AMCP: The Academy of Managed Care Pharmacy

The patient-centered medical home (PCMH) has many key goals and components. When paneled, the majority of AMCP 2013 Nexus attendees agreed that the PCMH is best described as a practice model that organizes primary care practice operations and incentives to deliver patient-centered, coordinated, comprehensive care with the goal of improved quality and efficiency.

Since 2010, the growth and proliferation of accountable care organizations (ACOs) has increased, and the rise of this collaborative care model is not without reason. Lack of consumer engagement, lack of competition, and misaligned incentives have made care less affordable.

Richard Stefanacci, DO, chief medical officer, The Access Group, said that it is necessary for retail pharmacists to break out of their silo. Dr Stefanacci noted that retail pharmacists are being utilized within practices and stepping out of their normal roles.

Suzanne Tschida, PharmD, vice president, specialty benefits & outcomes, OptumRx, said that at UnitedHealth Group a tiering system is used for the management of specialty medications with a cost-share or copay structure.

Highlights from The Academy of Managed Care Pharmacy's 25th Meeting & Expo, which took place on April 2“5, 2013, in San Diego, CA, are available in a newsletter published by The American Journal of Managed Care.

Yelena Yankovskaya, PharmD, a managed markets fellow at the Mayes College of Healthcare Business and Policy, describes the expectations and roles of predictive modeling, value-based insurance design, and gamification/social media in contemporary managed care pharmacy.

In an educational symposium entitled, "The Evolution of Multiple Sclerosis Treatment: The Role of the Managed Care Pharmacist," Kristen Helms, PharmD, and her 2 colleagues discuss how treatments for multiple sclerosis (MS) have evolved over the past 2 decades, explore the novel and emerging therapeutic strategies for MS, and cover strategies to improve medication adherence for the chronic disease.

Daniel Tomaszewski, PharmD, PhD Candidate, an assistant professor at the University of Minnesota, College of Pharmacy, Duluth, discusses the impact of managed care pharmacy on current legislation, regulatory policies, and ongoing healthcare reform.

Eric A. Wright, PharmD, BCPS, an investigator at the Geisinger Center for Health Research, discusses the implications of medical moments of truth (MMOTs) on current therapeutic and managed care strategies.

In an educational session satellite symposium entitled "Biologic Therapies for Chronic Diseases: Factors Influencing Treatment Decisions," Robert P. Navarro, PharmD, along with his colleagues, delves into the current trends of specialty pharmacy and biological therapies, and how managed care discussions have evolved to optimize patient outcomes within a cost-constrained healthcare environment.

Rebecca P. Snead, RPh, the executive vice president and CEO of the National Alliance of State Pharmacy Associations, discusses the current movement toward pharmacist provider status, and elaborates on the challenges and opportunities encountered.

In an educational seminar entitled "How Much of the $3 Billion in Star Rating Bonuses Did Your MCO Capture?," David Nau, RPh, PhD, CPHQ, FAPhA, along with his colleagues, discussed Medicare star ratings and how managed care organizations have implemented practices and processes to ensure the delivery of high-quality care to their members.

Mattias Cheung, PhD, FCSHP, FASHP, discusses the ongoing progress of orphan drugs for rare diseases in today's health care environment, and explores their challenges and opportunities in the current managed care landscape.

Matthias Cheung, PhD, FCSHP, FASHP, a principal at Advanced Rx Consulting, LLC, and an adjunct professor of pharmacy practice at the University of the Pacific, Thomas J. Long School of Pharmacy and Health Services, discusses the circumstances and factors that catalyzed the passage of current legislation and regulatory policies for orphan drugs, rare diseases, and ultra-rare diseases.

Debora Sternaman, PharmD, the director of commercial formulary services at Catamaran in Georgetown, TX discusses the Health Insurance Marketplace and how the new model offers a different experience from the current managed care structure.

In a presentation entitled "Hemophilia Management: Collaborating in a New Era to Optimize Cost and Clinical Outcomes in Managed Care," 5 key thought leaders and managed care authorities shared their insights on the changing therapeutic landscape for hemophilia management.

Robert W. Dubois, MD, PhD, the chief science officer of the National Pharmaceutical Council discusses the initial expectations of implementing accountable care organizations (ACOs) and how those expectations have evolved over time.

In a presentation entitled "Accountable Care Organizations: 2013 and Beyond," 4 managed care experts shared their insights and thoughts on the ongoing paradigm shift in managed care towards accountable care organizations, elaborating on current trends, unmet needs, and the future direction of the managed care landscape.

Highlights from the Academy of Managed Care Pharmacy's 2012 Educational Conference, which took place on October 3-5, 2012, in Cincinnati, Ohio, are available in a newsletter published by The American Journal of Managed Care. Topics discussed include the ways in which heterogeneity shapes therapeutic decisions, patient outcomes, and coverage policies; assessment of the evidence for new medications; and phone-based medication therapy management services.

In this video, Aaron McKethan, PhD, Vice President, Strategy and Business Development, RxAnte, talks about new strategies to improve patient medication adherence.

There exists a need for a standard of care to ensure that each patient's medications are appropriate, effective, safe, and able to be taken as intended. Medication therapy management (MTM) is a professional service that can help meet this need. Although the practice of providing comprehensive MTM services by phone has many positive attributes, there are many challenges associated with this type of intervention.

Brian Sweet, RPh, MBA, Executive Director, Health Care Alliances, AstraZeneca Pharmaceuticals, talks about the progress that has been made to-date in integrating clinical data elements with administrative claims data.

Medication assessments directly impact the way a drug is covered, and drugs with better quality data with a higher level of certainty are more favorably covered. Accurately assessing the evidence for new medications will help payers summarize a drug's benefit-to-risk ratio.

In this video, Aimee Tharaldson, PharmD, Senior Clinical Consultant, Emerging Therapeutics Express Scripts, Inc, talks about the impact that biosimilar medications could potentially have on the specialty pharmacy market.

Edith Rosato, RPh, IOM, the chief executive officer of the Academy of Managed Care Pharmacy, recently shared the organization's Top 5 strategic priorities for the coming year.

In this video, Feng Zeng, PhD, Senior Health Economist, MedImpact, discusses how the implementation of copayment reduction in the gap in 2011 influenced adherence measures for oral diabetes medications.

The role of the pharmacist in the care of patients with cancer is evolving. Pharmacists can help optimize treatment outcomes for each patient through use of patient-specific and disease-specific strategies.

In this video, David Nau, PhD, talks about data challenges as they relate to medication adherence measures. "One data challenge that Medicare plans face is getting all of the prescription field data from the pharmacist," says Dr. Nau.

Managed care pharmacists can help optimize outcomes in patients with age-related eye disease by addressing concerns regarding affordability of therapy, instructing patients on proper eye drop instillation, and evaluating the effects of different therapies. Ophthalmologists and optometrists should take part in managed care formulary discussions to help achieve optimal patient care.

In this video, Mark Zitter, MBA, talks about the implications of Co-Pay Offset Programs for managed care. "Co-pay programs affect managed care very differently depending on the nature of the program," says Zitter. "These programs are tremendously varied."