February 2012

Cover Story

Narrow Networks Found To Yield Substantial Savings
An early managed care idea that the marketplace once rejected is now being embraced by employers and offered by health plans

Joseph Burns

You Are Not Alone, Clinical Executive
The Medical Directors Forum offers an opportunity for discussions with peers and a resource for information about guidelines

Targeted Medications: New Focus on Companion Tests
While developing drugs with corresponding tests may mean lower costs to insurers, it poses significant challenges to the approval process

Thomas Reinke

Q&A

A Conversation With Paul H. Keckley, PhD: Clinical Perspective Critical to Health Care Reform
A longtime consultant says health plan CMOs now have the toughest job in managed care

John Marcille

‘B’ Isn’t Always for Biologics
Insurers need to know the rules for Medicare Part B and Part D coverage, but they are not always easy to find or interpret

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD

Editor’s Memo

One Network Makes Comeback While Another Is Just Beginning

John Marcille

Legislation & Regulation

Eyes on Medicare Program’s House Calls for Comorbid Patients
The hope is that sending a doctor, nurse practitioner, or pharmacist to a frail old person’s home will keep the patient out of the hospital

John Carroll

Medication Management

Health Plans & PBMs Need Better Data Analysis for Clinical Management
New software capabilities provide the power to integrate medical and pharmacy data

Thomas Reinke

Evidence Review

Full-Rotation Three-Dimensional Intraoperative Imaging During Spinal Procedures
A summary of ECRI Institute’s Emerging Technology Evidence Report
Compensation Monitor

Primary care continues to feel the strain
The Formulary Files

Copayment, coinsurance rates change little
Plan Watch

Engaged Consumers’ Decisions Help Aetna’s CDHP Program Save
Online tools and an emphasis on patient-provider communication encourage more utilization of preventive medicine

Frank Diamond

Tomorrow’s Medicine

Using Virtual Assistant Technology to Improve Outcomes, Adherence
Advances in computer technology have placed us on the threshold of a new way of delivering care that is both economical and incredible

Thomas Morrow, MD

Managed Care Outlook

Wellness programs grow to meet challenge



News & Commentary

Payer/Provider Link May Get Stronger

N.Y. Waiver Program Aims at Dual Eligibility

Briefly Noted

Insured more inclined toward healthy behavior

Retail Clinic Use Rises Steeply But Impact on Costs Is Unclear

Pharmacist Counseling Proves Cost-Efficient

3.6 Million Benefit From Smaller 'Doughnut Hole'