September 2011

Cover Story

At Long Last… Pay for Outcomes Starts to Replace Pay for Performance
Think of P4O as P4P with its eyes on the prize. Unfortunately, even ordinary P4P is not yet widespread.

Joseph Burns

Biologics Debate Heats Up Between FDA, NCCN
Is the breast cancer drug Avastin the opening salvo that brings efficacy, toxicity, and costs together? Who will blink first — health plans, providers, regulators, or patients?

John Carroll

Q&A

A Conversation with David Nace, MD: Primary Care Stakes a Big Tent
As the medical home concept grows, many in health care will have to define new roles

Heart Failure Treatment Gaps Costs Lives, Hikes Expenses
Health insurance plans need only bolster the following accepted guidelines to see a return on a very little bit of investment

Bob Kirsch

Peer-Reviewed

Meeting the Challenges and Burdens Associated With Hereditary Angioedema
With the advent of new disease-specific agents, some patients with HAE may find relief from its enormous physical and psychological toll

Michael Toscani, PharmD ; Marc Riedl, MD, MS

Editor’s Memo

Managed Care Industry Change Looks to Outcomes, Not Process

John Marcille

Legislation & Regulation

Tougher CMS Readmissions Rules Afflict Hospitals at a Bad Time
In the long run, health plans will benefit from the new rules. In the short run, hospitals say they already have enough economic pressures.

John Carroll

Medication Management

Plans and Oncologists Don’t See Eye to Eye on Prior Authorization
Expect more denials as more specialty drugs are introduced and prescribed

Thomas Reinke

Compensation Monitor

Plastic surgeons ask: What recession?
The Formulary Files

Drug tier coverage differs by plan type
Tomorrow’s Medicine

Injected Device Shown Effective in Reducing Fecal Incontinence
For this condition that is largely confined to the Medicare population, a new treatment is now available

Thomas Morrow, MD

Managed Care Outlook

Health plan enrollment to grow 2 percent by 2014



News & Commentary

Group Wants More Imaging for Stroke

As CDHPs Grow More Prevalent, Savings Will Probably Decline

U.S. Docs Outspend Ontario Physicians

How much do private insurers pay for outpatient mental health services?

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