Managed Care magazine

November 2009

Features

Cover Story

How Patient-Centered Medical Homes May Change U.S. Medicine
These re-engineered versions of the primary care practice have been discussed since 1967. Has their time come at last?

Will the New Fat-Fighter Drugs Be More Worthy of Coverage?
Diet and exercise are increasingly seen as only the first steps in a journey that should include medication for weight maintenance

Q&A

A conversation with James Sabin, MD: When Values Clash
You don’t have to be an experienced psychiatrist to puzzle out the ethical dilemmas of health care delivery today. But for this ethics-program pioneer, it helps.

Research Topics Underpin Comparative Effectiveness
The government committee charged with helping health plans and providers choose best treatments suggests 100 areas of interest

Peer-Reviewed

Effect of Social Work Intervention On Hospital Discharge Transition Planning In a Special Needs Population

Departments

Editor’s Memo
A Sound Proposal, But Look at the Implications

Legislation & Regulation
Global Payment System No Massachusetts Miracle
The state’s experience is that providers are unwilling or unable to buy into the process

Medication Management
Everybody Wants to Close The Doughnut Hole
Narrowing the coverage gap will help beneficiaries, health plans, and even pharmaceutical companies. Just how to do that is debatable.

Compensation Monitor
Marginal increase in chief medical officer pay

The Formulary Files
Retail pharmacies miss out on specialty drugs

Plan Watch
Review Panels Pay Off For Colorado-Based Plan
The historically strong relationship between Rocky Mountain Health Plans and its doctors helps contain costs

Tomorrow’s Medicine
Replace All Those Sample Closets With High-Tech Dispensing Machines
Health plans can benefit when these therapeutic ATMs are used because of their ability to track dispensing data

Managed Care Outlook
Shortage of chest surgeons likely by 2020

News

New Organization Will Calculate Out-of-Network Physician Charges
Cheaper Dressings Just as Effective
HMO–PPO performance gap narrows

Tumor Necrosis Factor Inhibitors in the Treatment of Chronic Inflammatory Diseases

A review of immunogenicity and potential implications

Opioids in the Workplace

Advances in treatment have helped patients manage chronic pain with pharmaceutical pain relievers, but some drugs — particularly opioids — carry the risk of dependence. Opioid dependence is a medical condition, and it can be treated, but employers may not know about all the treatments that are now available, or that they are covered by most health plans.

Not only are treatments covered by insurance, but the Americans with Disabilities Act and the Drug Addiction Treatment Act, passed by Congress in 2000, encourage employers to support employees with opioid dependency. Qualifying physicians may now treat opioid dependence directly, letting the abuser seek help in the privacy of a physician’s office rather than at a public clinic.

Highlights

How opioids hijack the brain
Ways in which employers deal with dependence
Successful approaches to treatment