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, President George W. Bush signed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This legislation was enacted to address several shortcomings in the existing Medicare program, including the lack of a prescription drug benefit for seniors in the United States. 1 Other important components, aside from outpatient prescription medications for seniors, are 2 : • grants for physicians to implement electronic prescribing • payment/reimbursement for inhalation drugs • recognition of nurse practitioners as attending physicians to serve hospice patients • coverage of an initial preventive physical examination • study/report on concierge care and coverage of chiropractic service • Medicare Advantage quality-improvement programs and research strategies for the chronically ill • study and report on drug importation One of the provisions of the MMA that is relevant to health care practitioners, managed care payers, and patients, is Section 1013. II Section 1013 Section 1013 is titled "Research on Outcomes of Health Care Items and Services." 2 It is significant because it focuses on the effectiveness, quality, and efficiency of delivered health care and improved health outcomes. Specifically, MMA Section 1013 is designed to address the lack of comparative data with respect to prescription drugs. This Act instructs the Secretary of the Department of Health & Human Services (DHHS), acting through the Agency for Healthcare Research and Quality (AHRQ), to conduct and support research with a focus on outcomes, comparative clinical effectiveness, and appropriateness of devices, pharmaceuticals, and services to meet priorities and requests for scientific evidence in a number of topic areas. 3, 4 AHRQ is the government agency whose mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. The AHRQ Effective Health Care Program has 3 basic components to gauge comparative effectiveness of different treatments and clinical practices 4 : (1) to review and synthesize existing knowledge through Evidence-based Practice Centers (EPCs), (2) to promote and generate new knowledge through the DEcIDE (Developing Evidence to Inform Decisions about Effectiveness) Research Network, and (3) to compile the findings from the EPCs and DEcIDE Network and then translate (synthesize scientific evidence about effectiveness and explain it in terms that can be more easily understood by all decision makers) and disseminate that knowledge. The John M. Eisenberg Clinical Decisions and Communications Science Center was chosen to compile the research results into a variety of useful formats for stakeholders.

OBJECTIVE: To review managed care's current cost management trends and the consumerism movement; to elucidate the pros and cons of key issues; and to describe the philosophy of focusing on the patient, also called patient-centric care, while improving the patient's care through value-based purchasing and plan design.SUMMARY: Managed care is sometimes practiced using a silo approach with little concern for the consumer. In this model, medical and pharmaceutical issues are addressed in silos, and value is narrowly defined. Increasingly, cost and responsibility is shared with or shifted to the patients. Patients may be unable or unwilling to assume these costs or responsibilities. Several studies have demonstrated that they may react with noncompliance. Managed care's definition of value must expand and integrate across silos to consider the needs and interests of the patient's overall care, in particular, addressing key cost drivers in terms of diseases that cause recurring costs. Using predictive modeling can result in cost savings. A case study (Pitney Bowes) is included in this article.

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