May 2009

Cover Story

If You Think It’s Bad Now, Plans Could See Worse
Dwindling market share, rising costs, and a drastic drop in investment income buffet the health insurance industry

Frank Diamond

Q&A

A Conversation With Stephen C. Schoenbaum, MD, MPH: Learn From Existing Examples of Excellence
Great work is being done in many places, says an executive of the Commonwealth Fund in a wide-ranging discussion

John Marcille

The Federal Stimulus Package: What’s in It for You?
If you are looking for direct aid, you are probably out of luck, but a goodly amount will help health insurers indirectly

John Carroll

How To Develop Coverage Policies For Molecular Diagnostics
These tests can be expensive. Worse, they can pave the way for enormous costs, some unwarranted. And there are more of them every year.

Douglas Moeller, MD

When Should Insurers Cover Off-Label Drug Usage?
You don’t want to send money down a rat hole, but then again, off-label usage may be just what a patient needs

Lola Butcher

Managing the Cost of Diagnosis
With diagnosis accounting for 10 percent of medical costs, there’s a big opportunity to save. Did someone say ‘diagnosis benefit manager’?

Lynn Feldman

Editor’s Memo

Not the Best of Times For Managed Care Plans

John Marcille

Legislation & Regulation

The Ingenix Aftermath
When a new UCR database is created, how will health plans change their out-of- network payment policies?

John Carroll

Medication Management

Drug-Drug Interactions Focus of PBMs’ Efforts
New order-level systems could save $20 billion by preventing adverse events

Martin Sipkoff

Compensation Monitor

Medical directors’ pay is far less when hospital owns the practice
Tomorrow’s Medicine

In Narrow Heart Vessels, Catheter Device Prevails
A development in the catheterization lab involves using a flexible catheter tip to provide 360 degrees of motion

Thomas Morrow, MD

Managed Care Outlook

Storm brewing over virtual colonoscopy
The Formulary Files

Step therapy works initially, but not for long



News & Commentary

High Copayments Delay Rx Initiation

Costs and Complications Fall With Rising Use of Bariatric Surgery

Headlines On Deadline ...

Members With High Deductibles Choose Lower-Cost Options

Private insurers cover majority of costly conditions for children

Battling Inflation With Generics