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The American Journal of Managed Care Aug 2020Alzheimer disease is the most common cause of dementia and the fifth leading cause of death in adults older than 65 years. The estimated total healthcare costs for the...
Alzheimer disease is the most common cause of dementia and the fifth leading cause of death in adults older than 65 years. The estimated total healthcare costs for the treatment of Alzheimer disease in 2020 is estimated at $305 billion, with the cost expected to increase to more than $1 trillion as the population ages. Most of the direct costs of care for Alzheimer disease are attributed to skilled nursing care, home healthcare, and hospice care. Indirect costs of care, including quality of life and informal caregiving, are likely underestimated and are associated with significant negative societal and personal burden. Managed care organizations are in a unique position to develop utilization strategies that would positively impact early diagnosis and treatment to lead to better outcomes and lower costs for patients, caregivers, and the healthcare system. Additionally, the recent inclusion of Alzheimer disease diagnoses into risk corridor calculations by the Centers for Medicare & Medicaid Services may encourage Medicare Advantage organizations to invest in programs that aid in its early detection and diagnosis.
Topics: Aged; Alzheimer Disease; Caregivers; Cost of Illness; Health Care Costs; Humans; Managed Care Programs; Medicare; Quality of Life; United States
PubMed: 32840331
DOI: 10.37765/ajmc.2020.88482 -
Primary Care Dec 2019There is growing recognition that social determinants of health influence individual and population health. A well-designed population health management strategy can... (Review)
Review
There is growing recognition that social determinants of health influence individual and population health. A well-designed population health management strategy can yield improved outcomes for a given community, while improving the financial health of health care systems and providers. This article provides an overview of aligned care delivery, community engagement, education, technology, and other key strategies required to address the needs of patients and communities. A holistic vision incorporating social factors can lead to a return on investment and improvement in the health of a community, at the same time decreasing health care costs for the population managed.
Topics: Healthcare Disparities; Humans; Managed Care Programs; Medicaid; Medicare; Population Health Management; Social Determinants of Health; State Health Plans; United States
PubMed: 31655752
DOI: 10.1016/j.pop.2019.07.013 -
Journal of Managed Care & Specialty... Apr 2020To review the development and implementation of prescription formularies by managed care organizations, identify their current applications, and recognize future trends... (Review)
Review
To review the development and implementation of prescription formularies by managed care organizations, identify their current applications, and recognize future trends in the managed care pharmacy environment. Current journal articles and texts regarding the use of formularies and the managed care environment. Not applicable. Formulary systems have proven to be a valuable means to control the pharmacy benefit and can be expected to expand in both scope and sophistication.
Topics: Formularies as Topic; Health Plan Implementation; History, 20th Century; History, 21st Century; Managed Care Programs; Pharmacy Service, Hospital; Pharmacy and Therapeutics Committee
PubMed: 32223609
DOI: 10.18553/jmcp.2020.26.4.341a -
The Psychiatric Clinics of North America Jun 2021Although there is debate about the importance of a strong foundation in psychotherapy for psychiatrists, the literature provides ample evidence of the positive impact on... (Review)
Review
Although there is debate about the importance of a strong foundation in psychotherapy for psychiatrists, the literature provides ample evidence of the positive impact on patient care outcomes when psychiatrists are competent to provide this important form of treatment. Despite financial pressures and increases in managed care posing a threat to the maintenance of psychotherapy as a core skillset for psychiatrists, psychotherapy training should not only be maintained within psychiatry residency training but should in fact be given a renewed focus and priority within training programs.
