Pharmacy Benefit Management:
In 1993, a group of pharmacists in Omaha, Nebraska, got together and a company called
Pharmaceutical Technologies, Inc. (PTI) was born. This group came up with a solution to the
1. Examine the main events in the history of health insurance from the mid-twentieth century to
the present. Explain how these events led up to the evolution of managed care organizations.
Not only are there cultu
In 1965, at a time when individuals with disabilities, end-stage renal disease (ESRD), and
those who were 65 years and older needed assistance paying for their medical bills, the federal
government came up with a
Today there are many forms of managed health care insurance plans which reimburse
hospitals and providers for inpatient and outpatient services, some of which are the preferred
provider organizations (PPOs), Medica
What are the purposes of Medicare regulations other than the one mentioned above?
One purpose is to award contracts on either regional or state basis to manage billing and reimbursement
programs. A few other purposes are to cont
Examine the three types of inpatient or outpatient reimbursement systems?
One reimbursement system is called Global Reimbursement or bundled payment. What this means is
that the provider is paid one fee for multiple procedure co
What are the challenges faced by MCOs regarding practice variations? What do you think can be done
to meet these challenges?
Practice variations are a challenge faced when MCOs cannot control costs. It also involves the issue of
1) The patient-center medical home and managed care: Times have changed, some components
have not (Baird, 2011).
The patients have the main role in the patient-centered models. These aid them with better