Medical directors at health plans saw a 7.2 percent rise in mean direct compensation from 2003 to 2005. Average pay increases for physician executives in recent surveys ranged from 5 percent to 7 percent. What is surprising is that when compared to the larger group of all physician executives surveyed, medical directors at health plans came out on top: 7.2 percent versus 6.7 percent. The Cejka Search/American College of Physician Executives 2005 Physician Executive Compensation Survey found that the mean direct compensation for all medical directors employed by any organization rose 5.5 percent to $239,630 in 2005, compared to $227,010 in 2003. In the bonus department, goals and objectives are still the leading component, but the percentage of physicians with bonuses tied to quality measurements more than doubled, from 15 percent to 31 percent. The number and types of quality measurements factored into a bonus rose by 107 percent.

The top earners among physician executives were medical directors of single-specialty groups who reported an average yearly income of $340,000. Compare this with executives working for government institutions, who reported an average income of $170,000.

Some positions reported declines from 2003 to 2005. Chief medical officers in both HMOs and multispecialty groups, along with associate and assistant medical directors in multi-specialty groups, reported decreases that ranged from 4 percent to 7 percent.

2003 and 2005 median physician executive compensation

Source: Cejka Search/ACPE 2005 Physician Executive Compensation Survey

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.