March 2013

Cover Story

Tiger in the Fiscal Room: Beware the Increasing Cost And Number of Orphan Drugs

While Congress worries about physicians’ salaries and employers bemoan the cost of imaging, it’s orphan drugs that might deserve most attention

Ed Silverman

Calling Something an ACO Does Not Really Make It So

Many who claim to be constructing such entities are really creating ‘clinically integrated organizations’

Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD ; Scott Guerin, PhD

Consumer-Directed Health Plans Continue to Gain Adherents

Everything is relative, but there’s been what many experts describe as substantial growth for a lot reasons

John Carroll

5 Product Engineering Methods To Use in Health Care Management

These tools, often adopted by other industries, can help insurers improve health care delivery

Preetinder S. Gill

Some Plans Ignore Nay-Sayers When It Comes to Telemedicine

A controversial study challenges backers to prove that these technologies are cost-effective

Frank Diamond

A Multidimensional Framework For Specialty Drug Management

An MCO with an integrated medical and pharmacy benefit management system can overcome the challenges associated with this costly category

Gregory K. Bell, PhD ; Shannon A. Baumann, MS

Peer-Reviewed

Cost Comparison of Immediate One-Stage And Tissue-Expander Breast Reconstructions After Mastectomy in Commercially Insured Patients

There was little difference between the options in terms of the frequency and cost of return visits. Patients receiving one-stage reconstructions returned slightly less often for breast-related services during the first 18 months after reconstruction, but the difference was not statistically significant.

Navin K. Singh, MD ; Nancy L. Reaven, MA ; Susan E. Funk, MBA

Editor’s Memo

Choosing Wisely Campaign Grows Wider and Deeper
John Marcille

Legislation & Regulation

Pressure Builds to Replace ‘Sustainable Growth Rate’

The SGR, ill-conceived and continually bypassed, may be nearing the end of its pathetic, useless life

John Carroll

The Formulary Files

Zero copayment for generic statins could save billions

Plan Watch

Kaiser Permanente Goes All Out To Provide Access to Wellness

The insurer studies exactly what works and why in studying two programs that battle diabetes

Frank Diamond

Tomorrow’s Medicine

For Patients Who Inherit Homozygous Familial Hypercholesterolemia, 2 New Treatments Available

This population can benefit from Juxtapid and Kynamro, but the cost is not addressed by health reform

Thomas Morrow, MD

Managed Care Outlook

Can anything stop the coming Alzheimer’s explosion?

News & Commentary

Readmission Study Offers No Quick Fix

News & Commentary

Medicare Advantage Beneficiaries Seem to Consult Star Ratings

News & Commentary

Medicare Advantage Loses Sicker Enrollees

News & Commentary

Workers at small companies less likely to be covered

News & Commentary

Briefly Noted

News & Commentary

Essential Benefits Standards Issued