September 2010

When a health plan contracts with a PBM, it should insist on strict definitions of brand drug and generic drug, an experienced negotiator advises

$10B to Study Payment Systems

Under PPACA, CMS is directed to test new payment models, leaving advocates holding their collective breath

Provenge Approval Means Sensitive Coverage Decisions

Coverage of this costly biologic for prostate cancer is generally being provided under very specific circumstances

Interim Federal High-Risk Groups May Far Exceed $5B Allocation

Not only is the program expected to be short on cash, but many patients may not be able to afford even the subsidized rates

A Conversation with Ted Eytan, MD: Social Media Are Your Friends

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

Helping Hispanics Means Improving Preventive Care

Bracing for an influx of enrollees, medical managers at some plans take creative approaches to fixing a decades-old problem

Holistic Care Management Requires IT Integration

When we truly begin to manage the person and not the condition, there will be payoffs on both the cost and quality fronts



Defined Contribution Health Care Could Really Shake Up the System


Coverage, Recission Reviews to Get Tougher in Some States Under Reform

Health reform requires a uniform process for member appeals, and the NAIC approach has been adopted by the Department of Health and Human Services

Pay raises in store for clinical executives


Strengthening diuretics’ role in hypertension


Program Keeps Dually-Eligible Adults Out of Nursing Home

Emblem Health is starting slowly with an effort that demographics nearly guarantee will catch on in New York and across the country

New Players Enter Field of Regenerative 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

PPACA causes short-term increases in costs

News & Commentary

CDHP Enrollment Grows More Slowly

Chemo Treatment Rates Increased Under Medicare Modernization Act

Study Reports On LTC Costs

Headlines On Deadline …

Providers lag in ICD-10 readiness