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January 2013

The United States Preventive Services Task Force has recommended against several screenings, yet health plans are finding that it’s not so easy to just drop coverage

Michael D. Dalzell

While there has been movement in many states, health plans would first want to make sure that they wouldn’t be breaking any law

Peter Wehrwein

Extra payments of $1,200 per member per year are being eliminated as CMS seeks to increase competition among plans

A new IOM report urges widespread adoption of innovations. The committee’s chair and the California HealthCare Foundation’s CEO, Mark Smith is working to make that happen.

John Marcille

Despite popular usage, these two terms mean different things, especially when coverage decisions need to be made

Ed Silverman

A CMS demonstration program will determine whether Medicare Advantage health plans improve their quality scores by responding to bonuses that correspond with a five-point rating scale

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD ; Scott Guerin, PhD
Overweight or obese patients who participated in a medical nutrition therapy benefit sponsored through their insurer were compared with individuals who did not participate. Outcomes, including weight change, body mass index, waist circumference, and physical exercise, were collected at baseline and 2 years later.
Donald W. Bradley, MD ; Gwen Murphy RD, PhD ; Linda G. Snetselaar, RD, PhD, LD ; Esther F. Myers, PhD, RD, FADA ; Laura G. Qualls, MHA



Departments
Editor's Memo
John Marcille
Legislation & Regulation

The Affordable Care Act requires insurers to measure up if they want to participate in the new state marketplaces for individual policies

John Carroll
Medication Management

Formulary decision makers will probably be disposed favorably toward Xeljanz, the first Janus kinase inhibitor approved for rheumatoid arthritis

Thomas Reinke
Plan Watch

The health plan’s New Hampshire subsidiary rolls out its Compass SmartShopper program to small employers this month

Frank Diamond
Tomorrow's Medicine

For many affected by vitreous degradation, surgery was the only treatment until the development of ocriplasmin

Thomas Morrow, MD

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014