May 2008

Medicare’s Big Changes
Moving to a payment system tied to the severity of illness and refusing to pay for hospital-acquired conditions may encourage private payers to do the same

Martin Sipkoff

Cover Story

Explosive Numbers
In 2006, health care spending averaged $7,026 per person. By 2017, that will shoot up to $13,101.

John Carroll

How MCOs Can Get Optimal Value from Their Pharmacy Benefit Managers
There is no one-size-fits-all contract, says a senior executive at Prescription Solutions. A PBM can perform many functions.

John D. Jones, RPh, JD

Q&A

A Conversation With Reed Tuckson, MD: Championing Change from the Inside
The UnitedHealth executive brings experience in public health and physician leadership to bear on issues facing health plans

Delivering RomneyCare
Many are calling this attempt at universal coverage a failure, but health plans, physicians, and policymakers in Massachusetts say “Not so fast!”

Frank Diamond

Tomorrow’s Medicine

Surgeons Now Have Glue to Keep Skin Grafts in Place
Artiss, a fibrin product, is a breakthrough, allowing burn patients to avoid anesthesia, staples, and a subsequent operation to remove the staples

Thomas Morrow, MD

Compensation Monitor

46% jump in number of physicians working part-time
Editor’s Memo

Health Care Spending Explosion May Lead to a Drastic Solution

John Marcille

The Formulary Files

PDP drug costs are higher than employer plans
Medication Management

FDA Considers Implementing Behind-the-Counter System
Other countries do it, and the FDA is thinking about creating a class of drugs that would not require a doctor’s prescription but would require a pharmacist’s approval

Martin Sipkoff

Managed Care Outlook

Worldview: U.S. health inflation not so bad
Plan Watch

Capping Rollover Amount Leads to CDHP Success
Aetna releases a five-year study showing that companies that do this correctly can enjoy impressive savings

Frank Diamond

Legislation & Regulation

Legislation Would Put Drugs and Other Therapies to a Useful Test
A proposed research institute would pit medications against each other instead of against placebos, and that might save $368 billion over 10 years

John Carroll

Viewpoint

Health Care IT Lessons from North of the 49th Parallel
We Yanks might learn a thing or two about making decisive, countrywide health care decisions from our Canadian neighbors

Lorraine Fernandes, RHIA, RHIT



News & Commentary

E-Prescribing Tools Touted

Lower Expenses, Fewer Rxs Follow Multitiered Drug Benefit Design

Headlines on Deadline…

Plan Design Helps Poor Get Coverage

Hospitals give payers low marks on image, reputation