Vol. 18, No. 1, 2015 Educating Medical Directors of Employers, Health Plans and Provider Systems FEATURED ARTICLES INCLUDE: GBEMTI Perspectives: U.S. Managed Care Perspectives on Assessment and Uptake of Molecular Diagnostics: State of the Union and Areas for Additional Improvement Advanced Non-Small Cell Lung Cancer: Toward a Personalized Approach Risk Stratification: The Practical Implementation of a Powerful Tool THE NEW NONINVASIVE OPTION FOR AVERAGE- RISK PATIENTS WHO AVOID COLONOSCOPY Cologuard is the colorectal cancer screening test that uses innovative stool DNA technology to detect cancer with 92% sensitivity and 87% specificity.1 It’s noninvasive and easy to use, with no special preparation required. No wonder patients are excited—and you will be, too. Covered by Medicare. CologuardTest.com. Cologuard is intended for the qualitative detection of colorectal neoplasia associated DNA markers and for the presence of occult hemoglobin in human stool. A positive result may indicate the presence of colorectal cancer (CRC) or advanced adenoma (AA) and should be followed by diagnostic colonoscopy. Cologuard is indicated to screen adults of either sex, 50 years or older, who are at typical average-risk for CRC. Cologuard is not a replacement for diagnostic colonoscopy or surveillance colonoscopy in high risk individuals. Rx only. 1. Imperiale TF, Ransohoff DF, Itzkowitz SH, et al. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med. 2014;370(4):1987-97. Cologuard is a registered trademark of Exact Sciences Corporation. ©2015 Exact Sciences Corporation. All rights reserved. CG-00120-01-January 2015 XXXXX_NAMCP_PrintAd_1-0.indd 1 1/22/15 4:14 PM Journal of Managed Care Medicine JMCM The Official Journal of the NATIONAL ASSOCIATION OF MANAGED CARE PHYSICIANS MEDICAL DIRECTORS INSTITUTE JOURNAL OF MANAGED CARE A Peer-Reviewed Publication MEDICINE Vol. 18, No. 1, 2015 4435 Waterfront Drive, Suite 101 Glen Allen, VA 23060 (804) 527-1905 fax (804) 747-5316 TABLE OF CONTENTS EDITOR-IN-CHIEF J. Ronald Hunt, MD GBEMTI Perspectives – U.S. Managed Care Perspectives on Assessment and Uptake of Molecular Diagnostics: State of the Union and Areas for PUBLISHER Additional Improvement Katie Eads Eric Faulkner, Joshua Ransom, Geneva Briggs, PharmD, John Hanna. 5 DIRECTOR OF Advanced Therapeutic Strategies in the Successful COmmUNICATIONS Management for Patients with CRPC Jeremy Williams Pamela Ellsworth, MD . 15 JOURNAL MANAGEMENT Emerging Trends and Strategies in the Treatment and Douglas Murphy Management of Metastatic Melanoma Communications Inc. P.O. Box 71895 Evan J. Lipson, MD. 20 Richmond, VA 23255-1895 (804) 387-7580 Evolving Treatment Paradigms in the Management fax (703) 997-5842 of Relapsed/Refractory Multiple Myeloma Cristina Gasparetto, MD.. 24 MANAGING EDITOR Barry Barnum Advanced Non-Small Cell Lung Cancer: Toward a Personalized Approach [email protected] Shirish M. Gadgeel, MD. 28 GRAPHIC DESIGN Incorporating Updated Treatment Strategies in the Management of PAH Douglas Murphy Communications, Inc. Victor F. Tapson, MD, FCCP, FRCP . 32 Custom Article Reprints Optimizing Treatment Strategies to Improve Patient High quality reprints of individual articles Outcomes in the Management of Type 2 Diabetes are available in print and electronic formats. Contact Katie Eads, [email protected], Philip Raskin, MD. 35 804-527-1905 for reprints. Practical Strategies to Improve Patient Outcomes in the Prevention and Treatment of COPD ISSN:ISSN: 1094-1525.1094-1525. TheThe v Journalis published of Managed by Association Care Robert Sussman, MD. 39 ServicesMedicine Inc.is published Corporate by Associationand Circulation Services offices: Inc. 4435Corporate Waterfront and Circulation Drive, Suite offices: 101, Glen4435 Allen,Waterfront VA 23060; Tel (804) 527-1905; Fax (804) 747-5316. Edito- Drive, Suite 101, Glen Allen, VA 23060; Tel (804) 527- rial and Production offices: 2613 N. Parham Rd., Utilizing Anticoagulants for Atrial Fibrillation Related Stroke Prevention Suite1905; B,Fax Richmond, (804) 747-5316. VA 23294; Editorial Tel and(804) Production 272-9100; Faxoffices: (804) P.O.272-1694. Box 71895, Advertising Richmond, offices: VA 23255-1895;Jack Klose, Rajat Deo, MD, MTR. 44 804Tel (804)Broadway, 387-7580; W. Long Fax (703)Branch, 997-5842. 