AMCP Managed Care 101 The Ohio State University

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AMCP Managed Care 101 The Ohio State University GBM 9/8/2014

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 &

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

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

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

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 � 3 rd party administrator of Rx drug programs or service

Pharmacy Benefit Management � 3 rd 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

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

AMCP Internships �Summer internships for students interested in learning more about managed care and industry �Pfizer �Allergan �AMCP Headquarters (4 th year rotation) �Express Scripts (4 th year rotation) �FDA* (4 th year rotation) �CDC* (4 th year rotation)

Managed Care Residencies and Fellowships �Attend AMCP Nexus to learn about opportunities �Managed care

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

What you can do now �Get involved! �OSU AMCP Student Chapter �Attend our meetings

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? �Ngzheng. 1@osu. edu �amcp. ohiostate@gmail. com �www. amcp. org �www. amcposu. weebly. com

�Questions? �Ngzheng. 1@osu. edu �amcp. ohiostate@gmail. com �www. amcp. org �www. amcposu. weebly. com

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What is Managed Care Pharmacy Developed by AMCPWhat is Managed Care Pharmacy Developed by AMCP
OHIO STATE UNIVERSITY EXTENSION OHIO STATE UNIVERSITY EXTENSIONOHIO STATE UNIVERSITY EXTENSION OHIO STATE UNIVERSITY EXTENSION
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OHIO STATE UNIVERSITY EXTENSION Officer Training OHIO STATEOHIO STATE UNIVERSITY EXTENSION Officer Training OHIO STATE
WHY OHIO STATE The Ohio State University CollegeWHY OHIO STATE The Ohio State University College
OHIO STATE UNIVERSITY EXTENSION Dining Etiquette OHIO STATEOHIO STATE UNIVERSITY EXTENSION Dining Etiquette OHIO STATE
Managed Care is Dead Long Live Managed CareManaged Care is Dead Long Live Managed Care
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Managed Care Managed Care In the broadest termsManaged Care Managed Care In the broadest terms