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Managed Care


June 2015

It has been tried again and again. But government and private payers are wagering on ACOs as a way to hit the health care jackpot: managed costs and high quality.

Robert Calandra
Are confusing, repetitive, jargon-ridden communications souring your member relations? Take a look at how Medica, a Minneapolis health plan, is tackling the problem.
Timothy Kelley
Health plan efforts include identifying at-risk members and prescribers who write an unusually large number of opioid prescriptions.
Larry Beresford

Legislation & Regulation
The Lone Star State may be a lone wolf when it comes to regulating virtual visits.
Richard Mark Kirkner
Medication Management
Generics for other diseases have upended formularies, but the effect of generic Copaxone may be limited.
Thomas Reinke
Medical Device Monitor
A low bar for market entry leaves health plans unsure of the value of devices. Adding a unique identifier for each product could help with decision making.
Katherine T. Adams

Not only did the number of infants with neonatal abstinence syndrome increase dramatically from 2004 to 2013, but the proportion of NICU days devoted to caring for those infants increased to 4% in 2013 from just 0.6% in 2004, according to a study in the New England Journal of Medicine.

Tomorrow's Medicine
The investigational product coaxes the immune system into attacking the deadliest skin cancer. But can we afford these expensive cancer drugs?
Thomas Morrow, MD

Explore the complexities of the biosimilars’ landscape, such as naming, interchangeability and substitution, differences in the manufacturing processes, as well as the approval pathways & FDA guidelines for biologics, including draft guidance on biosimilars.