The forum--Managing managed health care: Developing and utilizing the potential of group psychology-- Part II: Selecting patients/clients to insure group development and success: Integrating social role and individual personality

The result ERISA compels us to reach means that the Corcorans [who lost their unborn child allegedly as a result of United Healthcare’s negligent determination that hospitalization was not medically necessary] have no remedy, state or federal, for what may have been a serious mistake. This is troubling....In the words of its sponsor, Senator Jacob Javits, the Employee Retirement Income Security Act (ERISA) was enacted in 1974 “to maintain the voluntary growth of private [pension and employee benefit] plans while at the same time making needed structural reforms in such areas as vesting, funding, termination, etc. so as to safeguard workers against loss of their earned or anticipated benefits....” Ironically, one of ERISA’s provisions—its indeterminate provision for the preemption of state law—has probably created more uncertainty about the adequacy and security of health care benefits than any other piece of legislation. Neither ERISA nor any other federal statute comprehensively regulates the content of employer provided health care plans, including benefits provided through managed care organizations (MCOs).

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Drug Formulary: The Cornerstone of a Managed Pharmacy Program

Journal of Pharmacy Practice ◽

10.1177/089719009200500206 ◽

1992 ◽

Vol 5 (2) ◽

pp. 75-81 ◽

Cited By ~ 1

Author(s):

Richard J. Bruzek ◽

Debra Dullinger

Keyword(s):

Health Care ◽

Selection Process ◽

Drug Evaluation ◽

Evaluation Process ◽

Outpatient Setting ◽

Hospital Environment ◽

Drug Formulary ◽

Managed Health Care ◽

Cost Efficiencies ◽

Evaluation Matrix

Drug formularies have migrated from the inpatient hospital environment to the ambulatory outpatient setting. Although formularies in use by managed health care organizations may vary widely in their design, they have quickly become the cornerstone of the managed pharmacy benefit. A carefully designed formulary can direct drug use to the safest and most efficacious products that may ultimately lower total drug costs. Other managed health care drug formulary considerations are presented. A method is described to develop a drug formulary. The drug evaluation matrix (DEM) provides a systematic, reproducible drug selection process based on efficacy, safety, and cost. DEM allows the user to assign different weights to these factors during the drug evaluation process. The product of DEM is a drug formulary that is therapeutically complete, consistent with accepted medical practice and maximizes cost efficiencies achievable from a drug formulary.

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The glue of managed health care

The Case Manager ◽

10.1016/s1061-9259(96)80040-3 ◽

1996 ◽

Vol 7 (4) ◽

pp. 75-80 ◽

Cited By ~ 1

Keyword(s):

Health Care ◽

Managed Health Care

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The Managed Health Care Market

Journal of Pharmacy Practice ◽

10.1177/089719009200500204 ◽

1992 ◽

Vol 5 (2) ◽

pp. 67-71

Author(s):

William A. Hemberger

Keyword(s):

United States ◽

Health Care ◽

Managed Care ◽

Health Care Delivery ◽

Care Delivery ◽

The United States ◽

Health Care Market ◽

Managed Health Care ◽

Program Benefit

Health care delivery and benefits in the United States are changing. This article provides a basic description of the present-day components, managed care constructs, and impact of medical/hospital program/ benefit designs on pharmacy programs.

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Who is a “Senior”? Looking for a definition in the healthcare system

Working with Older People ◽

10.1108/wwop-06-2021-0027 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Monica Consolandi

Keyword(s):

Quality Of Life ◽

Health Care ◽

Healthcare System ◽

Health Care System ◽

Design Methodology ◽

Social Role ◽

Content Type ◽

The Core ◽

Starting Point

Purpose Seniors are nowadays at the core of important reflections to understand both how to ensure them a proper quality of life and better recognize their social role, providing them services and proper health care to value them as persons and resources. This paper aims to find a through definition about who is a senior, in the author’s opinion the starting point to help them flourishing. Design/methodology/approach As an example of definitions, an online dictionary and two geriatric text-books are quoted, highlighting qualities and rights referred to seniors especially in the delicate context of the health-care system. Findings The lack of a commonly shared perspective on this delicate kind of patient entails the difficulty to reach a coherent and satisfying definition about who a senior is. Originality/value The lack of a commonly shared definition leads to inevitable misunderstandings and could explain the arduousness of considering seniors in all their aspects. Further investigations are suggested.

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