Managed care principles

Successful managed care systems deliver high-quality healthcare to their members, while maintaining low operating costs through effective application of basic principles of managed care. Three key issues addressed by these managed care principles include provider compensation, cost containment and quality of care. 

The AMCP is a professional association of pharmacists and associates who serve patients and the public through the promotion of wellness and rational drug therapy by the application of managed care principles. 

Dziegielewski, S. F. (1996). Managed care principles The need for social work in the health care environment. Crisis Intervention, 3, 97-111. 

Managed care origins, principles and evolution. BrMedj3, 1823—6. 

The basic concepts of managed care have evolved and are continuing to evolve over time. To understand this evolution, a brief historical perspective is presented first, followed by discussions of the language and principles of managed care. 

Intrinsic to the principles of managed care is the conflict between the desire to control costs and the desire to promote quality of care. Two common measures of quality of care are health plan member satisfaction and health plan accreditation. Member satisfaction surveys assess the extent to which a managed care plan is able to satisfy the diverse needs of its members. Increasingly, member satisfaction is an important measure for MCOs because it can impact the ability of the plan to attract and retain new members, reduce turnover rates and achieve accreditation. 

An association whose members value and promote application and advancement of pharmaceutical care principles in managed care pharmacy. 

An effective voice for the principles and practices of managed care pharmacy. 

Campbell, W.H. Newsome, L.A. Ito, S.M. The Evolution of Managed Care and Practice Settings. In A Pharmacist s Guide to Principles and Practices of Managed Care Pharmacy, Ito, S.M., Blackburn, S. Eds. Foundation for Managed Care Pharmacy Alexandria, Virginia, 1995 Vol. 5, 13. 

Wertheimer, A. Navarro, R. Managed Care Pharmacy Principles and Practice, Pharm Products Press Binghamton, New York, 1999 Vol. 232. 

Stern, C. The history, philosophy and principles of pharmacy benefits. J. Managed. Care Pharm. 1999, 5 (6), 525-531. 

What we learn from hits on the Internet, is that popular interest in the holistic approach is in marked contrast to the relative lack of interest in the application of holistic principles by mainstream medicine in the United States. Yet holistic, when entered with managed care, gave a significant 154,000 hits, but most sites were pro-holistic and anti-managed care. Still some web pages with large numbers of hits did speak favorably about early efforts to combine the two approaches. On the whole, the most common observations were about the lack of holism in mainstream medicine, the need to restore the holistic approach to mainstream medicine, and the extreme difficulty in doing so. 

Because of the more humanist nature of holistic medicine, this new medicine may drive a move to a more state-run system. For example, before the arrival of managed care, which we remember is healthcare management run on business principles, healthcare professionals focused mainly on providing medical care to patients. But now they have to focus on costs and management issues as well (in response, many physicians have been forming their own... 

While the US doesn t believe in the government negotiating prices with the pharmaceutical industry, the rise of formularies by Medicaid and by private insurers has played a similar role in cost contaimnent and has dramatically transformed the potential returns on research investment. The principle of tiered formularies is theoretically simple - insurers cover the cost of basic dmgs for an indication and the consumer then makes choices about how much additional value they want, and accepts the additional costs. Most formularies have three tiers, possibly four as shown in Table 11. Managed care formularies vary considerably in the co-payments expected for each tier, and the tiers assigned to a given dmg. 

Gwyther, L., and Rawlinson, E, Palliative medicine teaching program at the University of Cape Town Integrating palliative care principles into practice, ] Pain Symptom Manage May 33(5) 558-562,2007. 

These publications contain information on twelve key elements of chemical process safety management. In this section, seven of those elements that can be significantly impacted by paying careful attention to human factors principles are addressed. These are ... 

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