Transcript AMCP Managed Care 101

AMCP
Managed Care 101
The Ohio State University
GBM 9/8/2014
Topics Discussed
 AMCP
 Managed Care
 PBM
 Careers in Managed Care
 AMCP Internships
 Residencies & Fellowships
 Opportunities for involvement
What is managed care?
 Techniques used to improve the quality of care and reduce costs to
companies and individuals enrolled (patients)
 Health Maintenance Organization Act of 1973
 Reduce costs, hospitalizations, force providers to discount their rates
 Today- provider networks, MTM, disease management, wellness
incentives, preventative care
 Reduce overall cost (money and/or resources) of healthcare while
maximizing the access and quality of services for the patient
 Pharmacists, physicians, and nurses can all collaborate to provide
managed care
Academy of Managed Care Pharmacy
 National membership and student chapters
 Mission: to empower its members to serve society by using sound
medication management principles and strategies to improve healthcare
for all.
 Tasks
 Monitoring safety of medications in market
 Medication Therapy Management sessions
 Looking for cost effective measures to ensure access to medications
for all patients
 Participation in national conferences, online learning programs,
research, and advocacy
 www.amcp.org to learn more
Managed Care Professional
 Design and implement drug benefits for patients covered by
health insurance
 200+ million Americans
 Access to healthcare for all
 Managed care professionals- pharmacists, physicians, nurses
 Monitor safety/efficacy, MTM, “medical necessity” guidelines
for pharmacy benefits, cost effectiveness, etc.
 Humana, Aetna, Kaiser Permanente, University of Arizona
Medication Management Center, etc.
 AMCP stories on website
Pharmacy Benefit Management
 3rd party administrator of Rx drug programs or
service inside an integrated healthcare system
(Kaiser or VA)
 Process and pay Rx drug claims, develop and
maintain drug formulary, contract with
pharmacies, give discounts to drug
manufacturers, etc.
 Express Scripts (Medco), CVS Caremark, Prime
Therapeutics, United Health, and Catamaran
Others areas to practice managed care
 Hospital P&T Committee
 Governmental institutions (CMS)
 Industry
 Long-term care institutions
 *Come to the AMCP meetings to learn about the
different careers paths available
AMCP Internships
 Summer internships for students interested in
learning more about managed care and industry
 Pfizer
 Allergan
 AMCP Headquarters (4th year rotation)
 Express Scripts (4th year rotation)
 FDA* (4th year rotation)
 CDC* (4th year rotation)
Managed Care Residencies and
Fellowships
 Attend AMCP Nexus to learn about opportunities
 Managed care more prevalent on West Coast
 Training after graduation
 Clinical residencies
 OSU Health Plan
 Kaiser Permanente
 Fellowships in industry
 Novartis
 Allergan
 Pfizer
What you can do now
 Get involved!
 OSU AMCP Student Chapter
 Attend our meetings
 Participate in the P&T Competition
 Network/shadow
 Participate in research projects
 Apply for internships
 Attend AMCP Nexus Conference (Oct) and/or AMCP
National Meeting (Apr)
 Questions?
 [email protected]
 [email protected]
 www.amcp.org
 www.amcposu.weebly.com