December 2009

Cover Story

Who’s Tackling Rampant Overutilization? Health Plans!
The nation is in an uproar over rising medical costs, and much of the problem is excess or inappropriate utilization

Martin Sipkoff

How Insurers Can Bear The Burden of Proof for New Treatments
Too often, society prods regulators into adopting new drugs and technologies without adequate scientific analysis

Pierantonio Russo, MD ; Alan Adler, MD, MS

A Conversation with Brent C. James, MD

Health Reform Debate Overlooks Physician-Patient Dynamic
Pay for performance is not enough. Fundamental changes in the fundamental relationship have to be taken into account.

Community Pharmacy Struggles To Remain Relevant
A broad consortium of players joins with the NCQA to shine a light on the drugstore

Tom Reinke

Peer-Reviewed

A Claims-Based View of Health Care Charges And Utilization for Commercially Insured Patients with Osteoarthritis

Jeffrey D. Dunn, PharmD, MBA ; Michael W. Pill, PharmD

Editor’s Memo

Keeping Unemployed Covered In Managed Care’s Interest

John Marcille

Legislation & Regulation

Wellness Discount on Premiums: Some Say Useful, Others Say Harmful
Skeptics wonder if sticking sick people with high out-of-pocket costs simply encourages them to avoid care

John Carroll

Medication Management

Medication Therapy Management Faces Tighter Requirements in 2010
The Centers for Medicare and Medicaid Services will make the Part D reporting process more difficult and complex

Martin Sipkoff

Compensation Monitor

Health plan medical execs see pay increases
Plan Watch

Cigna Turns Toward the East
When your domestic business is steady or even declining, what’s a giant health care company to do but look abroad?

Frank Diamond

The Formulary Files

Specialty pharmacy’s true out-of-pocket costs
Tomorrow’s Medicine

Collegenase Molecules Provide Relief For Hand Contracture Disorder
Xiaflex may offer a better overall outcome and a much less invasive option than surgery for patients with Dupuytren’s disease

Thomas Morrow, MD

Managed Care Outlook

Segal sees little change in plan cost trends



News & Commentary

Pulmonary Embolism Leads Diagnostic Errors

Growth Potential Seen In Individual Markets

CAQH Certification Yields $1B Savings

Headlines On Deadline ...

For 2010, most PDPs do not offer gap coverage