There are no fewer than a dozen PBMs (pharmacy benefit managers) on the exhibit floor. All of the industry leaders are there along with new entrants and some I've not seen before. This is a bit of a change from last year, where there seemed to be fewer PBMs. I'm not sure why the PBMs have returned in force, or more accurately there are new entrants, but my guess is the increased presence is due to all the publicity surrounding the increase in drug costs in workers comp.

In a presentation on Medical Nuts and Bolts, Dr. John Cherf noted that if everyone in the (quite large) audience had an MRI of their back, abnormalities would be seen. Bulging discs, herniated discs, and other malformations and potential problems would show up, most of which would be asymptomatic. This is not new news, but reinforces the (correct) common knowledge that MRIs of the back are not terribly useful, and may be counter-productive.

By and large, presentations from companies active in the industry (carriers and TPAs) are less forthcoming than those from larger employers and providers. This is somewhat understandable given carrier/TPA concerns about revealing too much to competitors. My take is this is shortsighted, as there are also potential customers in the audience.

And it always comes down to execution - if the payer executes well, they don't really need to worry about the competition.

Next year, expect to hear more about pay for performance (John Cherf), the potential impact of next year's election (Dr. George Holmes), and perhaps the most useful cliche I've heard so far, "the only thing more expensive than a good doctor is a bad doctor."

More to come...