Defining discretionary health care is no easy task, but it may be imperative for 'consumer' health plans seeking to get patients more involved
The ability of the computer to find unexpected — and often unwelcome — patterns of utilization is at the heart of today's fraud detection methods
The Center for Medicare & Medicaid Services is a rich source of price and quality data. Isn't it about time it shared that data?
Nancy E. Taylor
William B. Eck
The director of California's Department of Managed Health Care sees problems if high-deductible plans replace the state's 'delegated model.'
Can commercial health plans learn from Medicare Advantage Prescription Drug Plans that have four or more formulary levels?
John A. Marcille
Legislation & Regulation
Wal-Mart laws aside, many factors converge to steer legislatures away from being too intrusive
The finance department and pharmacy are not speaking the same language. This model might just bridge that divide.
Defining noxious people as 'sick' distinguishes them socially from sinners, criminals, and scoundrels
Michael S. Victoroff, MD
The Formulary Files
As another treatment for pulmonary hypertension nears approval, insurers should adopt a stepped-care approach
Thomas Morrow, MD
Health plans and employers are convinced that improving quality will save money. This time, they think they've got the data.
Managed Care Outlook