November 2011

Clinical executives at health plans want to see how providers react to draft recommendation against procedure

Frank Diamond

Discrimination persists in many areas, but slow progress is being made

Joseph Burns

Cover Story
The size of the essential benefits package may determine whether insurers can operate in the highly regulated exchange market. Expect strong lobbying from health care interest groups.

Michael D. Dalzell

Determining return on investment and improvement of outcomes is essential when new programs are being tried, but the research method must be chosen carefully

Andrew Kolbasovsky, PsyD, MBA

With national attention on health care reform and new models of care, the NCQA’s VP for performance measurement looks at how quality improvement can stay at the forefront

Legislation & Regulation
The gray market, where medications can be repriced, is becoming unmanageable

John Carroll

Managed Care Outlook
Lipitor led the way, and other blockbusters are following

Medication Management
Decision support tools provide new options for oncologists and health plans

Thomas Reinke

Plan Watch
Holding physicians to best-practice guidelines with the threat of refusing to pay for unnecessary tests reaps dividends

Frank Diamond

Tomorrow’s Medicine
Managed care once again faces the all-too-familiar debate about cost and benefit

Thomas Morrow, MD

News & Commentary

News & Commentary