Managed Care Issues Research Articles

Pharmacy students' views of managed care pharmacy and PBMS: should there be more exposure to managed care in the pharmacy curriculum?

New accreditation standards implemented in 2007 have required schools of pharmacy to evaluate their existing curricula. An issue frequently encountered is the limited amount of content in the pharmacy curriculum specific to managed care and the role and function of pharmacy benefit management companies (PBMs). To determine pharmacy student knowledge and opinions about managed care pharmacy, including the function of PBMs in the delivery of health care, in a college of pharmacy, and to explore tendencies in communication between pharmacy interns and patients in the community setting. Students from all 4 PharmD years (n = 663) in 1 college of pharmacy were invited to complete an online survey consisting of 19 questions on demographics, students' views and understanding of PBMs, and interest in working at a PBM in their career. Follow-up in-person and online focus group sessions with representatives from each pharmacy class year were conducted to collect information from students regarding views and understanding of managed care pharmacy. Focus group data were analyzed using a constant comparative method by 2 independent researchers. Of 374 respondents, 332 (88.8%) answered all of the survey questions and were included in the analysis. Most students (72.0%) indicated that they understand little or nothing about the functions of PBMs; 84.3% rated the amount that they had been taught about PBMs in pharmacy school as "inadequate" or "very inadequate;" and 45.2% indicated little or no interest in a PBM career. Yet, 34.7% (99 of 285) of students with past or current community pharmacy work experience rated the percentage of time that PBMs directly affected their practice worksite during a shift at 50% or greater. Focus group emerging themes confirmed survey data findings that students feel uninformed about managed care but regularly communicate with patients about managed care issues. Focus group findings also suggest that students may perceive managed care to be a "masculine," "uncaring" field. In an exploratory survey conducted at 1 pharmacy school, students perceived themselves as generally uninformed about managed care issues, yet more than one-third believed that dealing with PBMs constituted a significant portion of their work day as community-based pharmacy interns. Managed care understanding is necessary for all pharmacy students because most graduates will practice in community settings. Patients are exposed to managed care and their pharmacy benefit primarily at the point of medication procurement and medication counseling. As a result, pharmacists provide many patients with managed care and pharmacy benefit education. Schools of pharmacy may wish to evaluate and consider increasing the amount of curriculum content specific to managed care and PBMs.

Exposure-Based Treatment for a Child With Stabbing Obsessions

This article describes the course of treatment for a 10-year-old boy presenting with a particularly challenging manifestation of pediatric Obsessive-Compulsive Disorder (OCD). Guided by a manualized cognitive-behavioral protocol, cognitive and exposure-based techniques were tailored to “match” the clients' interests and content of symptoms (stabbing self and mother). Several sources of information (continuous self-monitoring, rating scales, self-and parent-report) indicated significant treatment gains that were sustained 3 months posttreatment and offer possible insight as to the relative efficacy of treatment components. Several challenges were encountered, most notably designing and supervising exposure exercises involving sharp objects. Several treatment implications are discussed including tailoring manualized treatments, managed care issues, and recommendations for students, clinicians, and supervisors.

Managed care considerations.

Managed care issues arising from excessive daytime sleepiness (EDS), which impacts as many as 37% of adults, are widespread. In the United States, insomnia is among the 3 most common complaints. Often it is younger people who have difficulty falling asleep, whereas their elders report more difficulty remaining asleep. Currently, people in the United States sleep 25% fewer hours than they did 100 years ago. Chronic sleep deprivation may be a choice driven by economic or social factors. Industrialized countries engage about 20% of the work force in shifts, and people working night shifts are thought to average 8 fewer hours of sleep each week than day workers. Falling asleep behind the wheel is the single most imminent risk associated with excessive sleepiness.

Viscosupplementation: managed care issues for osteoarthritis of the knee.

