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Capitation and other risk-sharing arrangements have been pursued by provider organizations for the past two decades. Yet the law on whether such arrangements result in the provider organization being in the business of insurance has not fully evolved in all states.

Regardless of an insurer's composition - public or private, large or small, geographically diverse or regionally focused - reducing non-labor general and administrative (G&A) expenses can contribute greatly to margin improvement.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted to expand the recommended ages for annual influenza vaccination to include all children from 6 months through 18 years of age.

The purpose of the attorney-client privilege is to encourage frank communications between attorneys and clients, which promotes dissemination of sound legal advice. Regarding the Employee Retirement Income Security Act of 1974, as amended ("ERISA"), some courts have found that an ERISA plan fiduciary may not assert the attorney-client privilege against plan participants regarding matters of plan administration.

An investigational first-in-class dual angiotensin and endothelin receptor antagonist lowered systolic blood pressure (SBP) in patients with stage 1 and 2 hypertension in a phase 2a trial, reported Joel M. Neutel, MD, associate professor of medicine, University of California, Irvine, and medical director of clinical pharmacology, Orange County Research Center, Tustin, California. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.

The combination of amlodipine and olmesartan was demonstrated to be superior to monotherapy with either agent in difficult-to-treat hypertensive populations in a subgroup analysis of the registrational trial for this combination therapy. These results were presented at the 23rd Annual Scientific Meeting of the American Society of Hypertension, New Orleans, May 14–17, 2008.

The number of major employers offering employee wellness programs with incentives grew over the past year, according to a study presented by Health2 Resources. The National Association of Manufacturers and The ERISA Industry Committee participated in the survey.

The National Committee for Quality Assurance’s (NCQA’s) proposed standards and measures for a new Wellness and Health Promotion (WHP) product evaluation have been released for public comment.

Access to coverage, especially for individuals and small groups, is a constant issue. So much so that many Americans are taking great steps to change their lifestyles in order to obtain it. Get married to gain access to insurance? Some are doing just that.

Two votes from Republican senators killed a House bill that would have averted statutory payment reductions for Medicare physicians, just before legislators left Capitol Hill for their Independence Day holiday. Medicare physicians now face 10.6% fee cuts, but there is an opportunity for retrospective increases after the recess.

The risk of fracture is probably only slightly increased in persons with type 2 diabetes, said Peter Vestergaard, MD, PhD, DrMedSc, from the Osteoporosis Clinic, Aarhus Amtssygehus, Denmark.

Real-time continuous glucose monitoring (CGM) can significantly improve glycemic control, but it will not help all patients. "Real-time CGM will add significantly to glucose management for some people, but not for all," said Irl Hirsch, MD, University of Washington, Seattle. "Human factors make all the difference between success and failure. Some patients will never figure it out. That?s why real-time control is so challenging.

Good glycemic control is not sufficient to relieve painful diabetic neuropathy, necessitating investigation of other modalities to achieve analgesic efficacy. Dan Ziegler, MD, German Diabetes Clinic, German Diabetes Center, and professor of internal medicine, Leibniz Institute at the Heinrich Heine University, Düsseldorf, provided an overview of pharmacologic treatments that have been explored for painful diabetic neuropathy and the success achieved with each.

Clinicians and type 2 diabetes patients have a new worry: hepatic steatosis, or nonalcoholic fatty liver disease. Liver disease is a less-obvious problem than kidney disease but may have equally grave consequences.

Healthcare reform is a high-profile issue in the presidential election campaign, and drug access has become a central theme in the debate. Both Democratic and Republican candidates have rolled out healthcare reform plans that promise to cover the uninsured while also providing tax breaks and other incentives to help individuals obtain health insurance.

Ambulatory patients with cancer who are undergoing chemotherapy should not receive prophylactic anticoagulation to prevent venous thromboembolism, according to new guidelines developed by ASCO. "It's not cost effective and we also do not recommend screening these patients for thrombophilia," said Mark Levine, MD, McMaster University, Hamilton, Ontario, Canada.

Physicians treating cancer-related depression with paroxetine should not expect patients' insomnia to also improve, according to a study presented by Oxana G. Palesh, PhD, University of Rochester Cancer Center, NY. "We know that insomnia and depression often occur together frequently in the general population, suggesting that there may be a common mechanism," she said.

Metformin may represent a novel antitumor agent, say investigators from the University of Texas M.D. Anderson Cancer Center, Houston.

Several factors contribute to a disparity of cancer care and outcomes between minority and majority populations in the United States.

Advanced age should not be a barrier to initiating adjuvant chemotherapy in patients with stage III colon cancer. In an observational study, the oldest patients suffered no more adverse events when treated with adjuvant chemotherapy than did younger patients but were much less likely than their younger counterparts to actually receive adjuvant chemotherapy for their colon cancer, said Katherine L. Khan, MD, professor of medicine at the University of California, Los Angeles.

Cancer-related fatigue significantly interferes with patients' quality of life, and some areas often affected among these patients are not normally included on standard quality-of-life assessments, said Karen M. Mustian, PhD, University of Rochester School of Medicine, NY. More randomized, controlled trials are needed to identify these areas, she said.

Magnetic resonance imaging (MRI) is superior to mammography alone in diagnosing intraductal components of invasive breast cancer, allowing more accurate mapping before breast conservation surgery, said Simone Schrading, MD, Department of Radiology, University of Bonn, Germany.

An individualized exercise program may significantly reduce fatigue, increase strength, and improve psychosocial functioning during cancer treatment, according to results of a small study reported by Maike de Wit, University Clinic Hamburg, Germany.

An RNA signature present in blood that is highly accurate for detecting prevalent lung cancer can accurately predict the development of lung cancer within the next 2 years 80% of the time, said Thomas Zander, MD, Department of Internal Medicine and the Center for Integrated Oncology, University Clinic Cologne, Germany. "Early detection of lung cancer is a major need, as most patients present for diagnosis at a late stage when there is no chance for cure," Dr Zander said. Two-year survival after a lung cancer diagnosis is approximately 15%. Early detection may therefore be a promising strategy to improve survival rates.

A small study suggests that acupuncture has the potential to reduce pain and dysfunction in patients with head and neck cancer who have undergone neck dissection, said David G. Pfister, MD, chief, Head and Neck Medical Oncology, Memorial Sloan Kettering Cancer Center, New York.

High-dose vitamin D supplementation can provide relief of symptoms related to vitamin D deficiency from aromatase inhibitor therapy in postmenopausal women with breast cancer, said Q.J. Khan, MD, Cancer Center of Kansas, Wichita.

Most elderly patients do not receive combined modality treatment (CMT) with both chemotherapy and radiation for locally advanced, non-small cell lung cancer (NSCLC) despite trial data indicating that CMT enhances survival, decreases comorbidities, and is potentially curative. Data presented by Martin J. Edelman, MD, professor of medicine, University of Maryland Greenebaum Cancer Center, Baltimore, indicate that elderly patients receiving chemotherapy followed by concurrent chemotherapy and radiation derive the most significant survival benefit.

Strict evidence-based criteria should be used when prescribing erythropoiesis-stimulating agents (ESAs) for cancer, as ESAs appear to activate signaling pathways that are important in altering tumor behavior and treatment response, experts said.