Group practice strategies to manage pharmaceutical cost in an HMO network

Citation
Ka. Galt et al., Group practice strategies to manage pharmaceutical cost in an HMO network, AM J M CARE, 7(11), 2001, pp. 1081-1090
Citations number
56
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
Journal title
AMERICAN JOURNAL OF MANAGED CARE
ISSN journal
1088-0224 → ACNP
Volume
7
Issue
11
Year of publication
2001
Pages
1081 - 1090
Database
ISI
SICI code
1088-0224(200111)7:11<1081:GPSTMP>2.0.ZU;2-R
Abstract
Objective: To evaluate the prevalence of various pharmaceutical cost manage ment strategies used by group practice, within a managed care network and t heir relationship to drug costs among enrollees. Strategies Studied: Care management (gatekeeping, practice profiling, pract ice guidelines, case management), techniques for maintaining clinic medicat ion records, and policies regulating physician interaction with pharmaceuti cal sales representatives (PSRs). Study Design: Cross-sectional survey of primary care group practice organiz ations (n = 103) affiliated with Blue Cross Blue Shield of Minnesota in ear ly 1996. Methods: Multivariate linear regression analysis was performed on correspon ding claims data for members continuously enrolled in these practices from January 1 to December 31, 1995 (n = 76,387), using the patient as the unit of analysis. Results: Substantial variation in strategy prevalence was observed; this va riation was thought to influence pharmaceutical costs. Seventy-six percent of practices had medication lists in outpatient medical records, 53% had po licies limiting pharmaceutical detailing, and 44% had patients assigned to primary care gatekeepers; however, only 10% used outpatient nurse case mana gers. Use of outpatient nurse case managers (P < .010), primary care physic ian gatekeeping (P < .002), policies to control pharmaceutical detailing (P < .001), and medication lists and outpatient charts (P < .001) was found t o be independently associated with lower pharmaceutical expenditures. Signi ficant colinearity was found between group size and the strategies studied. Conclusions: Significantly lower pharmaceutical costs per member per year w ere observed in the groups reporting primary care gatekeeping, outpatient m edication records, outpatient case managers, and policies regarding physici an interactions with PSRs.