Osteoarthritis (OA) affects an estimated 49 million adults in North America, or nearly 1 of every 6 adults. More than 8 million North Americans have limited mobility to some extent because of OA. By 2030, an estimated 71 million North Americans will be diagnosed with OA, an increase of 45% over current figures. For one group-model health maintenance organization (HMO), the average cost of care for patients with OA was $543 per member, a total annual cost to the HMO of $4,728,425. Of this total amount, 46% was for inpatient care, 32% was for medication, and 22% was for ambulatory care. To determine the impact of OA on managed care and discuss treatment options available to those with OA, particularly of the knee. OA represents an advanced stage of an active, progressive disease process. We know from medical research that OA is the endpoint of a progression in tissue degradation that results in loss of cartilage structure and function. Relief of pain and preservation of joint tissue must evolve to encompass treatments that interfere with cartilage-degrading mechanisms that follow acute or chronic injury, restore normal cartilage and joint homeostasis, and arrest the progression of disease. Optimal future treatments will also reverse existing damage and restore normal cartilage structure and function. Viscosupplementation with an elastoviscous fluid containing polymers of hylan derivatives of the natural glycosaminoglycan hyaluronan is indicated for treating pain of OA of the knee that has not responded to or is contraindicated for conservative nonpharmacologic therapy and traditional analgesics. These analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and cyclooxygenase-2 (COX-2) inhibitors. Clinicians in the managed care setting may consider using viscosupplementation in patients (1) who have persistent pain despite their use of conservative nonpharmacologic and pharmacologic therapy (e.g., exercise, weight loss, physician therapy, bracing/orthotics, NSAIDs, COX-2 inhibitors, and intra-articular glucocorticoids); (2) who have compromised gastrointestinal (GI) function or who are at risk for GI bleeding due to the adverse events of NSAIDs; (3) who are taking concomitant anticoagulant therapy for any condition; (4) who have cardiovascular or renal risk factors that preclude use of COX-2 inhibitors; and (5) for whom surgery is not appropriate. Further study should be conducted with larger numbers of patients to help identify a subgroup of patients with OA in whom viscosupplementation may have even greater effects. Additional research should also concentrate on assessing the risks and benefits of extended treatments, because limited data are available concerning the effectiveness of multiple courses of therapy. OA is an important public health issue as the leading cause of disability in North America. As populations age, socioeconomic costs of OA will dramatically increase. Among available treatment options, viscosupplementation is a valuable alternative to more conservative therapy and has the benefit of circumventing the possible side effects of systemically administered pharmacologic agents. Viscosupplementation demonstrated efficacy in OA of the knee, and its use in the managed care arena may generate savings in hospitalizations and other costs.

The Use of Exposure and Ritual Prevention in the Treatment of Harm Obsessions With Covert Compulsions

This case study illustrates the use of exposure and ritual prevention in the treatment of obsessive-compulsive disorder (OCD) involving obsessional thoughts but without overt compulsions. Such presentations, once considered rare and treatment resistant, are now thought to represent a considerable portion of OCD sufferers. Recently, innovative treatment approaches with exposure and ritual prevention have shown encouraging treatment outcomes for this population. Successful treatment requires careful assessment of cognitive misappraisals and covert compulsions. A theoretical and research basis for obsessions is discussed along with a cognitive behavioral conceptualization of the problem. A detailed discussion of the course of treatment, complicating factors, managed-care issues, and recommendations to clinicians is included.

Improved resource utilization in a practice with a high indigent patient population

Medicaid provides care for 11.2% of the population in the United States, and an additional 14% are uninsured. Poor reimbursement, restricted formularies, high no-show rates, managed care issues, and a population that often requires complex care, create difficulties in providing care for under/uninsured patients (US, those with Medicaid or no insurance). University Dermatology is the faculty practice of the Department of Dermatology at Wayne State University School of Medicine. We are an office-based private practice with locations in downtown Detroit and a suburb of Detroit, Rochester Hills. Both sites are managed and run by the same staff and physicians, but the patient composition varies significantly (40% US downtown; <2% US in the suburbs).

