Managed Care - November 2008 - (Page 2)

EDITOR’S MEMO Care Editor M A N A G E D Health Plans Should Try To Feel Physicians’ Pain By John Marcille JOHN MARCILLE Managing Editor FRANK DIAMOND Associate Editor M 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 President and Group Publisher TIMOTHY P. SEARCH, RPH President and Group Publisher TIMOTHY J. STEZZI Eastern Sales Manager SCOTT MACDONALD Senior Account Manager anaged care is a topic that’s hard to avoid even in one’s casual reading. In “The Doctor’s Office,” a regular column that appears in the Wall Street Journal, Benjamin Brewer, MD, laments the changes in his profession. The complaints will sound familiar to readers of this publication as, for instance, when Brewer states that “Somewhere along the line too many doctors stopped being healers and became prescribers and technicians.” That’s a frequent complaint, and worth addressing. “I can’t put my finger on a day the profession was transformed,” Brewer says, “but the change is driven home every time a health insurance company calls me a ‘provider’ instead of a doctor.” Brewer understands that this is a nod to those health care practitioners who are not MDs but who treat patients, but it still rankles. I do sympathize with Brewer and I think health plan administrators should as well. However, when Brewer complains about not being able to spend as much time as he’d like with patients and points to managed care as the cause, he leaves something out. There are fewer caring family practitioners like Brewer in the market. About 70 percent of medical school students are graduating as specialists. The money isn’t as good in primary care, and the hassles seem to get worse each year. It’s quite expensive to run your own business, for instance. Brewer states that “there are months when the practice isn’t profitable.” The crisis in primary care can present itself as an opportunity to health plans. If insurers do all that they can to ease the burden on PCPs then who benefits? The entire health care industry, that’s who. Including health plans. Perhaps the burgeoning advanced medical home movement will make a difference. Something to think about as we await the changes that a new presidential administration will bring. MC KENNETH D. WATKINS, III Director of Production Services CONTACT E-MAIL ADDRESSES: Editors: Editors_mail@ManagedCareMag.com Circulation: Managedcare@icnfull.com Advertising: Advertising_info@ManagedCareMag.com Reprints: Reprints_request@ManagedCareMag.com WANETA PEART Circulation Manager 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 11. 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, PO Box 2019, Langhorne, PA 19067. 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. 2 MANAGED CARE / NOVEMBER 2008

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

Managed Care - November 2008 Editor’s Memo Contents News and Commentary Legislation & Regulation Letters Medication Management Compensation Monitor Do It Yourself for Less Biomarkers Promise, but Do They Deliver? Oncologists Complain About Drug Payment Consider Blood Pressure Self-Monitoring Q&A: Keep Industry in the Game Formulary Files Plan Watch Tomorrow’s Medicine Outlook Respiratory Syncytial Virus Managed Care Considerations Contents Continuing Education Objectives RSV Disease in the Pediatric Population In the Trenches RSV Infection in the Adult Population Health Plan Medical Director Health Plan Pharmacy Director RSV Issues and Solutions Assessment/Evaluation/Certificate Request Post-Test

Managed Care - November 2008

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