September 2009
Features
Cover Story
Accountable Care Organizations Give Capitation Surprise Encore
Many see ACOs as the model for reform, but if provider groups dole out payment, then what roles will health plans play?
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Plans Clamp Down on Utilization and Doctors’ Tempers Flare
Physicians are really getting ticked off, just as they were in the ’90s, but it is possible to reduce their pain without abandoning the process
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Q&A
Medicare Part D Offers Template for Success
This spokesman for PBMs urges Congress to learn from his industry’s experience in driving down costs
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Departments
Editor’s MemoHealth Care Reform Fails If Public Won’t Stay the Course
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New HIPAA Rules to Affect Health Plans in Many Ways
Despite all the talk about HIPAA privacy protections, there was little action. New regulations are intended to ensure compliance.
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Lowering Part D Drug Costs Without Direct CMS Negotiations
A Boston University law professor proposes that Medicare allow health plans to negotiate aggressively with pharmaceutical companies
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'The Badger State' pays FPs and GPs the most
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Are You Prepared for ICD-10?
Train an in-house team to help make the transition smooth by determining who is affected, and how
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Insurers Prepare for 2nd Wave of H1N1 Flu
They learned a lot from the avian flu scare of 2005 and are now ready to handle a swine flu epidemic this fall
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Patients, HMO win with cheaper drug
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New Heart Valve Avoids Sternotomy and Long Hospitalization
The Melody Transcatheter Pulmonary Valve is delivered through cardiac catheterization, a favorable alternative to chest surgery
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Medicare PDP premiums will increase slightly
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