Facing Many More Demands, P&T Committees Seek Expertise


John 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.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.

UP NEXT

Managed Care
By Peter Wehrwein
Managed Care
By Howard Wolinsky