MediMedia Managed Markets


Contributing Voices
Paul E. Terry, PhD and David Anderson, PhD, LP

Paul E. Terry, PhD

David Anderson

David Anderson, PhD, LP

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace health promotion.

He calls the paper “one of the best reviews ever conducted on any topic in workplace health promotion.” The study by Siyan Baxter and colleagues shows how the quality of the research methodologies used in the 51 interventions examined in their final analysis affected the magnitudes of the ROI’s reported. An archived webinar that summarizes the study findings is available free on this page at the  American Journal of Health Promotion.

Studies vary

There is a time-honored belief among health services researchers that the more rigorous the methodology, the smaller the size of the differences between groups will be. This is precisely what Baxter and colleagues found with respect to return on investment, which they calculated as ROI = (benefits – program costs) / program costs rather than the more typical approach of reporting ROI as the ratio of benefits to costs, i.e., ROI = benefits : costs. Nevertheless, Baxter, who is a PhD candidate in medical research at Australia’s University of Tasmania, found ROIs averaging 0.26 ($1.26 per dollar invested) in the 18 high-quality studies and –0.22 ($0.78 per dollar invested) in 12 studies using the most rigorous methodology, namely, the randomized controlled trial (RCT). For the 43 less rigorous studies of moderate or low quality, Baxter found ROIs averaging 1.79 (i.e., benefits of $2.79 per dollar invested), which is consistent with the oft cited ROI of 3:1 reported in a recent review by Harvard Economist Katherine Baicker and her colleagues.

Managed Care Outlook

Spending on specialty drugs is expected to jump 16% by 2016, according to Express Scripts. That’s actually an understatement, because about half of specialty medication costs are billed through the medical benefit and therefore not included in the Express Scripts calculation. 

Biologics in Development
Katherine T. Adams

More governments around the world are not buying this argument. Critics abound stateside, as well. The American Society of Clinical Oncology says that financial pressures and instability are a “major threat to practice” and that the quality of care throughout the United States is inconsistent.

News & Commentary

A problem, because concerns persist about the purity, toxicity and mislabeling of dietary supplements. The conditions or diseases more likely to encourage patients to mix the two are heart conditions, arthritis, diabetes, cancer, osteoporosis, and problems with the respiratory system, liver, and kidney. 

Michael Levin-Epstein

Their effect on health plans is unclear, as stakeholders explore options and alternative models for sharing vital diagnosis and treatment information. There are also significant concerns about the uncertainty of national standards of interoperability. Public exchanges, especially, are struggling.


Electronic health records have progressed further in hospitals and health systems than they have in doctors' offices and pharmacies; financial and technical difficulties continue to slow full implementation warns F. Randy Vogenberg, PhD, RPh.

Contributing Voices
Norman S. Ryan, MD

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even slightly below 4.

One way to view this challenge that may take the edge off the pain is that the CMS Five Star Quality Rating System for Medicare Advantage Plans is not just about being able to stay or earn a spot in the Medicare Advantage program. Taking steps to improve ratings can help Medicare Advantage plans and other health plans hoping to enter the program achieve the Triple Aim and move them even closer to getting the business results they really want.

News & Commentary

They shorten hospital stays somewhat, but do not reduce mortality or transfers to intensive care units, according to a study in the Journal of Hospital Medicine. The transfer rates for the control and study groups were not statistically significant. Neither was the need for subsequent long-term care.

Thomas Reinke

The issue is clinical utility. Many tests do not have enough evidence to demonstrate exactly how they will improve outcomes. While sequencing moves toward the magic $1,000 per patient mark, some critics argue that the increasing number of variants is leading to $1 million interpretations.


They are heart disease, cancer, chronic lower respiratory diseases, stroke, and unintentional injuries. They accounted for 63% of deaths in 2010; the next five causes were responsible for about 12%. The top five can be greatly reduced by screening, early intervention, and better treatments, say researchers.


What is population health? Start with this: 85% of a population’s well-being is due to factors outside of quality of care, says David B. Nash, MD, MBA, the founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia. “Population health is all about what goes on outside of the four walls of the hospital or the four walls of the doctor’s office.”

Watch the full interview with Dr. Nash or read the edited transcript.

Susan Worley

Many experts say “no.” Alzheimer’s disease and other dementias pose an enormous economic threat but, for now, the U.S. Preventive Services Task Force says that routine screening is unwarranted. The question behind the question: Should physicians diagnose only conditions for which they have a cure? 

News & Commentary

What can health insurers do? Hardeep Singh, MD, MPH, is the corresponding author of the meta-analysis in the journal BMJ Quality & Safety. Plans should “work with researchers to identify care patterns in electronic data that suggest … diagnostic errors.” 

News & Commentary

From 1990 to 2010, the number of adults in the United States with diabetes tripled, from 6.5 million to 20.7 million, according to a study in the New England Journal of Medicine. Researchers, meanwhile, credit preventive care for a 68% decrease in deaths from heart attack and a 64% drop in deaths from high blood sugar during the same period.