January 2012

Cover Story

Decision Support’s New Advocates
Attempts to replace radiology benefit managers with a more doctor-friendly system show success

Joseph Burns

Consumer-Directed Coverage Makes Market Inroads
Those who choose these plans tend to be more educated and dedicated to maintaining healthy lifestyles

Frank Diamond

Q&A

A Conversation With F. Randy Vogenberg, PhD, RPh: Changing Market for Pharmacy Benefits
Tight budgets and an increasing influx of expensive biologic drugs make it imperative to rethink risk management

John Marcille

Keeping ED Costs Down an Exercise in Frustration
Visits are going up and most cases seen in the ED are legitimate. What’s a payer to do?

John Carroll

Peer-Reviewed

Treatment Persistence & Health Care Costs of Adult MDD Patients Treated With Escitalopram Vs. Citalopram in a Medicaid Population
Escitalopram patients in a Florida Medicaid population had better treatment persistence and lower total health care costs than patients prescribed citalopram

Eric Q. Wu, PhD ; Rym Ben-Hamadi, MSc ; Mei Lu, MS ; Nicolas Beaulieu, MA ; Andrew P. Yu, PhD ; M. Haim Erder, PhD

Legislation & Regulation

Oral/Infusion Cancer Drug Parity Begins to Raise Health Plan Costs
Legislatures want medical-benefit practices applied to oral drugs provided under the pharmacy benefit, all to keep patients’ costs within reach

John Carroll

Editor’s Memo

Clinical Decision Support Systems Seem on Fast Track to Acceptance

John Marcille

Compensation Monitor

Business degrees boost pay for physician executives
The Formulary Files

Drug cost-sharing amounts stable 2010–2011
Plan Watch

Blues Plan Helps Practices Get Up to Speed for PCMHs
Independence Blue Cross teams up with the American College of Physicians to create an online program that facilitates creation of medical homes

Frank Diamond

Tomorrow’s Medicine

Catheter-Delivered Aortic Valve Avoids Major Invasive Surgery
Patients who were considered inoperable have a new option that involves placement of a bioprosthetic heart valve

Thomas Morrow, MD

Managed Care Outlook

Big pharma’s struggles might benefit health plans



News & Commentary

Search for Specific Information When Reviewing PCMH Studies

Depression, Diabetes Linked to Dementia

NQF Unveils New Surgery Measures

Headlines On Deadline ...

Keep Benefit Summaries Simple

Essential Benefits Guidance Questioned

Stress May Affect Physician Retention