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August 2011

Features

The History and Future of Personalized Medicine
The field of personalized medicine has made significant progress with key discoveries like single nucleotide polymorphism and microarray/biochips. These advances will benefit plans, patients, the pharmaceutical industry, and society.
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Cover Story

Health Plans Seek Leverage When Physicians Submit Extremely High Bills
One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation
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Will Mental Health’s ‘Bible’ Make Believers of Insurers?
When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental Disorders means even more coverage decisions.
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Health Plans Cannot Ignore Express Scripts-Medco Deal
The resulting company could control 40 percent of the PBM market, but would any savings be passed on to insurers?
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Nurses Join the Executive Pool
Some insurers are taking these health care professionals from the front lines and putting them into leadership positions
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Peer-Reviewed

Outcomes and Costs Associated With Initial Maintenance Therapy With Fluticasone Propionate-Salmeterol Xinafoate 250 μg/50 μg Combination Versus Tiotropium In Commercially Insured Patients With COPD
The comparison found that maintenance therapy with fluticasone propionate-salmeterol combination was associated with a 14% reduction in risk of severe exacerbation, less health care utilization, and 25% lower COPD-related medical costs
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Departments

Editor's Memo

If Doctors Practice Gouging, What Does It Mean for Society?
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Legislation & Regulation

Has Medicare Gone Too Far To Control Imaging Costs?
It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour?
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Viewpoint

Will Paying More Produce Better Quality?
Thanks to the fragmented compensation system, we are already paying more. The new payment system must elicit cooperation and coordination.
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Medication Management

Therapeutic Substitution: A Change for the Good -- or the Bad?
Automatic interchange at the hospital can disrupt medication therapy and affect outcomes in a suboptimal way
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The Formulary Files

Part D reduces hospitalizations for some conditions
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Plan Watch

Teaching the Teachers Means Better Doc Visits?
Anthem Blue Cross & Blue Shield of Indiana focuses on improving communications between minorities and their physicians
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Managed Care Outlook

Employers look far and wide to reduce expenses
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News

10 most costly conditions in men and women    DIGITAL | HTML

Headlines On Deadline    DIGITAL | HTML

IOM Tells Plans To Cover 8 Health Services for Free    DIGITAL | HTML

More Families Rely On State Insurance    DIGITAL | HTML

State Exchanges to Offer ‘CO-OPs’    DIGITAL | HTML