ASCP Reports

Pharmacy Services in Long-Term Care: A Guide for Managed Care Plans

ASCP's Long-Term Care Pharmacy and Managed Care, a companion piece to ASCP's Model Long-Term Care Benefit, makes its first appearance at ASCP's 27th Annual Meeting and Trade Exhibition in Nashville this month. The book provides an outline for managed care organizations of the principles and strategies they should consider when developing long-term care pharmacy benefit plans.

Homing in on Long-Term Care

Until very recently, long-term care and long-term care pharmacy, with a few significant exceptions, have not attracted the attention of managed care organizations to the same degree as primary and acute care. According to Michael Pollard, a Washington, D.C., attorney who specializes in managed care, "Health maintenance organizations haven't seen long-term care as a growth area. They've been afraid of assuming the risk for managing utilization in nursing homes."

MCOs also cite thin (2 to 5 percent) profit margins in the nursing home industry. And most Medicaid managed care projects have shied away from the low-income, chronically ill elderly, a population whose health care utilization is high and whose costs appear difficult to manage and predict.

However, all that is changing, much of it due to simple demographics. The aging of the population in this country will dramatically increase the demand for long-term care: It has been projected that the number of elderly persons needing long-term care will double between 1990 and 2030.

Core Assumptions

Long-Term Care Pharmacy and Managed Care reviews some key assumptions regarding long-term care and managed care:

• Most MCOs are moving from capitation/risk sharing for specific benefits (such as long-term care pharmacy) or even specific features of benefits (such as drug product costs only) to capitation/risk sharing for broader ranges of services (long-term care or even all health care). Many MCOs that are not proceeding in this direction wish to do so.
• Payers are seeking quality care for their enrollees, not just controls on their health care spending. In fact, sophisticated payers recognize that high quality care in the appropriate setting is cost-effective.
• While some long-term care pharmacists offer both distribution and consulting services in long-term care settings, others offer consulting services alone. Both groups of pharmacists are responsible for controlling the utilization and cost of medications. Of equal importance, they strive to improve patient outcomes (good health and quality of life) by minimizing drug-related problems and therapeutic failures. They must work closely with physicians, nursing homes, and other health providers to fulfill this responsibility.

The Guidelines

The document describes guidelines for managed care organizations to consider in their design of long-term care pharmacy benefits, including the uniqueness of the frail elderly, the cost of therapeutic failures and adverse consequences on total health care costs, and the value of long-term care pharmacists' consulting services.

To obtain a copy of Long-Term Care Pharmacy and Managed Care, please call ASCP's Customer Service department at 800-355-ASCP.

ASCP Seeks Executive Resident for 1997-1998

ASCP currently is accepting applications for its Executive Residency in Association Management Program. This one-year program offers a unique opportunity for a pharmacy graduate to gain experience in, and prepare for, a career in association management. While at ASCP headquarters, the executive resident will participate in a wide range of learning activities, including contributing articles for publication, planning staff and membership meetings, attending various ASCP meetings, representing ASCP at other association meetings, and responding to member inquiries.

The program is designed to prepare individuals for association staff positions in national, regional, state, and local pharmacy or other health-related organizations.

The deadline for receipt of applications is February 1, 1997. Please contact this year's resident, Caren McHenry Martin, at 703-739-1316, ext. 107, for more information.