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Managed Care/Market Forces

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Some managed care strategies to improve drug use appear to be effective, but little is known about long term clinical outcomes

Medication expenses account for as much as 15 percent of the total medical costs of some health plans. Many managed care organizations (MCOs) have used both financial and educational strategies to improve the quality of medication use and reduce costs. However, few well-designed, published studies have assessed the efficacy of these approaches, according to a study by the HMO Research Network Center for Education and Research on Therapeutics (CERT), which is supported by the Agency for Healthcare Research and Quality (HS10391).

Researchers at Harvard Medical School and Harvard Pilgrim Health Care systematically reviewed published studies of intervention strategies to improve the quality and efficiency of medication use in MCOs. Based on the 48 studies that met criteria for inclusion, consistently effective interventions for reducing medication costs included dissemination of educational materials with drug samples, participatory clinical guideline development, group or one-to-one educational outreach, and enhanced patient-specific feedback.

Disease management (primarily for depression and diabetes) showed promise in improving short-term outcomes, while dissemination of educational materials and aggregated feedback alone were ineffective. Interventions in staff-model health maintenance organizations (HMOs) were more effective than those conducted in group-model HMOs.

See "Changing medication use in managed care: A critical review of the available evidence," by Sallie-Anne Pearson, Ph.D., Dennis Ross-Degnan, Sc.D., Ann Payson, M.A., and Stephen B. Soumerai, Sc.D., in the November 2003 American Journal of Managed Care 9(11), pp. 715-731.

Editor's Note: Additional details about intervention strategies and actual tools/educational materials are also available online. Select to access the "Tools and Techniques of Improved Medication Use."

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