July 2011

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Features

COVER STORY

What Can Be Done to Counteract Growing Power of Providers?
Three health plans outline steps they are taking to deal with the effects of growing consolidation of providers
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Q&A

A Conversation With Regina E. Herzlinger, PhD: A New Individual Market on the Horizon
Health care reform sets the stage for employers to bow out of health care, creating an insurance market driven by individual choice, according to Harvard’s Professor Herzlinger
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Accountable Care — But the Patient Isn’t Accountable
CMS’s vision of a new kind of managed care organization fails to demand anything of patients while placing added pressures on providers
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Will That Defibrillator Really Do The Job?
A recent report that 1 in 5 implanted defibrillators may not be needed raises questions about the medical evidence
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Giving Members a Say In Benefit Plan Design
Group Health Cooperative and Geisinger Health Plan are two insurers that want members to weigh in on coverage issues
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Departments

EDITOR’S MEMO

Providers and Payers Have Common Interests
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LEGISLATION & REGULATION

Florida’s MCO Medicaid Path May Be Taken by Other States
Beneficiaries must soon choose between competing managed care companies, pay a $100 monthly premium, and be careful about heading over to the ER
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COMPENSATION MONITOR

How much return does that PhD provide?
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THE FORMULARY FILES

Adherence to statin therapy saves $944 over 18 months
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PLAN WATCH

Humana Steps Back To Seize the Future
With the purchase of Concentra, a company that operates 300 clinics, the health insurer once again provides care
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TOMORROW’S MEDICINE

Fewer Recurrent Infections of C. difficile Seen With Fidaxomicin
This new class of antibiotic — the macrocycles — has a greater sustained response against re-infection than vancomycin
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MANAGED CARE OUTLOOK

ACA’s effect on employer-sponsored insurance
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News

ED Visits Down a Bit In Mass. Reform Effort    DIGITAL | HTML

Headlines On Deadline    DIGITAL | HTML

HSA Rolls Continue to Grow, Up 14% From Last Year    DIGITAL | HTML

Outpatient Clot Care Overlooked by Docs    DIGITAL | HTML

Since 2008, improvement seen in insurers’ claims response times    DIGITAL | HTML