Conversations on The Changing Face Of Managed Care: Insights from the 2006-2007 Podcast Series

Based on a series of 10 podcasts conducted in late 2006 and early 2007 by internationally known author, consultant, and futurist Ian Morrison, this publication features interviews with various experts on issues important to the business and bottom line of managed care organizations.


  • Seeing Through Transparency: The Managed Care Evolution
    • A Health Plan Perspective – Margaret E. O’Kane
    • An Employer’s Perspective – Peter V. Lee, JD
    • A Consumer’s Perspective – Mark D. Smith, MD, MBA
  • Pay For Performance – Tom R. Williams
  • Electronic Health Information – David Brailer, MD, PhD
  • The Future of Disease Management – David Nash, MD, MBA
  • Medicare Part D – John Gorman
  • Evidence-Based Benefit Design – Helen Darling
  • Consumer-Directed Health Plans – Sara R. Collins, PhD
  • Specialty Pharmacy Management – Debbie Stern, RPh

Postherpetic Neuralgia: A Model for Treating Severe Pain

Postherpetic neuralgia is a disabling condition that impairs quality of life. Varying definitions of PHN have made it difficult to quantify its prevalence or qualify its severity. Clinically, PHN is a consequence of reactivation of the varicella-zoster virus. The result of viral damage to the nervous system, PHN can be severe and intractable to therapy. Targeted analgesia may be useful in reducing the chronic discomfort of PHN caused by central sensitization. Undertreatment of PHN is common and can carry costly implications for third-party payers.


  • Overview of Postherpetic Neuralgia (PHN)
  • Description of Neuropathic Pain
  • Clinical Manifestation of PHN
  • Risk Factors
  • Clinical, Economic, and Quality-of-Life Burdens
  • Implications for Payers

Scientific Understanding of PHN and Its Treatment

  • Etiology of PHN
  • Voltage-Gated Sodium Channels
  • Consequences of Neuronal Damage
  • Targeted Peripheral Analgesics
  • Clinical Trials of Lidocaine Patch 5%

Clinical Brief: A Single Tablet to Help Manage Patients With Hypertension and Other Cardiovascular Risk Factors

This Brief reviews a treatment option for hypertensive patients with other cardiovascular risk factors who need the blood pressure lowering of amlodipine and the cardiovascular benefits of atorvastatin. It also includes an analysis for MCOs by Steven R. Peskin, MD, MBA.


  • Discussion of management of blood pressure and dyslipidemia in terms of coronary heart disease
  • Overview of hypertension study results, including the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid-Lowering Arm and the Collaborative Atorvastatin Diabetes Study

Clinical Brief: The Etiology of Menstrual Migraine

This Brief provides a review of the literature pertaining to menstrual migraine, with an analysis for managed care decision makers.

  • Summary of migraine subtypes and associated characteristics
  • Overview of the prevalence of menstrual migraine in the population
  • Review of the physiological mechanisms underlying menstrual migraine

Innovations in Pain Management: New Therapeutic Options and Tools for Disease Management

Chronic pain is a serious and costly public health issue in the United States and remains largely undertreated. Pain management requires an understanding of how chronic pain manifests and the treatment options that are available to health care practitioners. The standard of care in treating chronic pain includes the judicious use of opioids and necessitates the development of realistic strategies to prevent their misuse. Pharmacists can play an important role in improving patient outcomes by collaborating with prescribers and patients to ensure that pharmacologic treatment is optimized and that patients receive education on the proper use of opioid analgesics.


  • Prevalence and Economic Implications of Chronic Pain
  • Treatment Options for Chronic Pain Management: Opioids Revisited
  • Disease Management Tools for Chronic Pain
  • Case Studies: Managing Debilitating Chronic Pain

This supplement is based on a satellite symposium held at the Academy of Managed Care Pharmacy 2006 Education Conference in Chicago. The authors, who are considered leaders in the field of pain management, present thought-provoking articles on the optimal management of patients with chronic pain and the necessity to address this costly and highly prevalent disorder.

Managed Care Best Practices in Oncology Management

Cancer, in its various types and presentations, is the number 2 killer in the United States. For managed care companies, access to and availability of cancer care itself and the attendant costs of such care will present an increasingly substantial managed challenge. This publication serves as an important educational tool for managed care professionals, pharmacists, and other health care decision makers so that informed decisions can be made regarding drugs, devices, and procedures utilized when treating patients with cancer.


  • Issues in Oncology Management
  • The Current Landscape of Oncology in Managed Care
  • The Process of Care
  • Protocols and Working With Oncologists
  • Pharmacy and Cancer Care
  • Managing Oncology Agents: An HMO’s Perspective

Based on an expert roundtable discussion conducted in Salt Lake City, Utah, this supplement focuses on collaboration and communication as key principles for ensuring the highest quality of patient care. Case studies that discuss typical patients encountered in the oncology field are also presented.

Clinical Brief: The Unique Burden of Menstrual Migraine

This Brief provides a review of the disability impact of menstrual migraine, with an analysis for managed care decision makers by Maria Lopes, MD, MS.


  • Physical symptomology of menstrual migraines
  • Overview of the impact of menstrual migraine on work and activities of daily living

Consulting on the Patient With Type 2 Diabetes:Matching Medication to Disease Mechanism

This supplement was developed to meet the educational needs of pharmacists who are interested in raising the level of care for their patients with type 2 diabetes.


  • Pathophysiology
  • Goals of Treatment
  • The Assessment of Risk and Benefits to Develop Effective Treatment Plans

Expanding the Boundaries Of Migraine Management: A Focus on Menstrual Migraine

Based on a breakfast symposium at the Academy of Managed Care Pharmacy 2007 Annual meeting, this supplement reviews opportunities to optimize short-term prevention of migraines in patients with specific treatment needs. The authors examine the advances in migraine prophylaxis and the emerging models in preventive treatment.


  • Prevalence and Burden of Migraine and The Impact on Managed Care
  • The Epidemiology and Pathophysiology of Migraine
  • Treatment of Menstrual Migraine: Evidence-Based Review
  • Panel Discussion: Optimal Patient Management

Influenza Vaccination: Trends, Recommendations, and Best Practices

Historically, health care professionals have focused on preventing influenza morbidity and mortality with vaccine, chiefly in the elderly and high-risk populations. Today, the larger public health objective is to prevent epidemics via complementary immunization strategies, which can include herd protection through vaccination of people who spread viruses to those at highest risk of complications and poor outcomes. New immunization strategies include vaccinating healthy children, adults, and health care workers. Efficacy data are presented for of trivalent inactivated influenza vaccine (TIV) and live attenuated influenza vaccine (LAIV), administered by nasal spray.


  • Burden of Influenza and Strategies for Prevention
  • Influenza Virus Mutation and Transmission
  • Best Practice From a Health Plan Standpoint
  • Real-World Experience of a Family Practitioner
  • Virginia’s Stay on Track Daycare Initiative
  • Panel Discussion: Overcoming Barriers to Immunization

This supplement is based on the Influenza Vaccine Expert Roundtable, held in Chicago on April 19, 2007. The authors include Robert Belshe, MD, considered a leader in the field of influenza prevention.

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.