October 2012

Cover Story

Is Bundled Payment an Idea Whose Time Has Come?

For decades, managed care plans have sought to stop paying fees for services. Now they’re trying bundled payments for episodes of care.

Joseph Burns

Cloud Computing Puts Stakeholders On Same Page

It might not be the road to totally overcoming the fractured nature of the health care system, but it should lead to better collaboration

Bob Franceschini

What the Medicaid Expansion Under the ACA Means for All MCOs

Medicaid plans in some states will expand, putting pressure on plans’ primary care networks

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

Three Principles for Improving Health Care Delivery

Learning these lessons from the Veterans Health Administration, the nation’s largest integrated system, leads to organizational success

Robert L. Jesse, MD, PhD

Peer-Reviewed

Health Care Resource Utilization and Costs Associated with Restless Legs Syndrome Among Managed Care Enrollees Treated With Dopamine Agonists

The researchers find that the costs of treating restless legs syndrome are fairly low, relative to the improved symptoms and associated health care outcomes, and are mainly attributable to prescription medication. Health plans are encouraged to expand coverage to reduce the associated suffering and costs.

Juliana Meyers, MA ; Sean Candrilli, PhD ; Richard Allen, PhD ; Ranjani Manjunath, MPH ; Michael Calloway, PhD

Editor’s Memo

Insurers Struggle To Adapt To Health Care Reform

John Marcille

Legislation & Regulation

It’s in Insurers’ Interest To Help Cut Readmissions

Hospitals now face stiff penalties and some health plans see this as a way to attain a long-sought goal

John Carroll

Medication Management

Biosimilars Might Not Measure Up To Health Plan Expectations

Analytical studies, rarely used to evaluate biotechnology products, will need greater attention

Tom Reinke

Compensation Monitor

Young physicians not keen on rural areas

Plan Watch

Clinical Bundling Pays Off, In Antisepsis Campaign

Intermountain Healthcare’s checklist for providers cut mortality rates for this fast-moving, and sometimes lethal, condition

Frank Diamond

Managed Care Outlook

How insurers and hospitals intend to contain costs



News & Commentary

Plan, Doc Teamwork Seen as Key to Care

For First Time Since ’07, Fewer CDHPs Offered

Biometrics now part of wellness mix

More Office Hours, Lower Expenditures

Don’t Let Guard Down, Says Study

More People Checked For Cholesterol Levels

Access to Notes Boosts Adherence

Briefly Noted