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MANAGED CARE September 2019

Primary Care as a Platform for Value
Michael D. Dalzell
Quantifying the worth of primary care and its delivery are essential for raising its profile. New data and payment incentives may push us closer.
Nurse Practitioners Can’t Do What Primary Care Docs Can Do
Alan Adler, MD
Nurse practitioners are wonderful, but they’re not doctors.
The Slow Reveal
Joseph Burns
Rebates have created pay-to-play dynamics. Employers facing high drug costs have “rebate addiction.” And the impressive “rebate guarantees” are hard to resist. But at least the process of how drugs get formulary placement is becoming clearer, and some PBMs have moved to charging administrative fees only.
Specialty Drug Spend Soars. Can Formulary Management Bring It Down to Earth? 
Thomas Reinke
Utilization management techniques for traditional medicines don’t translate to drugs covered by the medical benefit. Site-of-service programs show some promise, though.
Spread Pricing: From Largely Unknown To Much Scrutinized and Criticized
Ed Silverman
After Ohio uncovered huge spreads, other states have taken a hard look at spread pricing in their Medicaid programs. U.S. senators and CMS are also getting into the act.
The First and Last Resort
Robert Calandra
People with behavioral health problems have stretched emergency departments to their limit as the number of inpatient psychiatric beds has decreased. For many patients, the ED is the first place they go. Even people under the care of a mental health professional wind up in EDs because they’re in crisis and their provider’s office is often closed.
3 Years at the Top: Moving Intermountain to Wellness and Value
Interview by Peter Wehrwein
The insurer’s CEO explains the company’s approach to growth, how a team-based system nurtures better care, and why he thinks Medicare for all might not work.
The COMPARE Study: Facility Costs Associated With Hysterectomy, Myomectomy, and the Sonata Procedure for Treatment of Uterine Fibroids
Elizabeth Brooks, PhD
Linda Mihalov, MD
Dipak Delvadia, DO

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The First and Last Resort
Primary Care as a Platform for Value
Making the Patient Voice Matter In Value Assessment
Spread Pricing: From Largely Unknown To Much Scrutinized and Criticized
3 Years at the Top: Moving Intermountain to Wellness and Value
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IN THIS ISSUE

VA Mission Act: New Access to Care for Veterans
Cheryl Nagowski
Viewpoint
Primary Care in the Consumer-Centric Era
Sasha Preble
Nate Comstock
Bergen Schoenfeld
Viewpoint
How Health Plans Can Catalyze The Precision Medicine Revolution
Jordan Bazinsky
Viewpoint
Preparing Your ACO For Downside Risk Success
Mark Hefner
Viewpoint
Making the Patient Voice Matter In Value Assessment
Susan dosReis
Blue Cross Blue Shield of Massachusetts Makes Two-Sided Risk, Value-Based Care Work 
Frank Diamond
Alzheimer’s Affects Women Differently
Frank Diamond
Obesity Affects MS Treatment 
Frank Diamond
As Restrictions on Abortion Increase, Interest in Access Via Telemedicine Increases
Susan Ladika
Most Hospitals Fall Far Short on Leapfrog Surgery Volume Standards
Frank Diamond
Strategies to Optimize Adult Hepatitis B Vaccination
Benefit of a novel 2-dose, 1-month vaccination regimen to population health

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View Supplement
Patient Financial Burden: Considerations for Oncology Care and Access
One organization’s approach to addressing financial toxicity

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View Supplement
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