Group practice strategies to manage pharmaceutical cost in an HMO network

Kimberly A. Galt, E. C. Rich, J. E. Kralewski, P. D. Turner, T. S. Bernhardt, B. Dowd, R. Feldman, A. De Vries

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: To evaluate the prevalence of various pharmaceutical cost management strategies used by group practices within a managed care network and their relationship to drug costs among enrollees. Strategies studied: Care management (gatekeeping, practice profiling, practice guidelines, case management), techniques for maintaining clinic medication records, and policies regulating physician interaction with pharmaceutical sales representatives (PSRs). Study design: Cross-sectional survey of primary care group practice organizations (n = 103) affiliated with Blue Cross Blue Shield of Minnesota in early 1996. Methods: Multivariate linear regression analysis was performed on corresponding claims data for members continuously enrolled in these practices from January 1 to December 31, 1995 (n = 76,387), using the patient as the unit of analysis. Results: Substantial variation in strategy prevalence was observed; this variation was thought to influence pharmaceutical costs. Seventy-six percent of practices had medication lists in outpatient medical records, 53% had policies limiting pharmaceutical detailing, and 44% had patients assigned to primary care gatekeepers; however, only 10% used outpatient nurse case managers. Use of outpatient nurse case managers (P <.010), primary care physician gatekeeping (P <.002), policies to control pharmaceutical detailing (P <.001), and medication lists and outpatient charts (P <.001) was found to be independently associated with lower pharmaceutical expenditures. Significant colinearity was found between group size and the strategies studied. Conclusions: Significantly lower pharmaceutical costs per member per year were observed in the groups reporting primary care gatekeeping, outpatient medication records, outpatient case managers, and policies regarding physician interactions with PSRs.

Original languageEnglish
Pages (from-to)1081-1090
Number of pages10
JournalAmerican Journal of Managed Care
Volume7
Issue number11
StatePublished - 2001

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Group Practice
group practice
Health Maintenance Organizations
pharmaceutical
Outpatients
Gatekeeping
Costs and Cost Analysis
costs
Pharmaceutical Preparations
Blue Cross Blue Shield Insurance Plans
medication
sales representative
Primary Health Care
physician
manager
Nurses
nurse
Physicians
Drug Costs
outpatient care

All Science Journal Classification (ASJC) codes

  • Nursing(all)
  • Medicine(all)
  • Health(social science)
  • Health Professions(all)

Cite this

Galt, K. A., Rich, E. C., Kralewski, J. E., Turner, P. D., Bernhardt, T. S., Dowd, B., ... De Vries, A. (2001). Group practice strategies to manage pharmaceutical cost in an HMO network. American Journal of Managed Care, 7(11), 1081-1090.

Group practice strategies to manage pharmaceutical cost in an HMO network. / Galt, Kimberly A.; Rich, E. C.; Kralewski, J. E.; Turner, P. D.; Bernhardt, T. S.; Dowd, B.; Feldman, R.; De Vries, A.

In: American Journal of Managed Care, Vol. 7, No. 11, 2001, p. 1081-1090.

Research output: Contribution to journalArticle

Galt, KA, Rich, EC, Kralewski, JE, Turner, PD, Bernhardt, TS, Dowd, B, Feldman, R & De Vries, A 2001, 'Group practice strategies to manage pharmaceutical cost in an HMO network', American Journal of Managed Care, vol. 7, no. 11, pp. 1081-1090.
Galt KA, Rich EC, Kralewski JE, Turner PD, Bernhardt TS, Dowd B et al. Group practice strategies to manage pharmaceutical cost in an HMO network. American Journal of Managed Care. 2001;7(11):1081-1090.
Galt, Kimberly A. ; Rich, E. C. ; Kralewski, J. E. ; Turner, P. D. ; Bernhardt, T. S. ; Dowd, B. ; Feldman, R. ; De Vries, A. / Group practice strategies to manage pharmaceutical cost in an HMO network. In: American Journal of Managed Care. 2001 ; Vol. 7, No. 11. pp. 1081-1090.
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