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GLG News by Managed Care Experts

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July 10, 2008
Different reimbursement systems for oral and infusion drugs corrupts the drug use process
Analysis of: Pricey Drugs Put Squeeze on Doctors | online.wsj.com
Author: GLG Expert Contributor
To enhance health care efficiency, MDs should not have to purchase and stock expensive biotech drugs in their office.  Drugs should be charged to the health plan or PBM and the drugs should arrive at the MDs office labeled for the particular patient
Richard AmerlingJuly 10, 2008
So Much for Health "Insurance"
Analysis of: Pricey Drugs Put Squeeze on Doctors | online.wsj.com
Author: Richard Amerling, Director of Outpatient Dialysis, BETH ISRAEL MEDICAL CENTER INC
It's intresting that nowhere in this article was the topic of true insurance for catastrophic illness brought up.  The problem with our current health insurance market is that for most it is pre-paid care, not insurance against a rare, but catastrophic, event. 
Richard AmerlingJuly 10, 2008
Our Kids on Statins...........Not!
Analysis of: 8-Year-Olds on Statins? A New Plan Quickly Bites Back | www.nytimes.com
Author: Richard Amerling, Director of Outpatient Dialysis, BETH ISRAEL MEDICAL CENTER INC
With the pipeline for new drugs running dry, it is no surprise that pharmaceutical companies are looking to expand indications for existing products still under patent protection.  What better way to do this than by creating entirely new patient populations out of whole cloth?
July 9, 2008
PBMs and Big PhRMA fiddle while the health care system burns
Analysis of: Drug groups prescribe for future growth | www.ft.com
Author: GLG Expert Contributor
Pricing constraints in the US such as Best Price legislation preclude innovative outcomes based solutions from being adopted.  CMS should provide waivers to Best Price to enable payers and drug innovators to engage in risk based contracts
July 3, 2008
Wrong Solution By The Wrong People In the Wrong Way At The Wrong Time
Analysis of: AMA meeting: Delegates decry CMS no-pay list as unrealistic and call for revision | www.ama-assn.org
Author: GLG Expert Contributor
Somehow, healthcare, energy, education....in fact nearly every major issue today has turned into a contentious "them vs. us". It would always be preferable that reasonable men attempt to reach a reasonable conclusion, but government bodies today (eg., politicians and key administrators) are...
July 3, 2008
Missing Earnings in Turbulent Times Hospital and Medical Insurers
Analysis of: AMA meeting: Delegates decry CMS no-pay list as unrealistic and call for revision | www.ama-assn.org
Author: GLG Expert Contributor
CMS (and several large insurers) refusing to pay for "Never Events" will further challenge cash strapped hospitals, and poses increased pressure to increase prices as hospitals attempt to cost-shift to the commercial carriers.  Not paying for alleged hospital mistakes will garner stronger administrative...
June 26, 2008
Trends for Chronic Kidney Disease (CKD)
Analysis of: Resource Article: “Chronic Kidney Disease Prevalence Increases, Awareness Remains Low,” Drug Benefit Trends (vol. 20, no. 5, May 2008) | jama.ama-assn.org
Author: William Fink, President, Managed Care Pharmacy Consultants, Inc
There will be an increased use of costly diaylsis, especially among those people 70 years or older.  One would think that there would be a greater awareness of a disease consting $31 billion dollars a year.  However, this does not seem to be the case.
June 20, 2008
What Today's Health Care Provider Billing System's Need Under Consumer Directed Health Plans
Analysis of: Billing System Needs Under Consumer Directed Health Plans | www.phoenixservice.net
Author: GLG Expert Contributor
Consumer directed health plans are moving the financial responsibility for payment more and more from insurers to patients.  How does this affect the information system needs of physicians, hospital and other health care providers?
Robert ForsterJune 16, 2008
Genetic testing initially will promote Chaos and misinformation
Analysis of: Experts see boost to genetic testing from US bill | www.reuters.com
Author: Robert Forster, Healthcare Consultant, Robert Forster, MD
As a clinician leader for some time, it is overtly obvious that comprehensive genetic testing will be fraught with misinterpretation and will lead to consumer confusion and potentially wrong life behavior. Genetic testing has been available for 2-3 decades on a very limited basis and for specific fetal...
Robert ForsterJune 16, 2008
Behavioral change aint easy for physicians regardless of data
Analysis of: Good is Never Enough for P4P | www.hhnmag.com
Author: Robert Forster, Healthcare Consultant, Robert Forster, MD
Although administrative and nursing/allied medical staff can and will respond to the Quality challenges, physicians (forgive my stereotyping) must be approached more comprehensively to elicit medical behavioral change based on evidenced based medicine or process improvement.  They will slow the...

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