Lecture 9 Flashcards
true or false
managed care is the new healthcare
true
managed care includes managed care organizations such as….
aetna, signa, kaiser
what are ACOs
accountable care organizations
are managed care organizations physical entities?
yes
true or false
managed care is 100% privatized
true
managed care organizations offer ______
MCPs (managed care plans)
what are managed care plans?
insurance policies offered by MCOs purchased directly (through marketplace) or indirectly (through employer)
pharmacists may work in managed care organizations as _____
PRACTITIONERS
(when working for HMOs, PPOs, etc)
true or false
pharmacists working for HMOs and pharmacists working for retail or hospital have essentially the same roles —- dispensing and clinical roles
true
explain what accountable care organizations are
goes hand in hand with medicare. closely or loosely knit providers coming together to form a network of providers to provide high quality care to a designated group of patients
when NOT associated with r medicare, it’s called patient centered medical homes (PCMH)
are patient centered medical homes nursing homes?
NO
what law gave us ACOs?
obamacare
medical homes and ACOs are a network of _____
PROVIDERS
what does PPO stand for
preferred provider organizations
true or false
patient centered medical homes existed before obamacare
false
patient centered medical homes are a ____ based approach
TEAM
patient centered medical homes are focused on what kind of care?
PRIMARY CARE (like dr clinics)
to use a PCMH, does your insurance have to pay for it?
not necessarily, but they’re very expensive out of pocket. you technically can still use them if not in network
is pharmacy practice common in PCMH’s?
not very common, but it’s growing
explain what a case manager is and their responsibilities
similar function to hospitalists
primary function is COC — coordination of care in medical home. 1 person taking responsibility for a group of patients and coordinating care for them. they take care of every aspect —financial, administrative, logistics, scheduling, etc
many are healthcare professionals like nurse practitioners
true or false
pharmacists who are case managers or hospitalists can call themselves managed care pharmacists
true
what is the difference between pharmacists who are case managers and pharmacists who are hospitalists
the patients of case managers are primary care (PCMH)
the patients of hospitalists are inpatient care
true or false
pharmacists working for PBMS are in a traditional pharmacist role
FALSE — not doing dispensing or clinical
it’s called operational aspect — designing drug benefits, making formularies, etc
who are the 3 major clients of PBMS
employers
health plans
pharmacies
