PubMed · 9146085
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L BeSaw. 1997. UT's HMO.. https://pubmed.ncbi.nlm.nih.gov/9146085/
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The individuals and committees involved in each phase of the process for deciding which drugs to make available to HMO enrollees were identified, and level of participation and influence were studied. A questionnaire based on eight phases of the drug availability decision-making process that listed eight individuals and four committees was developed. The questionnaire was pretested and sent to 303 HMOs randomly selected from a 1993 national directory. Respondents were asked to rate on a 5-point scale the frequency of participation and the perceived influence of each person and committee at each phase. The survey response rate was 28%. Individuals and committees varied significantly within each phase of the process. Pharmacy directors, pharmacy and therapeutics (P&T) committees, formulary committees, and drug information specialists participated frequently to always in the first six phases; only pharmacy directors and P&T committees exerted a large influence to complete control during those phases. Pharmacy directors and drug information specialists participated most, compared with other individuals. Nursing directors and nurses participated least and exerted the least influence. Pharmacy directors and P&T committees participated the most and exerted the greatest influence in determining which drugs HMOs should include in their prescription benefits.
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As systems of health care delivery have evolved from claims-based fee-for-service to capitated or managed care, with its emphasis on cost-effectiveness, quality, and performance measurement, some states have begun to experiment with new ways to collect, organize, and share health information. In many cases, the drivers of these changes have been purchasers of health care, including large and small private employers and public agencies such as Medicaid. One of the results of these changes is the increased interest in the sharing of health information, between health plans and employers, and, in some instances, between private plans and public agencies such as public health. Massachusetts, which has one of the highest rates of managed care penetration in the United States, has brought together the various parties involved in the collection and utilization of health information, to craft agreements on standards and protocols that will allow the sharing of health data. While much of the activity involves business transactions between private sector health plans, the Department of Medical Assistance (Medicaid) has joined with its private sector purchasing partners in demanding cost-effective, high-quality care; it is these demands that have helped stimulate the need to reorganize previously proprietary health information systems. The activities of two public-private coalitions, the Massachusetts Healthcare Purchaser Group and the Massachusetts Health Data Consortium, have been critical in initiating and supporting the complex processes that have led to significant changes in state-based systems of health information.