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Report: Managed Care Plans Influence Physician Prescribing

Expansion of managed care influence in Medicare and Medicaid is key factor (November 18)

Decision Resources, a research and advisory firm located in Burlington, Mass., finds that prescribing influencers are increasingly consolidated among managed care plans as the payers become more prevalent in public-sector markets.

The report also finds that managed care’s controls over formularies and utilization is consolidating at the same time patients are assuming control of their own drug spending through high-deductible health plans and other benefit designs that require more patient out-of-pocket purchasing.

The findings reveal that more than half of the 60 million people enrolled in Medicaid in the U.S. are in managed care plans whose drug management is guided by the plans and associated pharmacy benefit managers. Three out of four U.S. citizens over 65 years of age are enrolled in Medicare Part D plans with built-in formularies and networks. At the same time, hospital and physician consolidation has concentrated prescribing influencers among large, integrated health systems.

“As health care reform unfolds, an emphasis on efficiency, value, and improved outcomes is changing prescribing dynamics,” said analyst Jane DuBose. “The accountable care movement transfers patient outcomes and financial risk to providers, and it is crucial not only to identify the risk takers among prescribers, but to understand the quality metrics that are guiding their behavior.”

Source: Decision Resources; November 18, 2013.

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