Managed Care - January 2008 - (Page 4) 16 Care Vol. 17, No. 1 January 2008 COVER STORY M A N A G E D The Flat-Rate CABG Alfred S. Casale, MD 16 Geisinger Health Plan’s “warranty” for coronary artery bypass graft surgery has gotten a lot of attention, but can this “pure form of P4P” work for other health insurers? 2008 Forecast: Challenging 27 27 Peter Kongstvedt, MD, outlines some major hurdles to profitability for managed care plans. Paying for Performance in Retail Pharmacies 32 The community pharmacist can do a lot to promote the interests of managed care. Is it time to dangle the carrot? Me-Too Drugs Are No Slam-Dunk Health plans are starting to apply tougher standards on what constitutes value. Peter Kongstvedt, MD 37 43 47 Lax Physician Coding Hurts Plans By assisting physicians to code properly, Medicare Advantage plans can get all the payment that is due, but that too often is lost. Prescribing 17P in a Medicaid Population There are options for when to administer 17 alpha-hydroxyprogesterone caproate to Medicaid mothers. DEPARTMENTS Editor’s Memo 3 Lower cost, higher quality. Really. Viewpoint 6 Warranty warrants interest. Snapshot 7 Copayments up faster than inflation. News and Commentary 11 ACP promotes Medicare for all. Medication Management 13 Should pharmacists vaccinate? Compensation Monitor 15 Nocturnist, laborist pay falls short. Formulary Files 53 Factors that affect formulary switching. Tomorrow’s Medicine 54 Avoid heart valve complication. Ad Index 56 Outlook 57 2008: A fairly good year seen for plans. 37 Helen Sherman, PharmD Visit us online at http://www.managedcaremag.com/ COVER ILLUSTRATION BY JOHN PATRICK http://www.managedcaremag.com/
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