Chief medical officers of HMOs have highest incomes in the Northeast, but their mean incomes are only about $200 more than the average total compensation of CMOs from the next most prosperous region — the West North Central area consisting of Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota. Median salaries are also close, and higher by $20,000 or more than other regions. Warren Surveys collected 2001 data from over 500 HMO and other managed care health plans nationwide. The survey defines CMO as "Top person responsible for overseeing the medical policies, medical service delivery and quality care for health plan members. In a large network and/or insurer-sponsored model, this person may have several medical directors for whom [he is] responsible." All CMOs are physicians.

Lowest compensation in the Mountain states

Bigger plan, better for CMO

Chief medical officers of plans with 500,000 or more members have considerably greater total earnings than CMOs at smaller plans.

Corporate status may play a role

The chief medical officer at a not-for-profit organization is compensated at a lower level than peers at for-profit organizations. The mean difference in salary (including bonuses) between CMOs in for-profit and not-for-profit organizations is over $30,000.

SOURCE: WARREN SURVEYS. THE HMO SALARY SURVEY: SPRING 2001. 815-877-8794

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.