April 2009

Cover Story

Comparative Effectiveness: An Idea Whose Time Has Finally Come
It is exactly what managed care has been promoting for years, but some people worry that the information it creates could be misused

Martin Sipkoff

Molecular Diagnostic Testing Presents $5 Billion Conundrum
Insurers know that the new tests can be valuable, but have trouble evaluating them and may not even know exactly which ones they are paying for

Emad Rizk, MD

Q&A

A Conversation With Paul Wallace, MD: Reaping the Benefits of a Connected System
Kaiser Permanente’s experience proves that plans play a valuable role in ensuring that all Americans have access to care

Health Plans and Providers Struggle to Fix Payment System
Medicare is expected to lead payment reform, but major players in the private sector are banding together to move it along

Lola Butcher

Peer-Reviewed

Barriers to Breast Cancer Screening In a Managed Care Population
Sharp Health Plan wanted to increase mammography screening for its at-risk female population. Thirty percent of at-risk members were non-adherent. Members’ reasons for avoiding screening were examined.

Sandra R. Parkington, MPH, RN ; Nora Faine, MD, MPH ; Marcia C. Nguyen ; Michelle T. Lowry, MPH ; Poorva A. Virginkar

Editor’s Memo

Let Comparative Effectiveness Help Docs to Select Right Tools

John Marcille

Legislation & Regulation

Congress Works To Permit ‘Biosimilar’ Drugs Very Soon
Legislators look for a way to help payers and patients cope with the high cost of biologics without destroying the businesses that made these products possible

John Carroll

Medication Management

FDA, Industry Collaborate To Strengthen Painkiller Restrictions
The agency believes current attempts to control prescribing and distribution of opioids and other strong painkillers is inadequate

Martin Sipkoff

Compensation Monitor

Physician retention programs gain acceptance
Tomorrow’s Medicine

Treating Depression With a Pulsating Magnetic Field
An electronic device is applied to the forehead in a 40-minute treatment, causing depolarization of neurons

Thomas Morrow, MD

Plan Watch

Probable NCQA Standard Addresses Minorities’ Needs
Insurers will be judged on how well they find and serve groups whose health outcomes have historically lagged

Frank Diamond

Managed Care Outlook

Downturn expected for imaging technologies



News & Commentary

Value-Based Insurance Design Might Help Medicare Cut Costs

Headlines On Deadline…

High-deductible health plans favored by individual purchasers