Managed Care


January 2015

‘Pharmatization’ might save health plans money. There are four major reasons to make the move — but also reasons to go slow.
Peter Wehrwein
Three conditions — hepatitis C, diabetes, and cancer — show how budgets can be busted (and patients harmed) if providers and payers don’t astutely manage the use of costly new drugs
Linda Cahn
As the editor of Managed Care steps down, he recalls his disbelief when Newt Gingrich told him in 2005 that everyone should be required to purchase health care, discusses the erosion of insurance through high-deductible health plans, and more
MargaretAnn Cross
Alone, medications and behavior modification aren’t solutions. Obesity”s complexity makes it difficult for payers to develop a strategy for reducing weight-related costs.
Katherine T. Adams
Seven health plans and 74 physician practices unite under a CMS program to bolster primary care
Frank Diamond

Editor’s Farewell Memo
John Marcille
ACO Update
Waivers and prospective attribution await ACOs in the proposed third track
Peter Wehrwein
Legislation & Regulation
The commission and employers are fighting over whether incentives make the programs involuntary
Richard Mark Kirkner
Medication Management
The regimens can be complex. PBMs use education, outreach, split fills, and other techniques to help with adherence.
Thomas Reinke
Medical Device Monitor
Physicians will be able to keep better tabs on heart problems and diabetes, and even help relieve chronic back and leg pain
Katherine T. Adams
The Formulary Files
Krishna Rutvij Patel, PharmD
Tomorrow’s Medicine
Cost will be a concern because it involves two separate procedures performed with two sets of catheters
Thomas Morrow, MD