I Am AMCP: What's 'AMCP'? | "It is not necessary to change"

by Gregg A. Masters, MPH and Fred Goldstein, MS

When ‘managed healthcare‘ first rolled out in California during the mid to late 80s the ‘V1.0 players‘ shortly thereafter migrated admittedly nascent (not ready for prime time) but emerging managed care organization (MCO) operational footprints into other states. Those early business models – at least in the HMO space – began to focus on the upside of ‘delegated’ risk transfer (or download) from the health plan to the participating medical group, IPA or other professionally managed provider network.

In certain markets with California leading the sector via risk bearing medical groups (and some willing hospitals) their leadership saw and even welcomed the upside of health plan risk transfer from the ‘license holding entity’ to the medical group or participating physician network. This shift was seen by some as an innovation opportunity to restructure a silo-ed, production driven fee-for-services healthcare ecosystem from a volume to value paradigm – although back then we hadn’t settled on the term value as we see it today.

Back then we had not yet developed the term ‘MSO‘ (management services organization) in common parlance today, let alone the software or IT platforms to accept, administer and thrive under the specific terms of a global (variably defined by principally both hospital and physician risk) to partial (either hospital or physician) contracts.

When I ran managed care contracting for a large faith based health system’s ‘Super PHO’ in North Texas, we assumed global risk with Aetna that included pharmacy risk before the house of cards came tumbling down and most if not all of the risk contracts the health system held were ‘renegotiated’ to discounted FFS arrangements including per diem and case rates vs. global or partial PMPM (per member per month) or percent of premium prepayment.

At that point the pharma spend ranged between 5-7% of total spend. Today that share ranges from 14% with some estimates closer to 17%, when considering only personal health care spending.

Fast forward a decade or so, and times have changed. Despite all the talk of ACOs and value based healthcare strategies, the accumulated knowledge base has been forged principally by the managed care industry.

Get to know ‘AMCP‘ the Academy of Managed Care Pharmacy a professional association:

leading the way to help patients get the medications they need at a cost they can afford. AMCP’s diverse membership of pharmacists, physicians, nurses, and professionals in life sciences and biopharmaceutical companies leverage their specialized expertise in clinical evidence and economics to optimize medication benefit design and population health management and help patients access cost-effective and safe medications and other drug therapies. AMCP members improve the lives of nearly 300 million Americans served by private and public health plans, pharmacy benefit management firms, and emerging care models.

As we continue to adjust to the ‘new normal’ induced by the COVID-19 pandemic with its shelter in place and social distancing mandates we’ve witnessed the dramatic rise of ‘virtual events’ from conferences, to trade shows to online learning.

AMCP has produced a timley online or virtual series titled eLearning Days running from April 20-24, 2020. Topics range from Pharmaceutical Marketplace Trends to Cannabis Use in Health Care: What Payers Need to Know. For more information or to register, go to AMCP Calendar.