Shared Flashcard Set

Details

Finance 2
pharmacy related finance (lectures 4,6,7)
77
Pharmacology
Graduate
12/06/2009

Additional Pharmacology Flashcards

 


 

Cards

Term
What can you prescribe for almost any problem?
Definition
Better Communication
Term
How good is the message in the chain of communication?
Definition
Its as good as the poorest communicator.
Term
What is the definition of communication?
Definition
Communication focuses on how people use messages to generate meanings within and across various contexts, cultures, channels, and media... to promote the effective and ethical practice of human communication.
Term
What has the greatest impact on effective communication?
Definition
Level of education
Term
How does communication vary in effectiveness and comfort when speaking to a co-worker vs speaking to a boss?
Definition
We are more comfortable speaking with a coworker and have more effective communication than speaking with a boss.
Term
What are the 3 basic tasks of communication?
Definition

- To inform

-To entertain

- To persuade

Term
What is the primary motivation for communication?
Definition

Power and Profit

Power: personal, employer, professional

Profit: monetary, credibility, career

 

Term
What are secondary motivations for communication?
Definition

- self expression

- warning

- celebration

- questioning/challenging

Term
What happens to information when you add emotions to the content?
Definition
It becomes memorable or motivational.
Term
How does communication change when information becomes active?
Definition
Information shifts from passive education to active collegial.
Term
What are the 3 tasks of business communication?
Definition

To record information

To transfer information

To present information

Term
What are 3 common elements to a service, product, or proposal?
Definition

Feature: characteristics that make it what it is, ie patient counseling

Advantage: something that has value to the end user, ie patient understands medications

Benefit: perceived value, ie better patient outcome

Term
What shapes the message?
Definition
The purpose
Term
Benefits are the message. What do they add?
Definition

They add interest by adding perceived value.

The benefits we listen for reflect things about us.

Term
What is an advantage?
Definition
Its a value for the end user.
Term
What needs are satisifed by benefits?
Definition

Economy: saving time and money

Achievement: the results that you want

Safety/security: avoid problems, minimal risk

Esteem: gain respect, recognition, admiration

Term
What is a benefit?
Definition
- A perceived value that satisfies a need.
Term
Where is the emphasis in communication?
Definition

- On the "you"

What does this mean for you?

Term
What is an objection?
Definition
Its a request for more information and its an opportunity for you.
Term
What functions do objections play in professional communication?
Definition

- Test credibility

- slow down communication

- show a need for more information

Term
What are the typical objections?
Definition

- Misunderstanding: issue of rephrasing

- stalling: issue of needing more infomation

- skepticism: issue of trusting you or the information

Term
If you have an objection what should you do?
Definition

- listen actively

- don't argue

- don't attack

- don't lose confidence

- do iluminate

Term
How do you welcome an objective?
Definition

- be open, not defensive

- show comfort and confidence

- encourage more dialogue

Term
How should you confirm an objective?
Definition
- By Rephrasing, you should never guess
Term
What are the steps in dealing with an objection?
Definition

welcome it

rephrase it

present/ transfer information

Test: close ended question

Ask: open ended questions

Term
After presenting new information in dealing with an objection what is the next step?
Definition
Test it with a close ended question.
Term
What is the most important thing in communication?
Definition
To hear what is not being said
Term
What are health disparities?
Definition

- population-specific differences in the presence of disease, health outcomes, or access to health care

 

- refers to gaps in quality of health and health care across racial and ethnic groups

Term
How does the death rate correspond to low income inequity?
Definition
The death rate is also low.
Term
What are the acute domestic agenda priorities?
Definition

- health care reform

-education

- economy

Term
What percentage of health care spending does the government cover?
Definition

About 50%

- 2009 47%

-2016 over 50%

Term
How does the US health care system compare to other countries in health status and cost?
Definition
- highest costs and worse health status in the developing world.
Term
Why is there an increasing growth of the uninsured?
Definition

- downturn in the economy and increased unemployment

- rising health care costs

- fiscal constraints on public health insurance coverage

Term
There are higher rates of rising chronic illness in Detroit, what happens if these are not managed in a Primary Care setting?
Definition

- increased utilization of ED

- 69% preventable hospitalization rate

- these things result in higher healthcare costs

Term
What is the ER crisis?
Definition

- There is a 15% decrease in the number of ERs

- increase number patients going to ERs

- 50% of ER visits are not urgent

- only 12% of ER visits result in hospital admission

Term
Where in MI has the most preventable hospitalizations?
Definition
Detroit
Term
What are the benefits of having a regular source of care?
Definition

- improves the utilization of ambulatory care

- encourages the receipt of preventable services

- reduces ER visits and preventable hospitalzations

Term
Why do most uninsured delay seeking health care?
Definition

- they dont know where to find affordable health care in their local community

- they avoid care because of prohibitive costs

Term
What are the 5 outcomes sought by the Kellogg Foundation's Community Voices grant initiative?
Definition

1. increases in acess to care for the uninsured and vulnerable

2. strengthening of the community safety net

3. Building of cost-effective and high quaility delivery systems

4. new model should provide system change so that it will be sustainable beyond the 5 yr grant

5. Develop practices to share with other communities

Term
What is the objective of the Voices of Detroit Initiative?
Definition
- providing leadership that helps organize care delivery and expand and improve access to cost-effective, high quality health care, for the uninsured and the underserved.
Term
What is included in the VODI intervention model?
Definition

