October 2010

Cover Story

Accountable Care Organizations Hold Promise, But Will They Achieve Cost and Quality Targets?
Though this innovation focuses mainly on the provider’s role, only health plans have the assets, such as claims data, to make it succeed

Peter Boland, PhD ; Phil Polakoff, MD ; Ted Schwab, MBA

Specialty Pharmacy Management Will Become More Intense
Because specialty drug expenditures will grow, P&T committees may become more involved with drugs provided under the medical benefit

Sarah Collins, MBA

Chronic Fatigue Syndrome Poses Management Challenge
CFS is one of a number of diseases with an uncertain etiology and a substantial effect on patients but with few or no verified treatments

William Atkinson

Q&A

A Conversation with Jeff Goldsmith, PhD: Reform Opens the Door For Consumer-Oriented Market
A consultant urges plans to streamline Web sites and devise new contracting strategies to prepare for an influx of individual customers

Medco Pushes the Envelope on Consumer Communications
Its new branding campaign may be a ‘right mistake’

Thomas Reinke

Funding Up for Grabs in Medicare Advantage
A new system set to start in 2012 will tie allocations to how well insurers hit quality benchmarks. There’s a curve, too.

Frank Diamond

Peer-Reviewed

Identifying Characteristics of Patients With Low Urgency Emergency Department Visits In a Managed Care Setting
A straightforward method of identifying potentially non-urgent ED visits from administrative data can be employed to calculate population-based rates, which might be applied in the development of managed care programs

James W. Davis, PhD ; Ronald Y. Fujimoto, DO ; Henry Chan, BS ; Deborah T. Juarez, Sc.D

Editor’s Memo

Putting ACOs Together May Be an Uphill Fight

John Marcille

Legislation & Regulation

GAO Audit of CMS Bodes Well for Plans
Federal auditors tell CMS it has been deficient in monitoring whether states are treating plans fairly

John Carroll

Compensation Monitor

Medicare P4P falling short on bonuses
The Formulary Files

Oral diabetes agent use is up, but insulin use falls
Tomorrow’s Medicine

Questions About Coverage Accompany New Fully Implantable Hearing System
For cosmetic reasons, this type of hearing system is desirable, but how much does it cost and who are the best candidates?

Thomas Morrow, MD

Managed Care Outlook

Gastric cancer incidence rate to rise



News & Commentary

New Study Suggests Older Stent Better Than New

Premium Costs Rise At Higher Rate

Employer-Based Coverage Declines

Headlines On Deadline…

Most provider-owned health plans weather economic downturn