The Mental Health Practitioner and the Law: A Comprehensive Handbook

Back to table of contents Previous article Next article Book ReviewFull AccessThe Mental Health Practitioner and the Law: A Comprehensive HandbookRayna L. Rogers, D.O.Rayna L. RogersSearch for more papers by this author, D.O.Published Online:1 Aug 2000https://doi.org/10.1176/appi.ps.51.8.1055-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Mental Health Practitioner and the Law is described as "a comprehensive handbook." The book is not "comprehensive" in the sense that a psychiatrist preparing to take the added-qualifications examination could rely on it alone for enough information to pass the exam, but it is certainly an excellent treatment of several pressing and timely issues in medicine and the law.The book's stated objective is to provide information on risk management to medical and mental health practitioners, and the editors have soundly achieved this objective. Practical tips on how to avoid being sued by patients are presented clearly and distinctly. The authors of each chapter have been careful to use language that is generic and egalitarian. Thus professionals from any discipline can learn from this handbook without feeling patronized. An especially welcome note is the focus on the cold realities of living in a managed care world. Managed care issues are addressed frankly and applied to every aspect of both clinical and forensic topics. To date, I have not seen a text that addresses these issues so thoroughly.The Mental Health Practitioner and the Law would be very helpful for mental health trainees preparing for clinical practice. Another target audience is forensic professionals who consult to colleagues about litigation matters and how to avoid them. Many of the later chapters are written at an advanced level and would be a useful update for even the most seasoned forensic professionals. I have already incorporated many points from this book into my own teaching of psychiatric residents at the University of California, San Francisco.In summary, The Mental Health Practitioner and the Law would be a welcome addition to any library. As more and more professionals enter the forensic arena, they need skills to interact safely and appropriately with the legal system. The final section about testimony and other expert-witness functions will prepare inexperienced professionals going to court for a good experience rather than a narcissistically traumatic one. Fortified with the information these authors provide, even a novice may enter the courtroom with serenity and confidence. Furthermore, clinicians who must deal with third-party payers and managed care schemes will gain new tools to protect themselves and their patients from exploitation. This is a gift of great merit.Dr. Rogers, a child and adolescent and forensic psychiatrist, is associate clinical professor in the psychiatry and law program at the University of California, San Francisco.edited by Lawrence E. Lifson, M.D., and Robert I. Simon, M.D.; Cambridge, Massachusetts, Harvard University Press, 1998, 395 pages, $49.95 FiguresReferencesCited byDetailsCited ByNone Volume 51Issue 8 August 2000Pages 1055-a-1056 Metrics History Published online 1 August 2000 Published in print 1 August 2000

Ethical Issues in Managed Care

Ethical Issues in Managed Care

米国におけるマネジドケアの現状と課題

米国におけるマネジドケアの現状と課題

The Impact of Interventions with Families Poststroke: A Review

(1998). The Impact of Interventions with Families Poststroke: A Review. Topics in Stroke Rehabilitation: Vol. 5, Issues in Managed Care and the Stroke Patient, pp. 69-85.

Pediatricians valued by employers, consumers: District IX survey

In 1994, when AAP District IX members began expressing strong concerns about managed care issues affecting their pediatric practices, the Managed Care Task Force was established. California9s rapidly changing health care delivery system and the shift of more patients into HMO plans, both in the private and Medi-Cal sectors, raised important issues among pediatricians. Members worried that patients in managed care plans might not have access to pediatricians for primary care and specialty services. Another concern was that pediatricians might not be categorized as primary care professionals in some HMOs/IPAs—only as specialists.

The Managed Health Care Handbook

This thoroughly revised and updated book provides a strategic and operational resource for use in planning and decision-making. The Handbook enables readers to fine-tune operation strategies by providing updates on critical managed care issues, insights to the complex managed care environment, and methods to gain and maintain cost-efficient, high quality health services. With 30 new chapters, it includes advice from managers in the field on how to succeed in every aspect of managed care including: quality management, claims and benefits administration, and managing patient demand. The Handbook is considered to be the standard resource for the managed care industry.

Future rural managed care issues.

Future rural managed care issues.

Ethical Issues in Managed Care

Ethical Issues in Managed Care

Legal issues in managed care: the pediatrician's perspective.

Legal issues in managed care: the pediatrician's perspective.

