Medical and pharmacy directors at health insurance plans have to always be on the lookout for what employers want. That’s been the nature of the managed care industry and of our entire health care system for decades and still is, for the most part. That qualifier is important. You may have noticed that change is afoot. That’s partly because of health reform. Anything that (dare we say it?) revolutionary is bound to have the “guinea pig swallowed by the python effect.” It will cause a bump for years to come.
This first issue of the new year — our 20th year — suggests how much has already changed. The stories do not focus solely on the employer-health plan dynamic. There’s more going on here, a deeper bow to the idea that doctors, hospitals and patients are business partners as well.
Our cover story about UnitedHealthcare’s attempt to get a grip on expenditures for cancer medications points out that the pilot projects wouldn’t have gotten off the ground without the cooperation of oncologists. Allan M. Korn, MD, the Blues’ chief medical officer, reminds us in an extended interview that about 250,000 people die in hospitals each year for causes unrelated to why they were admitted. He wants health plans to address this problem. Next is a story about how whether the increasing number of beneficiaries who manage their chronic diseases on their own can reduce costs along with symptoms.
Speaking of symptoms (real or imagined), insurers are being asked to guide providers dealing with patients with fibromyalgia. Meanwhile, another story deals with how ophthalmologists and optometrists don’t want stand-alone vision plans to participate in the new insurance exchanges. The story on health information exchanges is particularly timely given that these systems are crucial to the success of accountable care organizations, a provider-centric building block of reform.
There is much to digest here. Enjoy!