February 2011

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Features

COVER STORY

Changing Payment Methodologies Force Physicians Into Larger Groups
Health insurers will soon find themselves working with provider organizations that have vastly improved utilization management skills
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Q&A

Renewing Calls for Better Cost Profiling of Providers: A Conversation With Ateev Mehrotra, MD, MPH
The information that many plans use needs to be open to physicians for review, and the formulas need considerable improvement
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Can Value-Based Design in Pharmacy Save Money and Cut Heart Attacks?
Advocates say that what’s lost in lowered copayments is more than made up by lowered downstream costs, but skeptics find the data unpersuasive
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Many Federal CER Projects Will Benefit Managed Care
Just because Medicare is hobbled in what it can do with comparative effectiveness research, doesn’t mean that MCOs cannot use the information for both quality improvement and cost control
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Next Generation Anticoagulants May Push Warfarin to the Wayside
Atrial fibrillation patients are often noncompliant with warfarin but newer drugs have better safety and side effect profiles
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PEER-REVIEWED

Health Care Utilization & Costs For Cystic Fibrosis Patients with Pulmonary Infections

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Departments

EDITOR’S MEMO

Decline of the Small Practice Might Make Plans’ Job Easier
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LEGISLATION & REGULATION

HHS on 2 Tracks to Persuade Plans To Moderate Rate Hikes
In addition to the 85 percent rule, the department is applying a ‘reasonableness’ criterion. But it’s all bark, no bite.
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MEDICATION MANAGEMENT

MCO Works Hard to Integrate Specialty Pharma Operations
In an effort to make the best use of specialty drugs, everybody gets into the act at Independence Blue Cross
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COMPENSATION MONITOR

School debt can be significant in primary care
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THE FORMULARY FILES

Prescriptions for generic drugs rise sharply
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PLAN WATCH

Medical Home Is Common Ground for BCBS/NC and Provider Group
BlueCross BlueShield of North Carolina’s vigorous patient-centered medical home may be an example to other plans and providers
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TOMORROW’S MEDICINE

Specialized Biomarkers Aid in Tumor Cell Imaging
NuView Life Sciences fuses molecular biology with imaging technology using the radioactive nuclide Copper 64
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MANAGED CARE OUTLOOK

Cancer costs to reach at least $173B in 2020
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News

Good Hospital Care Benefits Insurers    DIGITAL | HTML

Headlines On Deadline    DIGITAL | HTML

Injectable Drug Program Saves Plan $28.5 Million    DIGITAL | HTML

Majority of HMOs still develop their own formularies internally    DIGITAL | HTML