November 2010

Cover Story

Renewed Emphasis on Top-Tier Physicians
Employers want networks limited to only the highest performing physicians, and new tools can help clinical executives sort them out

Frank Diamond

Don’t Pay Too Much for Generic Fills
Pass-through pricing is a good way for a payer to realize the benefit of increased prescribing of generic drugs

Linda Cahn

Q&A

A Conversation with Randall S. Krakauer, MD: Meeting Medicare Challenges
Aetna’s chief medical director for Medicare draws on years of experience to chart opportunities and challenges of the new legislation’s focus on innovation

Stroke Rehabilitation Requires Knowing What Level a Patient Needs
We have certified centers that do a great job for some patients, reducing downstream costs, but are of little benefit to others

Bob Kirsch

Payer and Provider Collaborations that Improve Quality Outcomes in Oncology

Jeffrey D. Dunn, PharmD, MBA; Peter G. Ellis, MD; John L. Fox, MD, Ms; Ira Klein, MD, MBA; Maria Lopes, MD, MS; David B. Nash, MD, MBA; Lynn Nishida, RPh; Lee S. Schwartzberg, MD; Winston Wong, PharmD

Editor’s Memo

Political Landscape May Change But Systemic Problems Remain

John Marcille

Letters to the Editor
Legislation & Regulation

Plans Give Docs Seed Money for Meaningful-Use Systems
Highmark’s effort to get physicians up to speed with 21st century technology has been extended with a bonus system based on federal standards

John Carroll

Medication Management

Meaningful-Use Measures Fall Short on Medication Safety
CPOE systems, according to data from the Leapfrog Group, do an inconsistent job of shielding patients from serious errors

Thomas Reinke

Compensation Monitor

Seven design features that could improve P4P
The Formulary Files

Alzheimer’s drug costs likely to rise as boomers age
Plan Watch

Plan Uses AAA-Type Tracking to Reduce ER Overutilization
A program by a Medicaid insurer keeps in touch with patients throughout their entire episode of care

Frank Diamond

Tomorrow’s Medicine

New Bone Kit Uses Platelet Growth Factor
The complications of autograft surgery are largely avoided when advances in biotechnology play a role in tissue regeneration and repair

Thomas Morrow, MD

Managed Care Outlook

1 in 3 adults could have diabetes by 2050