Managed Care - June 2008 - (Page 1)

EDITOR’S MEMO Care Editor M A N A G E D Creativity Required Equally In Short Run and Long Run By John Marcille upply meeting demand isn’t always good. We watched for years as young doctors displayed less and less interest in primary care. They’re only human, after all. An income difference between primary care physicians and specialists that can be measured in hundreds of thousands of dollars is difficult to ignore. That’s why the point made by Barbara Starfield, MD, subject of this month’s Q&A on page 33, serves as a warning. “The specialist, oversuspecting the likelihood of a serious illness, will do a very expensive and unnecessary workup. And all the things that are done in an unnecessary and expensive workup have a finite chance of an adverse side effect, including death. . . . If you don’t have something that requires a specialist, it’s dangerous to see one.” It’s difficult to see how the marketplace can fix this problem, since the marketplace seems to be the cause. Health plans will need to come up with some creative approaches. That’s what they seem to be doing in response to the economic slowdown that’s afflicting the country and industry, according to our cover story on page 24 by Contributing Editor Martin Sipkoff. Some companies have decided to focus on underserved populations to help get them through. “Insurers have the ability to change to meet the needs of the culture, and that is what they’re doing,” says Aetna spokesman Mohit Ghose. Ghose’s remarks underscore just how proactive insurers need to be these days, a sentiment echoed by Paul Ginsburg, PhD, president of the Center for Studying Health System Change. “Whether plans can continue to adjust to a changing market remains an open question,” says Ginsburg. “Those who do will survive. Those who fail to adjust fail to survive.” A pretty stark assessment. Good luck. MC JOHN MARCILLE Managing Editor FRANK DIAMOND Associate Editor S TONY BERBERABE Consulting Editor MICHAEL DALZELL Senior Contributing Editor MARGARETANN CROSS Contributing Editors LOLA BUTCHER JOHN CARROLL MAUREEN GLABMAN MARTIN SIPKOFF Design Director PHILIP DENLINGER Group Publisher TIMOTHY P. SEARCH, RPH Director of New Product Development TIMOTHY J. STEZZI Eastern Sales Manager SCOTT MACDONALD Senior Account Manager KENNETH D. WATKINS, III Director of Production Services WANETA PEART Circulation Manager CONTACT E-MAIL ADDRESSES: Editors: editors_mail@managedcaremag.com Circulation: managedcare@icnfull.com Advertising: advertising_info@managedcaremag.com Reprints: reprints_request@managedcaremag.com JACQUELYN OTT Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this publication may reflect the professional literature or other clinical sources, or may reflect the clinical experience of the authors, and might not be the same as what is on the approved package insert. Please consult the complete prescribing information for any products mentioned in this publication. MediMedia USA Inc. assumes no liability for the information published herein. MANAGED CARE (ISSN 1062-3388) is published monthly by MediMedia USA, Inc. at 780 Township Line Road, Yardley, PA 19067. This is Volume 17, Issue 6. Phone: (267) 685-2788; fax (267) 685-2966. Send letters to the editor to Frank Diamond, MANAGED CARE, 780 Township Line Road, Yardley, PA 19067. Letters may be edited for length and clarity. Copyright 2008 by MediMedia USA, Inc. All rights reserved under the United States, International, and Pan-American copyright conventions. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, electronic, or otherwise, without the prior written permission of MediMedia USA Inc. The copyright law of the United States governs the making of photocopies or other reproductions of copyrighted material. Subscriptions for individuals or institutions in the U.S.A. are $100 per year, $10 per single copy; elsewhere, $120 per year, $22 per single copy. Inquiries about paid subscriptions: Lisa Gardineer, telephone (267) 685-2789; e-mail: lgardineer@medimedia.com. Postmaster: Send address changes to MANAGED CARE, 2900 New Rodgers Road, Bristol, PA 19007. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Major articles are reviewed by appropriate members of the editorial advisory board and/or other qualified experts. Opinions are those of the authors and not necessarily those of the institutions that employ the authors, nor of the publisher, editor, or editorial advisory board of MANAGED CARE. JUNE 2008 / MANAGED CARE 1

Table of Contents Feed for the Digital Edition of Managed Care - June 2008

Managed Care - June 2008 Editor’s Memo Contents Viewpoint Letters News and Commentary Legislation & Regulation Medication Management Compensation Monitor Plans Chart Course in Rough Waters A Conversation With Barbara Starfield, MD Smoke Signals from Payers Slow Going for Clinical Decision Support Back Pain and Physical Therapy Formulary Files PlanWatch Outlook

Managed Care - June 2008

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