Valuing Value
Michael D. Dalzell
A Conversation with J. Kevin Croston, MD, and Craig Samitt, MD
Interview by Peter Wehrwein

News Wire

Understanding Neural Ensembles in Infralimbic Cortex May Lead To Improved Addiction Treatment
KRAS Oncogene Is a Problematic Target So Researchers Are Trying Workdarounds
Judicious Use of Antibiotics May Not Be Enough To Defeat Bacteria That Carry On By Going Into a Dormant State
Drug Boosts Levels of Natural Endocannabinoids
Disrupting Gut Microbiome Could Be Key
The number of participating ACOs dropped this year as tougher downside-risk rules went into effect
Apple announces three new studies that use apps on its gadgets
Reforms are needed but the lower-priced competitors have grabbed significant market share against some reference products
A Conversation with Andy Slavitt
Interview by Richard Mark Kirkner
The former head of CMS takes Congress to task. The ACA is not perfect (no law is) but could be improved, in his view, if only lawmakers would show more political courage.
A Conversation with Daniel Knecht, MD
Interview by Frank Diamond
Aetna’s vice president of health strategy and innovation explains how tweaking an established program will offer vulnerable beneficiaries more value.
A Conversation with Mei Wa Kwong
Interview by Susan Ladika
The executive director of the Center for Connected Health Policy talks about the promise and obstacles of embedding this technology into our lives.
A Conversation with William Johnson, MD
Interview by Peter Wehrwein
The president of what started as a dental plan describes what it took to successfully launch a Medicaid ACO in the remote regions of Oregon and Alaska.
CURRENT ISSUE September 2019

Formularies, Revealed

Sure, formularies limit choice. Doctors, nurses, many patients—not fans.  The rhyme and reason? Calculations of cost and effectiveness. This issue of Managed Care looks at what formularies have become—and the crescendo of calls for reform. Rebates are driving decisions about which drugs make the lists. Employers are frustrated by the secrecy of those rebates deals—but also hesitant to rock the boat; rebates help knock down their soaring health care costs. Meanwhile, spread pricing and specialty drugs, which don’t lend themselves to formulary tactics, are roiling the waters. Read this issue to navigate the white water.

A Conversation with Marty Makary, MD
Interview by Peter Wehrwein
Don’t expect politicians to ride to the rescue, says the author of a book that examines just what went wrong and how we can fix it. He puts his faith in entrepreneurs, among others.
A Conversation with Ezekiel J. Emanuel, MD
Interview by Peter Wehrwein
The architect of the ACA waxes defiantly about how effective the law has been and what can be done to make it more so. Also, he is OK with Medicare for all but not the Sanders version.
Viewpoint
Lynn Barr
Even though misunderstandings abound, now is still a good time to take the plunge and become an ACO. New CMS rules have increased the chances of financial success.
Innovation ’19: Installment Plans for Drugs
Lola Butcher
An MIT-led collaboration is working on a pilot project on how to pay for Zolgensma—a $2.1 million gene therapy—in installments that are contingent on the drug living up to its curative promise.