Podcast
Questions and Answers
Pharmacists are involved in providing care for animals.
Pharmacists are involved in providing care for animals.
True
The role of managed care organizations is to ensure the provision of appropriate health care services in a cost-efficient manner.
The role of managed care organizations is to ensure the provision of appropriate health care services in a cost-efficient manner.
True
Which of the following are examples of managed care organizations? (Select all that apply)
Which of the following are examples of managed care organizations? (Select all that apply)
Health Management Organizations (HMOs) are a form of health insurance in which its members prepay a premium for the HMO's health services.
Health Management Organizations (HMOs) are a form of health insurance in which its members prepay a premium for the HMO's health services.
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Which of the following is NOT a benefit of being a member of an HMO?
Which of the following is NOT a benefit of being a member of an HMO?
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Pharmacy Benefit Management Companies (PBMs) are organizations that manage pharmaceutical benefits for managed care organizations, other medical providers or employers.
Pharmacy Benefit Management Companies (PBMs) are organizations that manage pharmaceutical benefits for managed care organizations, other medical providers or employers.
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Pharmacists in managed care practice provide a similar type of professional activity as pharmacists in traditional settings.
Pharmacists in managed care practice provide a similar type of professional activity as pharmacists in traditional settings.
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Economic and clinical outcomes are not weighed against each other to make decisions during a pharmacist's work in managed care.
Economic and clinical outcomes are not weighed against each other to make decisions during a pharmacist's work in managed care.
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What are the roles of pharmacists in a managed care organization? (Select all that apply)
What are the roles of pharmacists in a managed care organization? (Select all that apply)
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Pharmacists can provide enhanced pharmaceutical services in community pharmacies because they are part of a fully integrated patient care system.
Pharmacists can provide enhanced pharmaceutical services in community pharmacies because they are part of a fully integrated patient care system.
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Drug utilization review (DUR) identifies potential prescription-related problems such as drug-drug interactions, duplication of drugs, known allergies, under or overdosing, or inappropriate therapy.
Drug utilization review (DUR) identifies potential prescription-related problems such as drug-drug interactions, duplication of drugs, known allergies, under or overdosing, or inappropriate therapy.
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Prior authorization (PA) is a process that discourages the proper use of medications and encourages inappropriate prescribing.
Prior authorization (PA) is a process that discourages the proper use of medications and encourages inappropriate prescribing.
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Quality assurance (QA) programs are designed to enhance patient safety and improve patient drug use.
Quality assurance (QA) programs are designed to enhance patient safety and improve patient drug use.
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Clinical program development doesn't involve using evidence-based clinical and research data to create disease management programs.
Clinical program development doesn't involve using evidence-based clinical and research data to create disease management programs.
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Pharmacists in managed care are not involved in evaluating scientific evidence in order to select appropriate drugs for a patient population.
Pharmacists in managed care are not involved in evaluating scientific evidence in order to select appropriate drugs for a patient population.
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Pharmacists should not design and conduct outcomes-based research to help patients achieve desired results from their drug therapy.
Pharmacists should not design and conduct outcomes-based research to help patients achieve desired results from their drug therapy.
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Pharmacists cannot help prescribers choose drugs that meet patients' needs.
Pharmacists cannot help prescribers choose drugs that meet patients' needs.
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Pharmacists should not provide and educate patients about their individual prescription history and potential adverse drug reactions or duplicate therapies.
Pharmacists should not provide and educate patients about their individual prescription history and potential adverse drug reactions or duplicate therapies.
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A formulary is a list of medications that a health plan will cover.
A formulary is a list of medications that a health plan will cover.
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Decisions made by the pharmacist in a managed care setting usually involve an individual patient, not a 'population' of patients.
Decisions made by the pharmacist in a managed care setting usually involve an individual patient, not a 'population' of patients.
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Pharmacoeconomics is the description and analysis of the costs of drug therapy to healthcare systems and society.
Pharmacoeconomics is the description and analysis of the costs of drug therapy to healthcare systems and society.
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Quality assurance is a part of quality management. It focuses on providing confidence that quality requirements will be fulfilled.
Quality assurance is a part of quality management. It focuses on providing confidence that quality requirements will be fulfilled.
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Pharmacoepidemiology is the study of the use and effects of drugs in large numbers of people.
Pharmacoepidemiology is the study of the use and effects of drugs in large numbers of people.
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Patients' attitude towards pharmacy shouldn't be studied.
Patients' attitude towards pharmacy shouldn't be studied.
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Research into patient satisfaction is not helpful in improving care.
Research into patient satisfaction is not helpful in improving care.
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Evidence-based practice means using the best available evidence, clinical expertise, and patient values to guide health care decisions.
Evidence-based practice means using the best available evidence, clinical expertise, and patient values to guide health care decisions.
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Health planning involves defining health problems, identifying unmet needs, and surveying the resources to meet them.
Health planning involves defining health problems, identifying unmet needs, and surveying the resources to meet them.
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Regulatory affairs only aim to protect public health by controlling the safety and efficacy of products in areas including pharmaceuticals, veterinary medicines, medical devices, pesticides, agrochemicals, cosmetics, and complementary medicines.
