Managed Care - August 2012 - (Page 1)

EDitoR’s MEMo Getting in some Practice With Private insurance Exchanges By John Marcille Editor John Marcille Managing Editor Frank Diamond Associate Editor i Tony Berberabe senior Contributing Editors MargaretAnn Cross Michael D. Dalzell Timothy Kelley Contributing Editors Joseph Burns John Carroll Thomas Reinke Design Director Philip Denlinger President Emeritus Timothy J. Stezzi President Timothy P. Search, RPh VP, Group Publisher Maureen Dwyer Liberti senior Account Manager Kenneth D. Watkins, III Director of Production services don’t know about you, but I’m starting to be overwhelmed by the complexities of the Affordable Care Act, and that’s just the parts of it that interest me. One of those parts is the mandate for health plan purchasing exchanges in the states. All I can say is that I would not like to be the health plan executive who is responsible for creating the offerings that will to some degree determine that company’s success over the next few years. With millions of new members from the rolls of the uninsured up for grabs, and the possibility that small and large businesses may dump employees into the exchanges, the importance of having attractive products cannot be overstated. But designing and pricing those plans is going to be a lot different for most companies than designing and pricing the plans that they sold to employers, and the ones they sold on the individual market. I doubt that employees who had employer-sponsored insurance will be eager to do a lot of comparison shopping, and they will be frustrated in evaluating the plans in terms of their individual needs. And the health care companies themselves are looking at a new minefield of risk, where fear of adverse selection may push them to offer plans that offer them some protection, but may not be optimal for members. These are a few of the problems that Joe Burns explores in his article beginning on page 16 on private exchanges — laboratories for health plans and employers to try to figure it all out before the exchanges start operating at the beginning of 2014, or so the ACA specifies. Meanwhile, we have a Supreme Court ruling upholding most of the ACA, yet some states are refusing to participate, opening the door for federally operated exchanges in those states. As much as some governors and legislators might hate the law, do they really want the feds controlling the exchanges? But maybe the insurers in those states might welcome a more consistent regulation. CoNtACt E-MAiL ADDREssEs: Editors: Circulation: Advertising: Reprints: 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 21, Issue 8. 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 2012 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: Postmaster: Send address changes to Managed Care, PO Box 2019, Langhorne, PA 19067. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Waneta Peart Circulation Manager Jacquelyn Ott Managed Care is indexed in PubMed and in Scopus. The full contents of each issue are available free at 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. AUGUST 2012 / MANAGED CARE 1

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine

Managed Care - August 2012