream costs, but skeptics find the data unpersuasive
Richard Mark Kirkner
Just because Medicare is hobbled in what it can do with comparative effectiveness research, doesn’t mean that MCOs cannot use the information for both quality improvement and cost control
Sarah Collins, MBA
Atrial fibrillation patients are often noncompliant with warfarin but newer drugs have better safety and side effect profiles
Bob Kirsch
Amy K. O'Sullivan, PhD
Jane Sullivan, MPH
Keiko Higuchi, MPH
A. Bruce Montgomery, MD

Legislation & Regulation
In addition to the 85 percent rule, the department is applying a ‘reasonableness’ criterion. But it’s all bark, no bite.
John Carroll
Medication Management
In an effort to make the best use of specialty drugs, everybody gets into the act at Independence Blue Cross
Thomas Reinke
Plan Watch
BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers
Frank Diamond
Tomorrow's Medicine
NuView Life Sciences fuses molecular biology with imaging technology using the radioactive nuclide Copper 64
Thomas Morrow, MD