Regulatory affairs only aim to protect public health by controlling the safety and efficacy of products in areas including pharmaceuticals, veterinary medicines, medical devices, pesticides, agrochemicals, cosmetics, and complementary medicines.
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Patient satisfaction studies help to identify ways of improving practice, which could lead to better care for patients.
Patient satisfaction studies help to identify ways of improving practice, which could lead to better care for patients.
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The use of technology in gathering data from pharmacists is not a practical approach.
The use of technology in gathering data from pharmacists is not a practical approach.
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Traditional Medicine (TM) and Complementary Medicine (CM) products have become less important in pharmacy.
Traditional Medicine (TM) and Complementary Medicine (CM) products have become less important in pharmacy.
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Pharmacists have no barriers to the integration of TM/CM products into their practice.
Pharmacists have no barriers to the integration of TM/CM products into their practice.
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Pharmacists are reluctant to engage in practice-based research.
Pharmacists are reluctant to engage in practice-based research.
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Study Notes
Introduction to Managed Care
- Managed care is a system of clinical, financial, and organizational activities designed to efficiently provide healthcare services.
- It involves various organizations, payment methods, review mechanisms, and collaborations, often misunderstood in its scope.
- All healthcare and medical insurance professionals can be considered as managing care.
Managed Care Organizations (MCOs)
- A generic term for a managed care plan.
- Examples include HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and EPOs (Exclusive Provider Organizations).
- Also includes health plans or prescription benefit management companies (PBMs).
Health Maintenance Organizations (HMOs)
- A type of health insurance where members prepay for services, usually encompassing inpatient and outpatient care.
- Benefits include lower out-of-pocket costs and reduced paperwork.
Pharmacy Benefit Management Companies (PBMs)
- Manage pharmaceutical benefits for MCOs, other medical providers, or employers.
- They facilitate numerous activities like benefit plan design, network management, claim processing, and drug utilization review (DUR).
Pharmacists in Managed Care
- Pharmacists in managed care have a different practice role, requiring additional competencies.
- They monitor patient populations, use database reviews, and consider economic and clinical outcomes.
- They provide clinical drug management, quality-oriented services, and drug distribution/dispensing within managed care organizations.
Pharmacist Role in an MCO
- Drug distribution and dispensing
- Patient safety (DUR, Prior Authorization, Monitoring Programs, and Quality Assurance Programs)
- Clinical program development
- Communication with patients, prescribers, and other pharmacists
- Drug benefit design
- Business management
- Cost management
Drug Distribution and Dispensing
- Pharmacies may provide enhanced services to patients.
- Community pharmacies interact with MCO pharmacists for eligibility and claim processing.
- Mail order pharmacies assess prescriptions, eligibility, and appropriateness.
Patient Safety
- Drug Utilization Review (DUR) identifies prescription problems.
- Prior Authorization (PA) encourages appropriate prescribing.
- Monitoring programs and Quality Assurance programs improve patient safety and drug use.
Clinical Program Development
- Using evidence-based data to create disease management programs.
- Evaluating scientific evidence to select suitable medication for patient groups.
- Conducting outcome-based research.
Communication with Patients, Prescribers, and Pharmacists
- Helping prescribers choose suitable medications for patients' needs and insurance coverage.
- Providing medication history to dispensing pharmacists to identify risk factors.
Drug Benefit Design
- Deciding whether to use a formulary (approved list of medications) and how it should be structured.
- Implementing criteria and procedures for DUR.
Business Management
- Negotiating discounts with drug manufacturers.
- Providing customized clinical reports to meet client needs.
Cost Management
- Encouraging cost-effective drug choices by prescribers.
- Identifying prescription compliance and non-compliance patterns.
Research Areas in Social and Administrative Pharmacy
- Pharmacoeconomics: Analysis of drug costs.
- Professional Society Management: Management of professional groups.
- Outcomes Research: Evaluation of public health interventions.
Quality Assurance
- Systematically achieving required quality.
Pharmacoepidemiology
- Study of drug use and effects in large populations.
Quality-of-Life Studies
- Assessing individual's perception of life in various contexts.
Epidemiology
- Studying the distribution and occurrence of diseases.
Patient Attitudes Towards Pharmacy Profession
- Patients express positive attitudes toward pharmacists providing pharmaceutical care services
- Willingness to pay for these services to reduce medication-related problems.
Patients and Medication Adherence
- Medication adherence is an important area for study.
- Poor adherence to long-term therapies impacts public health.
Patient Preferences
- Determining preferences helps pharmacies improve services.
- Patients base their healthcare choices on factors like competence-based attributes.
Technology in Gathering Data
- Difficulty in collecting pharmacist data.
- Using smartphone application for activity tracking among pharmacists.
Research in SAP: Pharmacy Practice
- Challenges in pharmacy practice require research and solutions.
- Pharmacists working with traditional and complementary medicine products.
- Reluctance among pharmacists in conducting research due to time, training, and support limitations.
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Description
Explore the fundamentals of managed care, including its organizational structure and payment systems. Understand various types of managed care organizations such as HMOs, PPOs, and PBMs. This quiz is essential for healthcare professionals looking to deepen their knowledge in managed care systems.
