Upload
faiza-sibtain
View
221
Download
0
Embed Size (px)
Citation preview
8/6/2019 Managed Care 11
1/19
MANAGED PATIENT CARE
8/6/2019 Managed Care 11
2/19
MANAGED CARE
y An organized health care delivery system
designed to improve both the quality and
the accessibility of health care, including
pharmaceutical care, while containing costs.
8/6/2019 Managed Care 11
3/19
8/6/2019 Managed Care 11
4/19
WHAT IS A MANAGED CARE PHARMACIST?
y The areas of opportunities for pharmacists to coordinate patientcare include but are not limited to data integration,communication management with physicians and patients,
outcomes research efforts, drug utilization review, diseasemanagement, academic detailing, cost analysis programs, andpharmacy benefit design.
y In addition, pharmacists are able to qualify and quantifythe results of different therapies and programs, and
therefore add value to the health care team.
8/6/2019 Managed Care 11
5/19
NEED OF MANAGED CARE IN HEALTH
CARE SYSTEM
y To provide comprehensive pharmaceutical care and to work
directly with other health care providers to determine the
most effective pharmaceutical treatment for patients.
8/6/2019 Managed Care 11
6/19
ASSUMPTIONSWITHMANAGED CARE
y If you keep people healthy, you reduce costs.
y If you only give people what they need (as opposed to what
they want), you can reduce costs.
yIf you make providers and patients aware of costs, they will
be more prudent in their use of services.
8/6/2019 Managed Care 11
7/19
HOW DO MANAGED CARE PLANS AFFECT QUALITY
OF CARE?
y Studies have shown that elderly, poor and chronically ill
patients have worse physical outcomes under Managed
care.
y Hospitals under managed care plans more frequentlydeny admission or prematurely discharge mentally ill
patients.
8/6/2019 Managed Care 11
8/19
POTENTIAL BENEFITS PATIENTS
y Less over-treatment
y More preventive care
y Lower cost
y Minimal paperwork
y Low or no co-payment and deductibles
8/6/2019 Managed Care 11
9/19
POTENTIAL BENEFITS PHYSICIANS
y Lower practice start-up costs
y Dependable income
y Regular hours
y Structured practice
y Incentives for cost-effective care
y Assured patients
8/6/2019 Managed Care 11
10/19
POTENTIAL BURDENS PATIENTS
y Incomprehensible benefit plans
y Limits on specialty services, hospitalization, etc.
y Physician is no longer the patients advocate
8/6/2019 Managed Care 11
11/19
POTENTIAL BURDENS PAYERS
y Complex health care plans
y Inadequate data concerning outcomes, quality of care
y Concerns about price-fixing, monopolization
y Uncertainty concerning liability
8/6/2019 Managed Care 11
12/19
Choice
Cost Quality
Conflicts
8/6/2019 Managed Care 11
13/19
8/6/2019 Managed Care 11
14/19
.
y .
TYPES OF HEALTH ECONOMICS EVALUATION
Types of healtheconomic evluation
CBACost benefit
analysis
CEACost effective
analysis
CUACost utility analysis
8/6/2019 Managed Care 11
15/19
DUR
y Process used to assess the appropriateness of drug therapy
by engaging in the evaluation of data on drug use in a given
health care environment against predetermined criteria and
standards
8/6/2019 Managed Care 11
16/19
DUR INCLUDES.
y ABC / VENANALYSIS
y High cost, high volume, clinically important drugs are identified by ABC / VENanalysis.
y ABCANALYSIS
y ABC analysis is the method by which drugs are divided according to their
annual usage (unit cost times annual consumption)y ClassA items 1020% of the items that account for 7580% of the funds
spent
y Class B items 1020% of items and 1520% of expenditures
y Class C items 6080% of items and 510% of expenditures
y ABC analysis can be used to give priority to class A items in making drug
selection and procurement decisions as well as for inclusion in DUR.
8/6/2019 Managed Care 11
17/19
VEN ANALYSIS
y VENANALYSIS
y Setting priorities for drug selection, purchasing and reviewing in which drugsare classified according to their health impact
y V = vital drugs
y E = essential drugs
y N = non-essential drugsy Vital drugs = that are potentially life-saving (e.g. vaccines) that have
significant withdrawal side-effects such that a regular supply is necessary (e.g.propranolol, insulin, steroids)
y Essential drugs = that are effective against less severe, but significant formsof illness
y Non-essential= for minor or self-limiting illnesses, drugs that are ofquestionable efficacy, and drugs that have a high cost for marginal therapeuticadvantage.
8/6/2019 Managed Care 11
18/19
PHYSICIANS REACT TO MANAGED CARE
y The general reaction of physicians to managed care is negative:
y Quality care is being denied.
y Managed care is profit-driven.
y Managed care will bring on a single payer national plan.
y Physicians get hassled and burdened with paperwork.
y Traditional physician-patient relationship is poisoned.
y Physicians income is reduced.
y Managed care induces physicians to be manipulators.
8/6/2019 Managed Care 11
19/19
CONCLUSION