Implementing Quality in Managed Health Care

2020 ◽  
pp. 55-68
Author(s):  
A.F. Al-Assaf
1997 ◽  
Vol 23 (2-3) ◽  
pp. 251-289
Author(s):  
Margaret G. Farrell

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).


1992 ◽  
Vol 5 (2) ◽  
pp. 75-81 ◽  
Author(s):  
Richard J. Bruzek ◽  
Debra Dullinger

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.


1992 ◽  
Vol 5 (2) ◽  
pp. 67-71
Author(s):  
William A. Hemberger

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.


Author(s):  
Richard G. Frank ◽  
Jacob Glazer ◽  
Thomas G. McGuire

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