January 2006

Cover Story

What Doctors Don't Know About the New Plan Designs
Physicians are fairly ignorant of what consumer-directed health care will mean to them in terms of relations with patients and health plans

Maureen Glabman

Can We Design a Fair Benefit For Bariatric Surgery?
Insurers need a coverage strategy that focuses on reducing post-surgical complications and avoiding adverse selection

Catherine M. Murphy-Barron

Old Techniques Never Die, Nor Even Fade Away
Urged on by employers traumatized by costs, health plans are renewing their interest in prior authorization, but using a lighter hand

Martin Sipkoff

Q&A

A Conversation with James Robinson, PhD: Is Managed Consumerism The 'Third Way'?
The health care economist says that consumers ought to share in the savings from making the right choices. Insurers, providers, and hospitals should make sure that options exist.

Case Management Meets Home Care
Aetna incorporates a program developed at the University of Pennsylvania to deliver services where members live

MargaretAnn Cross

Editor's Memo

Will Tinkering With Premiums Make Beneficiaries Happier?

John A. Marcille

Legislation & Regulation

It's To Plans' Benefit To Spell Out Authority
Recent court ruling means that beneficiaries should be notified about insurers' decision-making powers

John Carroll

Medication Management

Skeptics Abound as Demand Grows For Obesity Treatments
Changes in reimbursement patterns for obesity drugs will take several years. Lifestyle changes remain the first approach.

Martin Sipkoff

Compensation Monitor

Docs distrust 'pay for performance'
The Formulary Files

PBMs report increase in drug margins
Tomorrow's Medicine

Four-Color Flow Cytometry Detects Minimal Residual Disease in Leukemia
Should a new (and cheap) test for chronic lymphocytic leukemia be a component of prior-authorization protocols?

Thomas Morrow, MD

Managed Care Outlook

Two surveys point to growth for consumer-directed plans



News & Commentary

Costs slow down, but not enough to assuage employers' concern

Videos of Actual Surgeries May Give Patients Pause