December 2010

Cover Story

Plans Confront Specialty Pharmacy’s Escalating Costs in Variety of Ways
Placing nearly all specialty drugs under the pharmacy benefit and using tiered formularies are among several promising strategies

Thomas Reinke

Is ‘Mobile Health’ Revolution Made for Managed Care?
Portable interactive communications technology promises to influence health behavior as mere postcards and email messages never did. There will be big rewards for the health plans that figure out how to use it well.

Steven R. Peskin, MD, MBA, FACP

Health Insurers Need Social Media Presence
Twitter and Facebook are good places to promote a health plan’s brand, and they can help members by reinforcing positive behaviors

John Carroll

What Do You Do About ER Costs?
We want to hear from medical directors about how they approach one of the most vexing and chronic problems in health care

Frank Diamond

5010 Compliance Effort Keeps Eye on Deadlines
El Paso First Health Plans did not lose sight of the two goals in the overhaul of the electronic data interchange system

Managed Care Staff

Peer-Reviewed

How the Doughnut Hole Affects Prescription Fulfillment Decisions Involving Cardiovascular Medications For Medicare Part D Enrollees
As Part D enrollees approach their coverage limits, their decisions are significantly affected through the doughnut hole period

John W. Hales, MA, PhD ; Stephen George, PharmD, MS, RPh

Editor’s Memo

We’ll Deal With Change in 2011

John Marcille

Legislation & Regulation

Nurses as Primary Care Providers Get New Backing, Old Opposition
A committee at the Institute of Medicine has called for better use of registered nurses, but physicians continue to try to keep them subordinate

John Carroll

Medication Management

Expanded Role for Pharmacists Tested
Health plans have another option to consider for improving medication outcomes

Thomas Reinke

Compensation Monitor

‘Freeze the pay on specialists’
The Formulary Files

In 2011, a third fewer nationwide Medicare PDPs
Plan Watch

Highmark’s P4P Program Uses 2 Different Approaches
Physicians can earn extra money, but hospitals can lose if they do not show an improvement in quality

Frank Diamond

Tomorrow’s Medicine

Telescope Placed in Eye Improves Central Vision
A new device can partially restore central field vision to thousands who suffer from a common cause of blindness

Thomas Morrow, MD

Managed Care Outlook

MA plans to limit members’ out-of-pocket expenses



News & Commentary

New Standards Assure PBM Transparency

HHS Regulations Identify MLR Provisions for Direct Care

Medicaid HMO enrollment up

United States Leads in Medical Costs

Headlines on Deadline…