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.
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.
The schedule is posted below:
Monday, April 20
- Noon-1pm ET: 2019-2020 Pharmaceutical Marketplace Trends
- 3-4pm ET: Developing Professional Strategies to Enhance Digital Engagement
- 5-7pm ET: Satellite Symposia – Debating Approaches to Atopic Dermatitis Treatment across the Lifespan
Tuesday, April 21
- Noon-1pm ET: Drug Pipeline: Traditional Pharmaceuticals and Biosimilars
- 3-4pm ET: Getting Up to Speed on Prescription Drug Pricing Reform Efforts
- 5-7pm ET: Satellite Symposia – Economic and Clinical Outcomes Assessment of Immuno-Oncology Agents: A Guide for Payer Decision Makers
Wednesday, April 22
- Noon-1pm ET: Digital Therapeutics: Understanding the Emerging Product Class
- 3-4pm ET: Evaluating Digital Therapeutics, Drugs, and Health Technology for Optimizing Clinical and Financial Outcomes
- 5-7pm ET: Satellite Symposia – Point-of-Care101™ – COPD in Managed Care: The Clinical and Utilization Benefits of Exacerbation Prevention
Thursday, April 23
- Noon-1pm ET: Oncology: Investigating Trends and Elucidating Value
- 3-4pm ET: Cannabis Use in Health Care: What Payers Need to Know
- 5-7pm ET: Satellite Symposia – Wet Age-Related Macular Degeneration: Advances in the Treatment Landscape
Friday, April 24
- Noon-1pm ET: Placing Potential Cures Within Reach: Real-World Experience and Evolving Management
- 3-4pm ET: Health Policy Trends Impacting Managed Care Pharmacy: Are You Ready?
If you can’t attend, follow the action on twitter via the hashtag #IamAMCP.