Topics: Education, Medical; Humans; Internship and Residency; Psychiatry; Psychotherapy
PubMed: 34049644
DOI: 10.1016/j.psc.2020.12.004 -
Health Affairs (Project Hope) Apr 2020
Topics: Humans; Managed Care Programs; Medicaid; Social Work; United States
PubMed: 32250692
DOI: 10.1377/hlthaff.2020.00180 -
Journal of Managed Care & Specialty... Aug 2020
Topics: Anniversaries and Special Events; Humans; Managed Care Programs; Periodicals as Topic; Pharmaceutical Services
PubMed: 32715966
DOI: 10.18553/jmcp.2020.26.8.942 -
Journal of Managed Care & Specialty... Oct 2020
Topics: Anniversaries and Special Events; Humans; Managed Care Programs; Periodicals as Topic
PubMed: 32996391
DOI: 10.18553/jmcp.2020.26.10.1199 -
Journal of Managed Care & Specialty... Nov 2020Managed care pharmacy has a relatively short history, but one that is defined by significant achievements. Since the late 1960s, managed care pharmacists have applied...
Managed care pharmacy has a relatively short history, but one that is defined by significant achievements. Since the late 1960s, managed care pharmacists have applied their unique skills to formulary management, clinical programs, benefit design, and contract negotiations to support patient access to life-saving therapies, while also ensuring cost-effective use of limited health care resources. Key milestones include establishing the pharmacy benefit as an essential component of the U.S. health care system, launching the Medicare Part D program, and expanding medication therapy management services. The year 2020 brings another milestone-the 25th anniversary of AMCP's flagship publication, the This year also serves as an inflection point. As managed care pharmacy professionals prepare for change and the challenges ahead-including the imperative to address the rising costs of health care and health disparities-the use of evidence, utilization management strategies, and innovation will support our continued success. No funding supported the writing of this commentary. The authors have nothing to disclose.
Topics: Anniversaries and Special Events; Drug Costs; Forecasting; History, 20th Century; History, 21st Century; Humans; Managed Care Programs; Medicare Part D; Medication Therapy Management; Periodicals as Topic; Pharmaceutical Services; United States
PubMed: 33119449
DOI: 10.18553/jmcp.2020.26.11.1379 -
Journal of Managed Care & Specialty... Mar 2022The Affordable Care Act led an additional 15 states to begin contracting with comprehensive, risk-based managed care organizations (MCOs) to administer pharmacy benefits... (Review)
Review
The Affordable Care Act led an additional 15 states to begin contracting with comprehensive, risk-based managed care organizations (MCOs) to administer pharmacy benefits for Medicaid beneficiaries between 2010 and 2017. Reasons for this shift included concerns about administering complex benefits for an influx of new beneficiaries, assumptions about the cost-saving potential of privately run managed care, and a desire for budget predictability. As drug prices increased during the past decade, the way that state pharmacy benefits were administered via MCOs affected the ability of states to meet the needs of their Medicaid beneficiaries. Here, we review the advantages and limitations of 2 strategies that give states more centralized control over management of the pharmacy benefit: excluding the pharmacy benefit from MCO contracts and aligning preferred drug lists across beneficiary types. We propose that centralizing utilization management tools, aligning incentives for managed care payers with the needs of patients and Medicaid programs, and the ability to implement formulary exclusions may enable states to achieve savings and better meet the needs of beneficiaries. No funding supported the writing of this Viewpoints article. Kesselheim is supported by grants from Arnold Ventures. Bendicksen has nothing to disclose.
Topics: Humans; Managed Care Programs; Medicaid; Patient Protection and Affordable Care Act; Pharmaceutical Services; Pharmacy; United States
PubMed: 35199580
DOI: 10.18553/jmcp.2022.28.3.354 -
Advances in Experimental Medicine and... 2021Naked mole-rats are a burgeoning model species in the field of biomedical research and are also housed at many zoos throughout the world. These mammals possess many...
Naked mole-rats are a burgeoning model species in the field of biomedical research and are also housed at many zoos throughout the world. These mammals possess many traits that have a large impact on the way that they are kept in captivity such as their eusociality, thermolability and lack of need for drinking water. This chapter outlines the captive care and unusual housing needs of these animals. Providing information and examples from our own experiences while working with naked mole-rats for many decades. While this chapter serves as a good framework for the captive care of this mammal species, it is in no way all-encompassing but simply reflects the way in which we have managed over many years to successfully sustain our colony of thousands of animals.
Topics: Animals; Managed Care Programs; Mole Rats
PubMed: 34424526
DOI: 10.1007/978-3-030-65943-1_16