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Accountable Care Organizations Give Capitation Surprise Encore
Many see ACOs as the model for reform, but if provider groups dole out payment, then what roles will health plans play?
Plans Clamp Down on Utilization and Doctors’ Tempers Flare
Physicians are really getting ticked off, just as they were in the ’90s, but it is possible to reduce their pain without abandoning the process
A Conversation With Mark Merritt: Medicare Part D Offers Template for Success
This spokesman for PBMs urges Congress to learn from his industry’s experience in driving down costs
Are You Prepared for ICD-10?
Jillian Harrington, MHA
Train an in-house team to help make the transition smooth by determining who is affected, and how
Insurers Prepare for 2nd Wave of H1N1 Flu
Tony Berberabe, MPH
They learned a lot from the avian flu scare of 2005 and are now ready to handle a swine flu epidemic this fall
U.S. Infant and Maternal Mortality Rates: Shamefully (and Unnecessarily) Bad and Getting Worse
A Mismatch Made in America
‘What if we become the change we want to see’?
High Administrative Costs and Low Enrollment Led To the Demise of Startup Insurer Crystal Run
AI for all that ails American health care. But how smart is that?
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Senate grills drugmaker CEOs, the most sweeping Medicare-for-all plan yet, & a Washington State effort to identify low-value health care services
More Americans riled about drug prices, bispecific antibodies have arrived, CMS rule requires more interoperability
IN THIS ISSUE
Health Care Reform Fails If Public Won’t Stay the Course
Legislation & Regulation
New HIPAA Rules to Affect Health Plans in Many Ways
Despite all the talk about HIPAA privacy protections, there was little action. New regulations are intended to ensure compliance.
Lowering Part D Drug Costs Without Direct CMS Negotiations
A Boston University law professor proposes that Medicare allow health plans to negotiate aggressively with pharmaceutical companies
‘The Badger State’ pays FPs and GPs the most
The Formulary Files
Patients, HMO win with cheaper drug
New Heart Valve Avoids Sternotomy And Long Hospitalization
Thomas Morrow, MD
The Melody Transcatheter Pulmonary Valve is delivered through cardiac catheterization, a favorable alternative to chest surgery
Managed Care Outlook
Medicare PDP premiums will increase slightly
Patient Financial Burden: Considerations for Oncology Care and Access
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