Magazine article Drug Topics

Medicare and Managed Care: Can They Live Together?

Magazine article Drug Topics

Medicare and Managed Care: Can They Live Together?

Article excerpt

What impact do Medicare patients have on managed care organizations? Enrolling these patients can increase an HMO's volume, but it can also create some problems.

Medicare recipients should have greater access to managed care plans than they now have, according to Kevin E. Moley, assistant secretary for management and budget, U.S. Department of Health & Human Services. "But," he conceded, "if we (the government) were paying a more equitable rate for Medicare reimbursement, it would be easier for managed care firms to make such an offer to those eligible for Medicare."

Moley was addressing the Academy of Managed Care Pharmacy's December Conference in New Orleans when he made those comments. Later, in informal discussions with attendees at that conference, several HMO pharmacists said that they do have Medicare patients enrolled in their ranks.

It's a matter of supply and demand, AMCP president Perry Cohen, Pharm.D., told Drug Topics. Cohen, assistant-v.p.-pharmacy programs, Aetna Health Plans, Hartford, Conn., said that the more patients enrolled in a managed care plan, the better the volume of services provided within the scope of that managed care organization. A larger volume of people using a business' service increases cash flow within that business, he added.

"This age group includes tremendous utilizers of medical services," commented Sanford Cohen, R.Ph., a regional pharmacy manager with Cigna Healthplan of California, based in Canoga Park. "They can be extremely expensive members." Many in that age group are on costly maintenance medications, he pointed out. …

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