September 2010

Defined contribution is a re-emerging health care reform idea. Its advocates say that it tackles reforms overlooked by other options, will tame costs, and will give employers incentive to stay in the game.
Thomas Reinke
When a health plan contracts with a PBM, it should insist on strict definitions of brand drug and generic drug, an experienced negotiator advises
Linda Cahn
Under PPACA, CMS is directed to test new payment models, leaving advocates holding their collective breath
Richard Mark Kirkner
Coverage of this costly biologic for prostate cancer is generally being provided under very specific circumstances
Ed Silverman
Not only is the program expected to be short on cash, but many patients may not be able to afford even the subsidized rates
John Carroll
He started blogging to get information out to physicians; now he believes that patients too will benefit greatly from e-mail, blogs, tweets, and the like
Bracing for an influx of enrollees, medical managers at some plans take creative approaches to fixing a decades-old problem
Frank Diamond
When we truly begin to manage the person and not the condition, there will be payoffs on both the cost and quality fronts
Emad Rizk, MD

Legislation & Regulation
Health reform requires a uniform process for member appeals, and the NAIC approach has been adopted by the Department of Health and Human Services
John Carroll
Plan Watch
Emblem Health is starting slowly with an effort that demographics nearly guarantee will catch on in New York and across the country
Frank Diamond
Tomorrow's Medicine
Biotechnology companies are doing promising work in producing new organs, with one adult stem cell therapy standing a good chance of approval in Canada
Thomas Morrow, MD