Next HMO quality hurdle: integrating medical and pharmacy data

A recent survey of pharmacy directors in 49 HMOs representing 9.5 million enrollees revealed that most of the plans have now embraced “disease state management” programs. Such programs, often implemented jointly with pharmaceutical companies or pharmacy benefit managers, seek to rationalize management of patients with certain conditions, employing aggressive treatment early to minimize expensive complications later. DSM works best, experts say, when plans’ information systems can integrate medical and pharmacy data. Only a minority of participating HMOs now boast that capacity, according to the survey, but more will be adding it soon.


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