December 2011

Cover Story

Health Plans and Medicare Step Up To Eliminate Costly Variation
Now that we know there is so much unwarranted deviation in care, payers are promoting comparative effectiveness research and other efforts to help providers embrace the evidence

Joseph Burns

Q&A

A Conversation With Lee N. Newcomer, MD, MHA: Payments With Purpose
UnitedHealthcare’s VP for oncology says it will take time to come to grips with the cost of chemotherapy, but we have to start now

John Marcille

New Hepatitis C Regimen Stimulates Changes in Therapy Management
Costly protease inhibitors work well in many patients, but call for careful monitoring

Thomas Reinke

Bundled Payment Fails an Early Test
Although three pilot programs came up short, experts say systems like PROMETHEUS could still succeed — if plan medical directors take an active role

Frank Diamond

Human Factors Inhibit Medication Adherence
We look at a few programs designed to address adherence-related behavioral problems

Carol Milano

Editor’s Memo

If Improvement Were Easy, It Would Have Happened Already

John Marcille

Viewpoint

There Are Good Reasons to Follow U.S. Preventive Services Task Force Recommendations
Weighing the risks and benefits of any treatment to decide whether it is worth pursuing takes a kind of knowledge that most in health care lack

Brent C. James, MD

Evidence Review

Treating Uterine Fibroids Using MR-Guided Ultrasound
A summary of the ECRI Institute’s Emerging Technology Evidence Report
Legislation & Regulation

Plans Can Help Manage Dually Eligible Population
However, they’ll need to prove it. Powerful interest groups say insurers have little experience with these patients and worry that MCOs will shortchange members.

John Carroll

Compensation Monitor

Physicians who want to work for hospitals
The Formulary Files

Copayment coupons undermine formularies
Plan Watch

Insurer's Wellness Effort Scores Good 5-Year Return
Healthy Blue Living in Michigan lets employers and members reap the benefits of lifestyle improvement

Frank Diamond

Tomorrow’s Medicine

Long-Term Safety Data Support Use of Bronchial Thermoplasty
Clinicians can consider this radiotherapy a viable treatment option

Thomas Morrow, MD

Managed Care Outlook

Seven Therapeutic Categories Account for Most Drug Cost Increases



News & Commentary

Out-of-Pocket Costs Hamper Utilization

Income Influences Heart Failure Rate

More pressure on Part D plans

Doc Data Oversight Crucial for Medicaid

Headlines On Deadline

Wellness Programs Increasingly Use Incentives and Penalties