- Kellogg Grant

- Intevention

- VODI providers provide Primary care at no or a significantly reduced cost

- VIM active outreach in ERs >>> PC sites

Term
What is the summary of the typical VODI patient?
Definition
- singel, AA women, less employed, poor, sicker, supporting multiple family members
Term
How much did the VODI shift active enrollees out of the ER and into a primary care setting?
Definition
- 55%
Term
What kind of savings was seen with the VODI intervention model?
Definition
42% cost savings
Term
What is VODI's premise with national implications?
Definition
We prove that you can cover everyone and simultaneously decrease healthcare costs.
Term
What are Obama's Health Care Reform Goals?
Definition

- lower costs

- cover everyone

- increase quality

Term
What congressional committees are working on major health care reform legislation?
Definition

3 House committees: Education and Labor, Energy and Commerce, Ways and Means

2 Senate Committees: Finance Committee, HELP Committee

Term
Can we cover everyone, control costs and make HC premiums afforable?
Definition
Yes, but not with the current status quo
Term
By covering everyone, what is the impact on me?
Definition
The insured are already covering the uninsured
Term
Where does health care reform need to focus?
Definition
Jobs and the economy
Term
What is the public option?
Definition

- option that would be available through a public health insurance exchange

- allows families that make between 133% to 400% of the federal poverty level to have some subsidized health care

Term
How will Americans benefit from new health reform laws?
Definition

- End the practice of denying insurance because of pre-existing conditions

- ends the practice of allowing the termination of insurance if you become seriously ill

Term
What is the Baucus Bill?
Definition
- Create health care affordability tax credits to help low and middle income families purchase insurance in the private market.
Term
What are Health Care Co-Ops?
Definition

- non-profit, membership owned groups of individuals and small businesses who join together to negotiate healthcare rates as a group

- the annual rate increase of 12% is coming close to the 15% associated with private insurance plans.

- not cheaper, too small to drive down costs, cant compete

Term
What is the core issue of healthcare reform?
Definition
Its about the Gov protecting the American people.
Term
What are the negotiated rates of the health care reform bill?
Definition
- reimbursement rate between Medicare plus 5%  and commercial rates.
Term
What is the reimbursement schedule of the health care reform bill?
Definition
- Medicare plus 5% for the 45 million uninsured americans
Term
What is the problem with negotiated rates?
Definition

It adds 85 billion over 10yrs to cost.

In order to cover this the house bill expands to 150% FPL as opposed to 133%.

Term
What is the Robust Public Option?
Definition
it equals the more affordable the health insurance product, the more people are covered
Term
What is the benefit of removing the anti-trust exemption?
Definition

- helps increase the insurance affordability

- eliminates the monopoly status, therefore drives down pricing in the market

Term
What is managed care?
Definition
- An organized healthcare program designed to manage both the quality and the cost of healthcare.
Term
What is a Health Maintance Organization?
Definition

- type of managed care plan where access to care is controlled by a primary care doctor

- coverage is limited to approved medical services

- prepaid

- members assigned to a PCP

- speciality care or surgery may require a referral or PA

- includes programs to improve health

Term
What is a PPO?
Definition

- A preferred provider organization

- similar to a HMO

- not restricted to network physicians

- richer benefits when in-network

- do not need referral for a specialist

Term
What is a Point of Sale Plan?
Definition

- HMO/PPO hybrid

- option to choose PCP

- richer benefits if you choose PCP for referrals

- larger costs if you go out of the network

 

Term
What is a staff model?
Definition
- Physicians are hired to exclusively serve the HMO population
Term
What is a Group Model?
Definition
- Large multi-speciality practice forms relationship with one HMO
Term
What is an individual practice association?
Definition

Individual or small group practices contract with mulitple plans

- the most common type of physician network

Term
What are the different types of physician risk arrangements?
Definition

Capitated: physician group assumes 100% risk

Shared Risk: Physician group and HMO share the risk

 No Risk: paid on a fee for service basis but usually incentivized to improve performance

Term
Compare the Early HMO vs Traditional Indemnity Insurance
Definition

- Not necessarily low cost. Cost greater than or equal to fee for service plans

- Enhanced Benefits

- Emphasis on preventive care, immunizations

Term
What are some things included in the Federal HMO Act of 1973?
Definition

- required firms with 25 employees to offer a HMO

- pre-empted state laws that banned prepaid groups

- provided 375 million in federal funds to help develop HMOs

Term
What did the Balanced Budget Act of 1997 create?
Definition

Medicare + Choice (Part C)

- Allows beneficiaries to receive Medicare benefits through private plans

- This gives them lower premiums, co pays, and deductibles and more benefits.

- favored by low income seniors

 

Term
What is a problem for Medicare Part C?
Definition
- federal reimbursments did not match the costs
Term
What resulted in the 2003 Medicare Modernization Act?
Definition

- Medicare Plus choice became Medicare Advantage, with enhanced payment from CMS

- Part D coverage becomes available in 2006

- MAPD plans created to combine Medicare Advantage Plans with prescription drug coverage

Term
How does the National Committee for Quality Assurance assess HMO's and PPO's?
Definition

- Plans reviewed against 60 standards: access & service, prevention, quaility of providers, chronic care etc.

- Online report cards

- Healthcare Effectiveness data and information set

Term
What are managed care pharmacy roles?
Definition

- Pharmacy Benefit Manager

- manage pharmacy claims processing systems

- utilization management

- contracting with pharmacies

- rebate contracting with other drug companies

- electronic prescribing

Term
What are some utilization management tools for managed care pharmacy?
Definition

- formularies

- quantity limits

- step therapy

- PA

Term
What are some clinical pharmacy programs?
Definition

- Medication Therapy Management

- Chronic care initative

- Advanced Medical Home

- Speciality Drug Management

- Review PA and appeals

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