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

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 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 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 to learn more

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 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 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 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 more prevalent on West Coast Training after graduation Clinical residencies OSU Health Plan Kaiser Permanente Fellowships in industry Novartis Allergan Pfizer

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?