Dear VIJAY PITHADIA:
Each morning the sun rises and each evening the sun sets. A fact, except that it’s wrong. In the fourth century B.C., Aristarchus argued that the sun remains stationary while the earth moves. Ptolemy disagreed, but it wasn’t until Copernicus took up the argument two millennia later that Aristarchus was finally proved right. Managed Care’s August issue profiles 7 contrarians. Their ideas are nowhere near universal acceptance. But in time…? You may not agree, but you can’t ignore when someone says CMS is going to tank, or ACOs are doomed, or not-for-profit insurers will come to dominate the markets. Do wellness programs discriminate, and is it time for a single-payer system? Time will tell. —John Marcille, Editor The Contrarians The history of health care in the United States is filled with contrarians, those who identified the system's failings and offered new, unproven ideas. For-profit insurers have historically encountered very little competition in many markets. Health reform is changing that. Accountable care organizations (ACOs) have very little experience with utilization management. In fact, they hate it. The problem is that it functions as both a payer and a regulator and, therefore, has conflicting missions. Despite the ACA, in 10 years we will still have 31 million uninsured. Cancer patients, especially, will continue to go broke. Value-based insurance design will change the conversation from how much we spend to how well we spend. Physicians, hospitals, and other providers pursue profit while all but ignoring the need for long-term cost control and quality improvement. Savings may not come from health improvement. They may come instead from shifting costs to low-earning, less-healthy employees. Politicians must defend where they stand on the Affordable Care Act. This discussion cannot be avoided, and the public remains divided. In this article, four experts explain the points of contention, as well as places where everybody seems to agree -- such as allowing young adults to stay on their parents' plans and providing coverage for pre-existing conditions. FOCUS ON BIOLOGICS It can be tricky, because these medications are expensive and require strict adherence. Then there's the fear factor. They tend to dislike injecting themselves, and will often abandon the regimen once they feel better. Conflicting findings from the huge phase 3 ALTTO trial and the NeoALTTO trial, the neoadjuvant counterpart to ALTTO, stole the spotlight at the annual meeting of the American Society of Clinical Oncology.
Call for papers We hope you enjoy this issue of Managed Care. If you have comments about any of the articles, suggestions for future articles, or manuscripts, please send an e-mail to me at jmarcille@medimedia.com. Sincerely,
John Marcille, Editor
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