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Takaji Kittaka, Jr, MD. 47 reproducedtransmitted inor any transmitted form or by in any any means, form electronicor by any means,or mechanical, electronic including or mechanical, photocopy, including recording, photo or- copy,any information recording, storage or any orinformation retrieval system, storage without or re- Current and Emerging Treatments and Novel trievalwritten system,consent withoutfrom the written publisher. consent The publisherfrom the publisher. The publisher does not guarantee, ei- does not guarantee, either expressly or by implica- ther expressly or by implication, the factual accu- Strategies in the Management of MS racytion, ofthe the factual articles accuracy and descriptions of the articles herein, and denor- doesscriptions the publisher herein, nor guarantee does the publisherthe accuracy guarantee of any Shiv Saidha, MD, MRCPI. 51 viewsthe accuracy or opinions of any offered views or by opinions the authors offered of said by the ar- ticlesauthors or ofdescriptions. said articles or descriptions. Improving Patient Outcomes in the Management of Obesity: POSTMASTER: Send address changes to The POSTMASTER: Send address changes to The Journal of Managed Care Medicine, 4435 Water- A Closer Look at New Treatment Options frontJournal Drive, of Managed Suite 101, Care Glen Medicine, Allen, VA 4435 23060. Water- front Drive, Suite 101, Glen Allen, VA 23060. Salila Kurra, MD . 56 www.namcp.org | Vol. 18, No. 1 | Journal of Managed Care Medicine 3 Editorial Review Board Alan Adler, MD, MS Sarath Gunatilake, MD, DrPH Gary Owens, MD Medical Director Professor, Health Science Department Principal Independence Blue Cross California State University, Long Beach Gary Owens Associates Devena Alston-Johnson, MD John W. Heryer, MD, FACS Philip Painter, MD Medical Director Medical Director Chief Medical Officer CIGNA Blue Cross Blue Shield of Kansas City Humana E. Paul Amundson, MD Kathy Hudson, PhD Mary H. Pak, MD Chief Medical Officer Director, Genetics and Public Policy Center Medical Director Dakotacare Johns Hopkins University Unity Health Plans Insurance Corporation Linda Ash-Jackson, MD Larry L. Hsu, MD Medical Director Medical Director Gary R. Proctor, MD Hometown Health Blue Cross Blue Shield of Hawaii (HMSA) Chief Medical Officer, Federal Division ValueOptions, Inc. Paul Bluestein, MD Stephen Keir, DrPH Co-Director, Center for Quality of Life Chief Medical Officer Carlos Ramirez, MD Connecticare Support Care Research Chief Medical Officer Robert Preston Tisch Brain Tumor Center Valley Baptist Health Plans Richard Bock, MD, MBA John Knispel, MD, CPE, FACOG Chief Medical Officer Paul Rein, DO Regional Medical Officer Molina Health Care of California Medical Director Humana Port Warwick Ambulatory Surgery Center Anthony Bonagura, MD Karen Knowles, MD Chief Medical Officer Internal Medicine Physician Kevin Roache, MD, MMM, CPE, FACPE Aetna, Inc. HCA/Emcare Vice President Medical Affairs Peoples Health, Inc. Salil V. Deshpande, MD Catherine Marino, MD Market Medical Officer Chief Medical Officer Joseph Schappert, MD United Healthcare MagnaCare Chief Medical Officer PAML Michael Fine, MD Jeff Martin, PharmD Medical Director Clinical Account Director Christine M. Seals, MD Health Net Innoviant, Inc. Medical Director Umpqua Health Alliance John K. Fong, MD, MBA Monte Masten, MD, MBA, MPH Vice President Senior Consultant Health & Group Jacque J. Sokolov, MD Blue Cross Blue Shield of North Carolina Benefits, Tower Watson Chairman SSB Solutions Stephen Friedhoff, MD Wesley Mizutani, MD Senior Vice President, National Medical Director Clinical Research & Chairman Scott Spradlin, DO, FACPE, ACOI Director Department of Rheumatology Vice President Medical Affairs/Chief Amerigroup/Wellpoint Healthcare Partners Medical Officer Group Health Plan Ronald Y. Fujimoto, DO, FAAFP Thomas Morrow, MD Chief Medical Officer Next IT William D. Strampel, DO, FACOI United Healthcare Dean, College of Osteopathic Medicine Barbara Nabrit-Stephens, MD, MBA Michigan State University Uwe G. Goehlert, MD, MSC, MPH, MBA Medical Director Principal United Healthcare Prentiss Taylor, MD Goehlert & Associates Corporate Medical Director Tim Newman, MD Advocate At Work at Advocate Steven E. Goldberg, MD, MBA Medical Director Health Care Vice President of Medical Affairs FirstEnergy Coventry Health Care of Kentucky Denis O’Connell, MD Pamella Thomas, MD,MPH, FACOEM Humberto Guerra-Garcia, MD, MPH, Medical Director Consulting Medical Director FACP Blue Cross Blue Shield of North Carolina Wellness Health & Productivity Strategies Chief Medical Officer MMM Healthcare, Inc./PMC Medicare Arik Olson, MD, MBA Robert A. Ziff, MD, MBA, FACS, CPE Choice Senior