Managed care organizations: an introduction--Part I of II

Area of Science:

• Pharmaceutical Sciences
• Health Services Research
• Managed Care Pharmacy

Background:

• Managed care organizations (MCOs) encompass diverse healthcare delivery models focused on cost-effectiveness.
• Pharmaceutical care is an integral component of MCOs, evolving significantly from past practices.
• The role of pharmacists within MCOs has transformed, expanding beyond traditional dispensing functions.

Purpose of the Study:

• To explore the evolving roles and responsibilities of pharmacists in managed care settings.
• To highlight the increasing involvement of pharmacists in drug therapy selection and management.
• To examine the impact of contemporary pharmacy practices on healthcare delivery within MCOs.

Main Methods:

• Review of current practices in managed care pharmacy.
• Analysis of pharmacist involvement in MCO decision-making processes.
• Examination of pharmacist contributions to cost-effective healthcare strategies.

Main Results:

• Pharmacists in MCOs are increasingly involved in selecting rational drug therapy.
• Key pharmacist activities include formulary management, drug review programs, and clinical guideline development.
• Pharmacists contribute to coordinated care committees and direct patient counseling.

Conclusions:

• The scope of practice for pharmacists in managed care is continuously expanding.
• Pharmacists are essential in optimizing pharmaceutical care and ensuring cost-effective healthcare delivery.
• Future roles will likely involve greater clinical integration and patient management within MCOs.