September 2004

Cover Story

Managed Care at the Crossroads
As rising costs drive CEOs' collective blood pressure off the charts, a group of experts considers whether managed care has reached another watershed — and whether the industry can reinvent itself yet again.

John Carroll

Q&A

Margaret O'Kane Gives the OK To Focus More on Providers
The head of the National Committee for Quality Assurance says health plans want to encourage physicians in the never-ending quest for quality.

CAM Offerings Really Can Enhance Quality of Care for Some Patients
People flock to these services whether insurers cover them or not. When does it make economic and medical sense to offer them?

Sherrie Dulworth, RN

Can Physician and Health Plan Get Together Over Guidelines?
Physicians are not the only problem. Health plans too often view guidelines as rigid routines rather than flexible aids to good practice.

Tony Berberabe

Peer-Reviewed

Improving Physician Attendance At Educational Seminars Sponsored By Managed Care Organizations
Although interactive educational seminars that target physicians require a large investment of resources, they can be cost-effective if medical care is improved as a result.

Michael D. Cabana, MD, MPH<sup>1</sup>; Randall Brown, MD, MPH<sup>1</sup>; Noreen M. Clark, PhD<sup>2</sup>; Diane F. White, RRT<sup>1</sup>; Juanita Lyons, PhD<sup>1</sup>; Sylvia Wanner Lang, PhD<sup>1</sup>; Susan L. Bratton, MD, MPH<sup>1</sup>

Employers Take Stock of Illness on the Clock
Presenteeism — the condition of being on the job, but giving less than 100 percent — is fertile ground for health plans with a suitable product.

MargaretAnn Cross

Editor’s Memo

Can Health Care Institutions Exploit Today's Opportunity?

John A. Marcille

Legislation & Regulation

Pfizer: DM Did Not Fizzle In Florida Medicaid Ruckus
The pharmaceutical giant contends that soon-to-be-released data will verify its program's effectiveness.

John Carroll

The Formulary Files

Cost-related underuse of heart meds leads to cardiac complications
Compensation Monitor

Four physician specialties report double-digit gains
Tomorrow’s Medicine

Orphan Drug Act Treatments Deserve Full Insurance Coverage
An important federal law encourages development of drugs for populations so small that the market would otherwise ignore them. Should they not then be covered?

Thomas Morrow, MD

Managed Care Outlook

Employers offer 'consumer' plans with trepidation



News & Commentary

VA Beats Managed Care In Treatment of Diabetes

Headlines On Deadline ...

Bush officials seek bounce from Medicare reform law