Managed care quarterly最新文献

Newer antidepressants are associated with higher costs of treatment of anxiety and depression. Managed care organizations are challenged to control treatment costs by implementing restricted formularies based on price and perceived medical value. Despite unfavorable side effects of efficacious tricyclic antidepressants, the low acquisition cost rationalizes the inclusion of this older class of agents on a formulary. On the other hand, cost-containment approaches have been taken toward more expensive drug classes (e.g., selective serotonin reuptake inhibitors) despite a superior safety profile of these drug classes over tricyclics. There is compelling evidence that dual reuptake inhibitors (e.g., venlafaxine extended-release), which have acquisition costs similar to serotonin reuptake inhibitors, have a broad spectrum of efficacy and thus added value, contributing to the cost-effectiveness of including this agent in the managed care formulary. Assessment of overall cost-effectiveness should not be limited by acquisition costs but should take total healthcare costs into consideration.

The development of the health Internet creates opportunities and challenges for health care organizations. One challenge is building trust among users of online health resources. Research suggests that consumers do not fully trust health Web sites, with privacy and content quality among their concerns. Accreditation may offer a mechanism for health Web sites to demonstrate quality and trustworthiness to patients. URAC has created such an accreditation program, which was fully implemented in December 2001.

Polypharmacy, the concurrent use of multiple medications, is a growing problem that is more common than most healthcare professionals realize. Most patients are seeing multiple doctors and have multiple prescriptions, therefore making it difficult for physicians to properly monitor their patients. However, there are steps that the healthcare profession can take to reduce the occurrence of polypharmacy. The use of a well-designed polypharmacy intervention program can help reduce the costs associated with polypharmacy, as well as improve patients' health by helping to detect and avoid unnecessary drug use.

Injectable medications represent one of the fastest growing and most expensive categories of prescription drugs with costs rising to $26 billion by 2006. Historically, managed care organizations have not aggressively overseen this area of the prescription benefit, resulting in a disjointed system. However, a growing number of MCOs are developing programs to better manage injectable medications. Key components of these programs include sophisticated infrastructure, clinical management, consolidated databases, and improved pharmaceutical contracting. This article presents a new model for managing injectables, illustrated by the implementation of a comprehensive injectables' management program for a large managed care population that resulted in a 12:1 return on investment.

The market-driven managed competition concept has been successful in reducing increases in healthcare costs by controlling utilization and price, but has failed to date to produce an effective and efficient delivery of health services. The proposed health reform plan calls for universal access (excluding illegal aliens), a relatively broad range of clinically effective basic benefits, an option to purchase supplementary benefits, a ceiling placed on the nation's total health expenditures, local decisionmakers allocating available resources, existing insurers administering the plan and providing consumers with additional quality of care comparisons.