Compensation for medical directors and CMOs at staff-model health plans and in high-deductible health plans, as well as HMOs and PPOs, remains competitive when compared to what their counterparts at hospitals, physician practice groups, and in about 15 other categories get paid, according to Cejka Search.

For all physician executives in general, the average compensation was $288,000 in Cejka’s 2009 survey, a two-year increase of 11.6 percent (from $258,000). It is also 44 percent above the $200,000 median of 1999.

Chief medical officers reported a median annual salary of $324,750 and medical directors reported a median annual salary of $251,000. These amounts are in line with earnings of physician executives in the health insurance industry, where CMOs earn $316,500 and medical directors earn $250,000 annually.

A comparison of median compensation between physician executives working in the health insurance industry and those working for a single-specialty group shows mixed results. Medical directors working in a single specialty earned a greater salary ($340,000) than those working in health insurance, while CMOs working for a single-specialty group earned a lesser salary ($306,125) than those in health insurance.

Median compensation of CMOs 1999, 2007, and 2009

CMO’s time given to administration

Note: Compensation includes salary, bonuses, incentive payments, research stipends, honoraria, and distribution of profits. The data also include the total compensation for both administrative duties and the clinical practice of medicine.

Source: Cejka Search, 2009 Physician Executive Compensation Survey http://www.cejkasearch.com/acpe

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.