August 2011

Cover Story
One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation

Joseph Burns

When does a characteristic become a disorder? The next edition of the Diagnostic and Statistical Manual of Mental Disorders means even more coverage decisions.

John Carroll

The resulting company could control 40 percent of the PBM market, but would any savings be passed on to insurers?

Frank Diamond

Some insurers are taking these health care professionals from the front lines and putting them into leadership positions

Frank Diamond


The comparison found that maintenance therapy with fluticasone propionate-salmeterol combination was associated with a 14% reduction in risk of severe exacerbation, less health care utilization, and 25% lower COPD-related medical costs

Anand A. Dalal, PhD ; Sean D. Candrilli, PhD ; Keith L. Davis, MA

Web Exclusive

The field of personalized medicine has made significant progress with key discoveries like single nucleotide polymorphism and microarray/biochips. These advances will benefit plans, patients, the pharmaceutical industry, and society.

Daniel Pucheril ; Smiriti Sharma

Thanks to the fragmented compensation system, we are already paying more. The new payment system must elicit cooperation and coordination.

Sanjaya Kumar, MD, MSc, MPH, and David B. Nash, MD, MBA

Legislation & Regulation
It’s one thing to encourage efficiency on the technical side, but do you really want your radiologist to read 50% more scans or X-rays per hour?

John Carroll

Medication Management
Automatic interchange at the hospital can disrupt medication therapy and affect outcomes in a suboptimal way

Thomas Reinke

Plan Watch
Anthem Blue Cross & Blue Shield of Indiana focuses on improving communications between minorities and their physicians

By Frank Diamond