Managed Care

 

Facing Many More Demands, P&T Committees Seek Expertise

MANAGED CARE December 2001. © MediMedia USA
Editor's Memo

Facing Many More Demands, P&T Committees Seek Expertise

John A. Marcille
MANAGED CARE December 2001. ©MediMedia USA

John A. Marcille

Those who are quick to disparage management by committee probably would be just as quick to disparage management by despotism, if they weren't so frightened of the despots. American entrepreneurial spirit has seeped into the most formal of businesses to facilitate a free flow of ideas. Or at least that's the aim.

Contributing Editor MargaretAnn Cross's cover story shows how health care is as attracted to the possibility of mining expertise as any other industry. Her article demonstrates how the formulary committee has been opened up to admit more than just those players who are still the recognized mainstays of those bodies — physicians, medical directors, pharmacists. Specialists, nurses, and PBM personnel are now coming aboard. Epidemiologists, statisticians, and actuaries aren't far behind. The chart reveals a whole category called "other."

Thanks to a rash of new agents flooding the market — and set against a backdrop of increasing public attention focused on access and out-of-pocket costs — P&T committees are expected to do more, review more, and take more into consideration when making decisions. As a result, they have been forced to go after experts they may not have needed in the past, and in the near future may have to go even further, tapping geneticists and ethicists to unravel the complications that genetic medicine will introduce.

What comes out of such committees is so vital that HMO physician executives seek extra training on the best ways to run such meetings, a point made by Alan G. Adler, MD, MS, the interim chief medical officer at Horizon Mercy, a Medicaid HMO in New Jersey. His first-person account about being coached in executive skills is all about listening. Ditto for our Q&A feature, in which Bob Stone, a DM lifer, explains how that niche industry has listened to what customers want and is evolving as a result.

Change is vital, even if it doesn't come easily. Yet not all change is desirable. Near the back of this issue, our thoughtful ethicist, Michael Victoroff, MD, discusses the utility of full body scans, and finds some reasons not to embrace the new.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014