PubMed · 8443528
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G Butland. 1993-01-23. Commissioning for quality.. https://doi.org/10.1136/bmj.306.6872.251
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As doctors jump at offers from practice managers, many ignore business basics. But even a good lawyer can't cover everything. "No matter how carefully you make an agreement with one company, if it is swallowed up by another, it can be very different than you anticipated," says a doctor who sold his Southern California network only to be fired after a change in owners. "You could go to bed with Albert Schweitzer and wake up with Attila the Hun."
Alliances between managed care plans and public health agencies are a growing phenomenon in local health care markets, with profound implications for health care quality, cost, and accessibility. A typology of interorganizational relations between managed care plans and local public health agencies is drawn from observations of over 60 public health jurisdictions. Relations are described along three dimensions corresponding to the strategic intent, functional operation, and structural design of each alliance type. The identified models of interaction reveal the motivations for forming alliances, the mechanics of their operation, and the possible outcomes. These alliances suggest that a wide range of interorganizational strategies is possible in order to pursue the shared interests of local public health agencies and managed care plans. Nonetheless, public health agencies may face challenges in forging managed care alliances that benefit community-wide populations and that are open to participation by the full spectrum of health care providers in the community.
In November 1994, the Department of Pharmacy at Madigan Army Medical Center and the 62nd Medical Group Logistics (Fort Lewis, Washington) examined the feasibility of prime vendor support for the 18th Mobile Army Surgical Hospital in a Table of Organization and Equipment (TOE) unit rapid deployment. The TOE medication list was deemed to be out of date and a state-of-the-art formulary was developed. By identifying three National Drug Code bioequivalent substitutes for each National Stock Number, a 94% prime vendor match was achieved for pharmaceuticals form the new formulary serving as our template. The 6% of medications that were not able to be matched consisted of items deemed as military-unique or items not covered by the prime vendor government contracts with wholesalers. On August 7, 1995, a trial was conducted to determine whether the local prime vendor had the capacity to support a deployment under its present contract with Madigan Army Medical Center. Two hundred eighty-six line items were ordered, mocking the deployment of two medical units. More than 95% of the line items were filled within 5 days from the local prime vendor. Under the local contract, the prime vendor was under no obligation to have out-of-stock medications provided by overnight shipment from other national distribution sites. This advantage, which is standard in national pharmaceutical prime vendor contracts negotiated by large civilian group purchasing organizations, would have substantially decreased the period of time to attain a > 95% fill. The results of this trial have provided strong support for prime vendor utilization in future deployments.