Robert Calandra

Sabra Matovsky

Diagnoses of diabetes go up with an expansion that includes many who’ve not managed their disease well. Optimists see a new chance to prevent expensive complications and help with behavioral issues. Here’s hoping that Medicaid managed care plans will bring their technology and monitoring techniques to the fight.

News & Commentary

A recent study by Spanish researchers posited: With the right diagnostic approach, primary care physicians (PCPs) should be able to get a bead on which of their patients might be most susceptible to major depression, and thereby intercept the problem before it begins. It didn’t quite work out that way, unfortunately.

Original Research
David Gregory, MPA
Dennis J. Scotti, PhD, MS, MBA
Daniel Buck, MBA, MPH
George Triadafilopoulos, MD

A minimally invasive endoscopic treatment that utilizes radiofrequency energy (RFE) can fill the gap between medical and surgical management for GERD. There are cost advantages as well. Payers that the adopt RFE can create notable savings to their plans when compared to surgery or medical management.

News & Commentary

Diabetes has become a problem in poor countries because of the growing number of people who are overweight and obese. Prevalence rose from just over 5% to about 7% in high-income countries. Rates in low-income countries rose from just over 3% to more than 7%.

Frank Diamond

Kenneth Thorpe
Emory University

Details are yet to come, but officials hope to replicate the impressive clinical and cost saving achievements garnered in a program that has been run out of selected YMCAs. Medicare officials estimate that the program saved $2,650 per person enrolled in the program over 15 months.

Legislation & Regulation: Campaign 2016
Richard Mark Kirkner

For presidential candidates, advocating for more drug imports as a way of driving down consumer drug costs can make for a neat campaign sound bite. Both Donald Trump and Bernie Sanders have embraced the idea, but the reality of importing drugs—or, rather, importing more drugs—isn’t so neat.

Cover Story
Timothy Kelley

Opportunity knocks. Complications are down, and programs targeting prediabetes work. Getting a handle on this costly problem gives insurers the chance to do well, while doing good. Yes, diabetes can be costly to manage because so much comes down to empathy and human interaction. But it’s cheaper than bypass surgery.

In a bold attempt to leverage various alternative payment model initiatives to move 50% of Medicare payments into alternatives to fee for service by 2018, CMS plans to launch the largest-ever multi-payer program to improve the quality of primary care. The initiative, called the Comprehensive Primary Care Plus (CPC+) program, is scheduled to start next year and builds on CMS’ Comprehensive Primary Care (CPC) initiative, which started in 2012 and will end this year.

MediMedia Research

Allowing CMS to negotiate drug prices was the top pick of Managed Care readers and other health care executives as a way to curb high drug costs, according to a MediMedia Research survey. But that pick doesn’t come with much optimism that CMS negotiation—or, for that matter, other efforts to rein in drug prices—can do much about the problem.


Managed Care Outlook

Drug prices will rise at least 5% annually from now until 2020, according to a survey of top pharmacists in the United States. In fact, 89% of the 134 pharmacists who responded called this possibility “very likely,” the highest percentage for that response to any of the 56 survey items.