January 2010

Cover Story

House Call Revival, Digital-Style
Telemedicine has different aspects, and one is the seemingly simple connection of a doc and a patient. When the stars are aligned, such an encounter can save money and time.

Maureen Glabman

How Plans Can Improve Outcomes And Cut Costs for Preterm Infant Care
Ten percent of newborns are admitted to a neonatal intensive care unit. NICU costs are high but controllable.

Michael Kornhauser, MD ; Roy Schneiderman, MD

Not Your Father’s Cadillac Plan
Just because a benefit package costs a lot doesn’t mean it pays for everything or improves outcomes. Many variables come into play.

Frank Diamond

States Collect Valuable Data On Hospital Prices and Performance
Pennsylvania’s mining of infection info, and the use of insurers’ own statistics in Maine are seen as great examples of measuring quality

John Carroll

Inpatient Rehab Facilities Benefit Post-Stroke Care
Rehabilitation at a skilled nursing facility lacks the intensity that most patients need, studies suggest

Richard L. Harvey, MD

Episode-of-Care Payment Creates Clinical Advantages
It is customary to think of this payment method as a cost-control mechanism, and it is, but it can raise quality of care too

Douglas J. Moeller, MD ; James Evans

Higher Copayments and Deductibles Delay Medical Care, A Common Problem for Americans
CDHPs and catastrophic insurance plans can save consumers money, but do high deductibles add to overall costs down the line?

Martin Sipkoff

Editor’s Memo

Looking Beyond Washington And Finding Much to Discuss

John Marcille

Letters to the Editor
Legislation & Regulation

Plans Scramble to Defend Their Medical Loss Ratios
Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House

John Carroll

Medication Management

Strict Regulatory Environment Dogs Cancer Pain Management
Although effective treatments are available, helping patients cope is a minefield of administrative and legal barriers

Martin Sipkoff

Compensation Monitor

Docs paid faster, with fewer claims denied
The Formulary Files

Testing alternatives to prior authorization
Tomorrow’s Medicine

New Anti-Asthma Treatment Smooths Muscle in Airways
If the Food and Drug Administration approves the bronchial thermoplasty system, it will be the first device specifically approved to treat the condition

Thomas Morrow, MD

Plan Watch

Hospital Board Members Trained on Blues’ Dime
A unique health plan-provider partnership focuses on giving practical knowledge to those to whom the CEOs report

Frank Diamond

Managed Care Outlook

Poor in Part D plans face more premiums in 2010



News & Commentary

Mobile App Helps Members Find Docs

EMRs Fall Short Of Docs’ Expectations

Blues’ Payment Model Keeps Pace with Inflation

Quality ratings of Medicare Advantage plans

Headlines On Deadline …

Hospital Costs Soar For 10 Procedures