Ethical issues in managed care: selected bibliography.

Ethical Issues in Managed Care Martina Darragh (bio) This selected bibliography supplements and updates Scope Note 31 “Managed Health Care: New Ethical Issues for All,” which appeared in the June 1996 issue of the Kennedy Institute of Ethics Journal 6 (2): 189–207. The citations, which represent literature from 1996 and 1997, have been selected from BIOETHICSLINE, the electronic database prepared at the Kennedy Institute of Ethics for the National Library of Medicine’s MEDLARS system. Angell, Marcia, and Kassirer, Jerome P. Quality and the Medical Marketplace—Following Elephants. [Editorial]. New England Journal of Medicine 335 (19 September 1996): 883–85. Balint, John, and Shelton, Wayne. Regaining the Initiative: Forging a New Model of the Patient-Physician Relationship. JAMA 275 (20 March 1996): 887–91. Bell, Howard. Managed Care Ethics: a Delicate Balance. Minnesota Medicine 79 (June 1996): 10–16. Berkowitz, Eric N. The Evolving Health Care Marketplace: How Important Is the Patient? Bioethics Forum 12 (Summer 1996): 40–44. Bernardin, Joseph. Managing Managed Care. Origins 26 (30 May 1996): 21–26. Biblo, Joan D.; Christopher, Myra J.; Johnson, Linda; and Potter, Robert Lyman. Ethical Issues in Managed Care: Guidelines for Clinicians and Recommendations to Accrediting Organizations. Bioethics Forum 12 (Spring 1996): MC/1–MC/24. Bodenheimer, Thomas. The HMO Backlash—Righteous or Reactionary? New England Journal of Medicine 335 (21 November 1996): 1601–4. Brody, Howard. Edmund D. Pellegrino’s Philosophy of Family Practice. Theoretical Medicine. 18 (March–June 1997): 7–20. Boozang, Kathleen M. Developing Public Policy for Sectarian Providers: Accommodating Religious Beliefs and Obtaining Access to Care. Journal of Law, Medicine & Ethics 24 (Summer 1996): 90–98. Brodeur, Dennis. Choice, Managed Care, and the Ethics Committee. Issues: A Critical Examination of Contemporary Ethical Issues in Health Care 11 (July–August 1996): 1–8. Byron, William J. Catholic Health Care: Partnering and Progress. America 175 (28 September 1996): 16–21. Capron, Alexander Morgan. Between Doctor and Patient. Hastings Center Report 26 (September–October 1996): 23–24. Cassel, Christine K. The Patient-Physician Covenant: An Affirmation of Asklepios. [Editorial]. Annals of Internal Medicine 124 (15 March 1996): 604–6. Christensen, Kate T. Physicians and Managed Care: Employees or Professionals? Bioethics Forum 12 (Spring 1996): 17–20. Churchill, Larry R. “Damaged Humanity”: The Call for a Patient-Centered Medical Ethic in the Managed Care Era. Theoretical Medicine 18 (March–June 1997): 113–26. Churchill, Larry R. Whose Good? Rethinking Beneficence in the Era of Managed Care. Clinical Ethics Report 10 (Spring/Summer 1996): 1–8. Cushman, Reid. Privacy, Confidentiality, and Security Issues for Electronic Health Care Information. In: BioLaw: A Legal and Ethical Reporter on Medicine, Health Care, and Bioengineering, Special Sections 2 (2–3): S:1–S:25. Frederick, MD: University Publications of America, February–March 1996. Daniels, Norman. National Health-Care Reform. In: Medical Ethics, 2d ed., ed. Robert M. Veatch, pp. 415–41. Sudbury, MA: Jones and Bartlett, 1997. Davis, Dena S. Legal Trends in Bioethics. Journal of Clinical Ethics 7 (Spring 1996): 90–94. DeGrazia, David. Why the United States Should Adopt a Single-Payer System of Health Care Finance. Kennedy Institute of Ethics Journal 6 (June 1996): 145–60. Eleazer, G. Paul; Hornung, Carlton A.; Egbert, Carolyn B.; et al. The Relationship Between Ethnicity and Advance Directives in a Frail Older Population. Journal of the American Geriatrics Society 44 (August 1996): 938–43. Ellwood, Paul M., and Lundberg, George D. Managed Care: a Work in Progress. [Editorial]. JAMA 276 (2 October 1996): 1083–86. Emanuel, Ezekiel J., and Emanuel, Linda L. What Is Accountability in Health Care? Annals of Internal Medicine 124 (15 January 1996): 229–39. Emanuel, Linda L. Professional Standards in Health Care: Calling All Parties to Account. [Commentary]. Health Affairs 16 (January–February 1997): 52–54. Felder, Michael. Can Ethics Committees Work in Managed Care Plans? Bioethics Forum 12 (Spring 1996): 10–15. Ferber, Joel D. Auto-Assignment and Enrollment in Medicaid Managed Care Programs. Journal of Law, Medicine & Ethics 24 (Summer 1996): 99–107. Firshein, Jane. Us Doctors Fight Gag Clauses in Contracts. [News].Lancet 347 (8994, 13 January 1996): 113. Flanigan, Rosemary. The Dilemma of the Medical Director for AAA Managed Care Plan. [Case Study and Analysis]. Bioethics Forum 12...

