Rowe Lecture

Question 1

What are staff model MCO’s?

Answer 1

managed care organizations that employs MDs and may own clinics, hospitals, and pharmacies for exclusive use of their enrollees

Question 2

What are Independent Practice Association model MCO’s?

Answer 2

MCOs that contract with independent MDs in the preferred provider organization

Question 3

What are the components of the “Triple Aim”?

Answer 3

1. Quality
2. Satisfaction
3. Affordability

Question 4

What are the three measures for quality for MCOs?

Answer 4

1. HEDIS
2. QARR
3. CMS Star Ratings

Question 5

What impact on patients does increased prescription drug costs have?

Answer 5

-increased premiums
-increased copays/coinsurance costs

Question 6

What are the main causes of increasing drug costs and spending?

Answer 6

1. better diagnoses
2. guideline changes
3. drug manufacturers setting high prices

Question 7

What are accelerated drug approvals?

Answer 7

pathway for companies to get unique meds to market faster

Question 8

What is a open formulary?

Answer 8

all drugs are available

Question 9

What is a closed formulary?

Answer 9

only listed drugs are available

Question 10

What is tier 1 of formulary?

Answer 10

generic drugs

Question 11

What is tier 2 of formulary?

Answer 11

-brands withsignificant clinical advantages
-first line therapy
-unique therapeutic agents for its approved indication

Question 12

What is tier 3 of formulary?

Answer 12

-default tier for new agents and “me too” drugs
-non-preferred drugs where utilization management is still needed