David Chess | PubMed Health

PubMed2005

Pharmacy utilization and the Medicare Modernization Act.

To control expenditures and use medications appropriately, the Medicare drug coverage program has established pharmacy utilization management (PUM) measures. This article assesses the effects of these strategies on the care of seniors. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt health outcomes. Our review raises concerns regarding the potential unintended effects of the Medicare drug program's PUM policies for beneficiaries. Therefore, the economic and clinical impact of PUM measures on seniors should be studied further to help policymakers design better drug benefit plans.

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PubMedDate not supplied

Creating a wellness program/safety net for the medically complex and frail patient.

There is a small subgroup of Medicare and Medicaid patients (2%-4%) who have complex illnesses, frailties, and often disabilities. The medical problems of these patients are characterized by multiple diagnoses, complex medication routines, frequent hospitalizations, many physicians and physician visits, impairment of activities of daily life (including cognitive disabilities), and reliance on a caregiver for support and keeping them in the community. The cost of their care increases year after year averaging $40,000 per year. Strongly associated with these multiple problems is isolation and often depression, which compounds their medical problems resulting in nonadherence to their prescribed medical regimes which might otherwise keep them out of the hospital. This article describes a new approach to providing both a wellness program and medical safety net for this unstable population.

Case Management↗