June 2012

Cover Story

The Next Frontier: Patient Engagement
Seeking the best return on shared-savings programs such as PCMHs and ACOs, health plans are investing cash and other resources to attract and hold patients’ attention

Joseph Burns

Reformed UCR Calculations Not Without Problems
Ingenix was criticized for understating UCR rates, but newer formulas also enrage members who get big balance bills

John Carroll

Specialty Societies Tell Members, ‘Think Twice About Those Tests’
This time the messenger matters as much as the message. Are specialists gearing up for life after fee-for-service?

Frank Diamond

Q&A

A Conversation with Donald R. Fischer, MD, MBA: Taking Charge in an Era of Change
Highmark’s CMO seeks new and improved models of health care delivery

John Marcille

Demystifying Pathways in Oncology
High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s role

William J. Sullivan, MBA

Costly Gaps in Physicians’ Drug Knowledge
When physicians don’t know how compliant their patients are, the health plan can step up

Tammy Worth

Editor’s Memo

At Last, Providers Are Acting To Reduce Nonessential Care

John Marcille

Snapshot

Let their fingers do the walking through the health care system
Legislation & Regulation

Plans OK With ICD-10 Delay, But Dread Too Long a Wait
Large insurers worry what will become of the hard work and money expended on the conversion if some providers get their way

John Carroll

Medication Management

New Anticoagulant Fights for Credibility
Formulary managers need to make head-to-head comparisons of dabigatran and other anticoagulants used to treat atrial fibrillation

Thomas Reinke

Compensation Monitor

Physicians uncertain about how ACOs might affect pay
Evidence Review

Minimally Invasive Two-incision Total Hip Replacement
A summary of ECRI Institute’s Emerging Technology Evidence Report
The Formulary Files

Specialty pharmaceuticals increasingly administered in costly outpatient clinics
Tomorrow’s Medicine

Gaucher’s Disease Treatment Option Rides on Carrot Cells’ Biologic Power
Elelyso, derived from plant-cell technology, avoids many of the problems encountered when mammalian cells are used to create drugs

Thomas Morrow, MD

Managed Care Outlook

Costs for traditional meds static while specialty drug costs soar



News & Commentary

Caveat Emptor For Locum Tenens

Provider Prices Drive Cost Hikes

Outcomes Derail Study on Educated Consumers

Briefly Noted

Billions in incentives wasted