Practice management and managed-care issues in onychomycosis.

The author gives a general overview of recommendations for practice success in a managed-care environment and describes a new practice paradigm for the treatment of onychomycosis. Recommendations are provided for ensuring optimal reimbursement, particularly in the treatment of managed-care and Medicare patients.

Pediatric emergency department analgesic practice.

To review recent acute pain management care issues in a pediatric emergency department (ED) in order to identify opportunities for a performance improvement program. Descriptive, retrospective chart review. Urban pediatric hospital ED. Between January 1 and December 31, 1994 consecutive patients identified by ED chart review with the following three acute painful conditions were included; sickle cell vasoocclusive crisis (VOC) not complicated by fever or neurologic symptoms, isolated lower extremity long bone fractures < 12 hours old that did not require a reduction, and second degree burns < 12 hours old. Data collection concluded when between 50 and 55 episodes of each painful condition were identified. ED analgesic administration, initial analgesic dose, initial time elapsed to analgesic administration, notation of pain relief, and home analgesic instruction. Recommended analgesic starting doses were chosen from the 1992 Agency for Health Care Policy and Research Clinical Practice Guidelines. None. ED analgesic use for VOC was 100%, for fracture was 31%, and for burn was 26%. A recommended starting analgesic dose was given to 78% with VOC, 69% with fracture, and 79% with burn. Mean time to initial analgesic for VOC was 52 minutes, for fracture was 86 minutes, and for burn was 29 minutes. In those given analgesics, notation of pain relief for fracture was 19% and for burn was 29%, this improved for VOC where it was 88%. Home analgesic instruction for VOC was 100%, for fracture was 74%, and for burn was 27%. These data from 1994 document suboptimal analgesic use and home analgesic instruction for children in our ED with burns and fractures. Other opportunities in our ED for acute pain management improvement include optimizing initial analgesic doses, shortening the time elapsed to initial analgesic administration, and documenting the response to pain management.

Ethical issues in managed care: a Catholic Christian perspective.

A Christian analysis of the moral conflicts that exist among physicians and health care institutions requires a detailed treatment of the ethical issues in managed care. To be viable, managed care, as with any system of health care, must be economically sound and morally defensible. While managed care is per se a morally neutral concept, as it is currently practiced in the United States, it is morally dubious at best, and in many instances is antithetical to a Catholic Christian ethics of health care. The moral status of any system of managed care ought to be judged with respect to its congruence with Gospel teachings about the care of the sick, Papal Encyclicals, and the documents of the Second Vatican Council. In this essay, I look at the important conceptual or definitional issues of managed care, assess these concerns over against the source and content of a Catholic ethic of health care, and outline the necessary moral requirements of any licit system of health care.

WASHINGTON US state legislatures kept busy with managed-care issues

WASHINGTON US state legislatures kept busy with managed-care issues