January 2013

The United States Preventive Services Task Force has recommended against several screenings, yet health plans are finding that it’s not so easy to just drop coverage
Michael D. Dalzell

While there has been movement in many states, health plans would first want to make sure that they wouldn’t be breaking any law

Peter Wehrwein
Extra payments of $1,200 per member per year are being eliminated as CMS seeks to increase competition among plans
Joseph Burns

A new IOM report urges widespread adoption of innovations. The committee’s chair and the California HealthCare Foundation’s CEO, Mark Smith is working to make that happen.

John Marcille

Despite popular usage, these two terms mean different things, especially when coverage decisions need to be made

Ed Silverman
A CMS demonstration program will determine whether Medicare Advantage health plans improve their quality scores by responding to bonuses that correspond with a five-point rating scale
Richard G. Stefanacci, DO, MGH, MBA, AGSF, CMD
Scott Guerin, PhD
Overweight or obese patients who participated in a medical nutrition therapy benefit sponsored through their insurer were compared with individuals who did not participate. Outcomes, including weight change, body mass index, waist circumference, and physical exercise, were collected at baseline and 2 years later.
Donald W. Bradley, MD
Gwen Murphy RD, PhD
Linda G. Snetselaar, RD, PhD, LD
Esther F. Myers, PhD, RD, FADA
Laura G. Qualls, MHA

Legislation & Regulation

The Affordable Care Act requires insurers to measure up if they want to participate in the new state marketplaces for individual policies

John Carroll
Medication Management
Formulary decision makers will probably be disposed favorably toward Xeljanz, the first Janus kinase inhibitor approved for rheumatoid arthritis
Thomas Reinke
Plan Watch
The health plan’s New Hampshire subsidiary rolls out its Compass SmartShopper program to small employers this month
Frank Diamond
Tomorrow's Medicine

For many affected by vitreous degradation, surgery was the only treatment until the development of ocriplasmin

Thomas Morrow, MD