Managed Care Pharmacy Overview

Managed Care Pharmacy

• Managed care is a healthcare delivery system aiming to control costs, quality, access, and availability of care.
• It's managed by those who pay for it (e.g., employers, insurers, and government).
• An initial impact on pharmacy practice was reducing costs.

Managed Care Pharmacists' Role

• Pharmacists must prioritize patient care over drug products.
• Provide high-quality, patient-centered care, considering both quality and cost-effectiveness.
• Enhance skills, competencies, and attitudes to succeed in managed care.
• Implement quality assurance programs to improve patient safety and service.
• Develop management strategies and strong clinical skills for evaluating and counseling patients.
• Implement medication management programs to improve patient health.
• Develop programs to decrease misuse of medications and drug diversion.
• Implement drug benefit programs which provide broad patient access to necessary medications.

Home Health Care Pharmacy

• Patients receive care at home instead of in a hospital or clinical setting.
• Home healthcare provides services to individuals and families at their homes.
• Purpose of home healthcare includes: promoting health, maintaining health, restoring health, and maximizing independence while minimizing illness.
• Advantages include easier access to patient records for healthcare providers, less duplication of services, better continuity of care, greater efficiency, and lower time consumption for the patient.

Home Health Care Pharmacy Services

• Pharmacists play a crucial role in providing complex intravenous medications.
• Services include: total parenteral and enteral nutrition, pharmaceutical care (identifying and resolving drug problems), pain management (especially for cancer patients), home medical equipment provision (e.g. walkers, wheelchairs, self-monitoring devices), and total quality management (TQM).

Long Term Care Pharmacy

• Covers a broad array of services over time for all ages with chronic conditions and functional limitations.
• Patients needing long-term care include those experiencing disabling effects of chronic diseases, accidents, and elderly individuals (over 65).
• Goals of long-term care revolve around health and functional restoration or maintenance.

Long Term Care Facilities

• Include nursing homes, assisted living, intermediate care, and Continuing Care Retirement Communities (CCRCs).
• Independent living: residents manage most tasks but receive back-up support.
• Intermediate care: more intensive than assisted living but less intensive than nursing homes.
• CCRC: a comprehensive retirement community offering different levels of care.

Consultant Pharmacy Practice

• Pharmacists with expertise in caring for long-term care patients.
• Settings include independent pharmacies, stand-alone long-term care pharmacies, pharmacies providing advice on procedures and therapies, and pharmacies located in nursing homes.

Services Provided by Pharmacists

• Drug regimen review (MUE assesses medication benefits and DUR identifies risks)
• Improve medication safety.

This quiz explores the principles of managed care pharmacy, focusing on the role of pharmacists in delivering patient-centered care while controlling costs. It covers the various strategies and programs implemented to enhance patient safety and medication management. Test your understanding of how managed care impacts pharmacy practice and patient outcomes.