December 2007

Cover Story

How Doctors Are Paid Now, And Why It Has to Change
Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn’t had much effect on its use

John Carroll

Large Plans Do Well Under Part D, But Premium Hikes Cloud Future
Profits should increase over the next two years for plans that stay the course, but politics and rising premiums may affect long-term results

Martin Sipkoff

U.S. Health Insurers Find Opportunities Overseas
The United Kingdom is proving hospitable to UnitedHealth Group and Aetna, and there is business to be had elsewhere in Europe and on other continents

Tom Reinke

Drugs to Plan For in 2008
There are not many traditional medications in the pipeline, and those that are in development probably won’t make waves

Ed Silverman

Insurers Get Involved in Campaign Against Hospital-Acquired Infections
Plans prod hospitals to do a better job of addressing problems that kill nearly 100,000 Americans a year

Lola Butcher

Editor's Memo

An Unexpected Observation

John Marcille

Legislation & Regulation

New York Plan Emerges As Pattern for Rating Physicians
The Empire State’s approach to physician ratings quickly gains health plan support and consideration as a national answer

John Carroll

Medication Management

Smoking Cessation Coverage May Be Worth Plans’ Effort
Programs that include a pharmacology benefit reap rewards for the health plan and the member. So why isn’t there 100 percent buy-in?

Martin Sipkoff

Compensation Monitor

Medical directors’ pay up 37% since ‘97 — or not
The Formulary Files

Insurers lean toward generic alternatives
Tomorrow’s Medicine

Human-Derived Clotting Agent Avoids Immunogenicity
Evithrom may minimize some of the antibody production associated with bovine proteins, but the possibility of human viral infection exists

Thomas Morrow, MD

Health Plan Design

From Consumer-Directed To Consumer-Driven
Many new programs offered by insurers bet that individuals, not employers, will one day be making the major decisions

Lola Butcher

Managed Care Outlook

Insurers offer more coverage to fill Part D gap



News & Commentary

Strong Support for Transparency, But Small Effect Expected on Costs

Web Site Helps Track Health Plan Rankings

Privately Insured Use Emergency Room Less

Most HSA/HDHPs Cover Preventive Treatment on a First-Dollar Basis

Headlines on Deadline ...

Employers offer financial incentives for healthy behavior