February 2013

Cover Story

Are We on the Way to a Real ‘Learning Health Care System’?

The fact that we waste hundreds of billions a year is all the more infuriating because we have the ability right now to stop the hemorrhaging

Joseph Burns

Aiming at a Moving Target In Rheumatoid Arthritis

As recommended treatment grows more aggressive, health plans should better manage both infusion and injectable medications

Thomas Reinke

Coverage With Evidence Development Allows Early Adoption, Better Evaluation

Health plans and providers can provisionally adopt promising therapies before all the evidence is in hand

Mark Perman, MD

More Data in Health Care Will Enable Predictive Modeling Advances

Rich data streams from electronic health records, when used appropriately, can transform population-based care management

David Bodycombe

Highmark’s Accountable Care Future Starts With Expansion of PCMH Model

A patient-centered medical home pilot project yields results that lead the health plan to launch a major effort

Frank Diamond

Managing Rapid Change In the Health Care Environment

Wrenching transformation in many forms is starting to be felt in many parts of the system. Here are ways to help resistant employees get on board.

Scott Guerin, PhD

Editor’s Memo

New Feature Focuses on Biotechnology Issues
John Marcille

Legislation & Regulation

EHRs Turning Out To Be Not as Wonderful as Expected

Meaningful use or not, electronic medical records are not delivering on the promise of improving care management

John Carroll

Medication Management

Insurers Expand Usefulness of Oncology Pathway Efforts

These programs tend to operate on the fringes of cancer care, but a movement to make them more central gains favor

Thomas Reinke

Snapshot

Physician assistants turn away from primary care

Biologics in Development

Another Cancer Vaccine, Another Retreat
Michael D. Dalzell

Trends

2012 drug approvals won’t be easy on pharmacy budgets

Book Review

How a Large Hospital System Profited by Putting Patients First

UCLA Health System went from bad to best, using a plan that emphasized increased respect for the patient

Peter Boland, PhD

Evidence Review

Total Knee Replacement Using Patient-Specific Templates

A summary of ECRI Institute’s Emerging Technology Evidence Report

Tomorrow’s Medicine

Relapsing Multiple Sclerosis Patients Can Look to Second Oral Agent

The recent approval of Aubagio (teriflunomide) provides an opportunity to conduct head-to-head trials in this expanding treatment category

Thomas Morrow, MD

Plan Watch

Value-Based Insurance Design Helps Cut Plan’s Diabetes Costs

UnitedHealthcare study unveils some impressive numbers, and now the company sets its sights on prediabetes

Frank Diamond

Managed Care Outlook

Commonwealth Fund sings bundling’s praises

News & Commentary

Pap Guidelines Followed — Mostly

News & Commentary

Transparency Depends On Consumers’ Rational Thinking

News & Commentary

Pediatricians’ Careers Influenced by Debt

News & Commentary

Cigna Sees Promise In Disability Program

News & Commentary

Social media mesh with dual eligibility

News & Commentary

Briefly noted