Prime Therapeutics Executive Summary

58 Words1 Page
bulb-icon

Recommended: Pros of managed care

The business being studied is that of a Pharmacy Benefit Management company called Prime Therapeutics. They are a privately held LLC headquartered in Bloomington, MN. It manages pharmacy benefits for health plans, employers and government programs, including Medicare and Medicaid. It also processes claims and delivers medicine to members, offering clinical services for people with complex medical

Show More
Related

  • Kaiser Permanente Essay

    1083 Words  | 3 Pages

    Kaiser Permanente is undergoing a supply chain transformation. It is the US’s largest none profit health plan, serving 9.5 million members with 38 hospitals and over 17,000 doctors and 48,000 nurses. Kaiser Permanente success depends on effectiveness and efficiency of their supply chain. Kaiser Permanente is successful because there chain management enhances performance and productivity with strategic combination of system, technology and people compare to other health care providers.

    Read More

  • Managed Care Quaternion Or Iron Triangle?

    785 Words  | 2 Pages

    This group is more focused on satisfaction, access and quality of care. Providers, or practitioners, are also key stakeholders within an organization. The term provider can encompasses not only physicians and surgeons, but also nurses, physical and occupational therapists, technicians, and other members of a clinical staff. Providers fall into two categories, primary, which includes hospitals and health departments and secondary, which includes educational institutions and pharmaceutical companies. Providers are focused on the best treatments for patients and are involved in delivering health services and products. The final element of the MCQ model is the employer who by far is the largest paying and purchasing stakeholder of an organization. The employers focus is primarily on their return on investment within an organization. Cost and quality is a focus for employers when choosing health benefits but are mindful that access is just as important. Within the Patient Healthcare model, MCQ explains the interactions between the four elements of employer, patient, provider and payer while the Iron Triangle focuses on the factors of cost, quality, and access. The Patient Healthcare model charges healthcare leaders with the task of balancing satisfaction with the stakeholder (employer, patient, provider, and payer) in relation to cost, quality and access. This may be very difficult since stakeholders may have competing priorities. Changes and variations made in how healthcare organizations operate may have profound effects on how stakeholders perceive the quality, access and cost. For instance, a patient may consider cost to be a top priority when seeking healthcare and at the same time the healthcare organization may consider raising costs and therefore devaluing access and quality. Patients who begin to incur high out-of-pocket costs may begin to perceive a financial

    Read More

  • Network Development In The Managed Care Organization

    1375 Words  | 3 Pages

    To guarantee that its members receive appropriate, high level quality care in a cost-effective manner, each managed care organization (MCO) tailors its networks according to the characteristics of the providers, consumers, and competitors in a specific market. Other considerations for creating the network are the managed care organization's own goals for quality, accessibility, cost savings, and member satisfaction. Strategic planning for networks is a continuing process. In addition to an initial evaluation of its markets and goals, the managed care organization must periodically reevaluate its target markets and objectives. After reviewing the markets, then the organization must modify its network strategies accordingly to remain competitive in the rapidly changing healthcare industry. Coventry Health Care, Inc and its affiliated companies recognize the importance of developing and managing an adequate network of qualified providers to serve the need of customers and enrolled members (Coventry Health Care Intranet, Creasy and Spath, http://cvtynet/ ). "A central goal of managed care is containing the costs of delivering care, but the wide variety of organizations typically lumped together under the umbrella of managed care pursue this goal using combination of numerous strategies that vary from market to market and from organization to organization" (Baker , 2000, p.2).

    Read More

  • Growth Strategies for Ophthalmic Consultants of Boston

    1827 Words  | 4 Pages

    In addition to this business plan, we must also address the financial issues plaguing this organization. To illustrate some of these issues lets look at some of the trends here at OCB and within our Industry: For example, OCB’s clinic operations profitability in 1990 was 60%, and now in 1996 our profitability is only 37%, which is down 23 percentage points! We can blame some of this on rising costs of overhead, consumables, etc, however this is happening as the industry as a whole is growing 5% annually, and as our customer base, largely senior citizens, population is growing at almost 1% as year. We should be capitalizing on these industry trends, however, as you all know, not all the trends work in our favor. For example, our lifeblood, the Insurance company’s managed care organizations, and government healthcare reimbursement programs shows a downward trend of allowable payments for our services (DRGs) For example in 1995 the DRG price of ...

    Read More

  • Case Study : Titus Lake Hospital

    1024 Words  | 3 Pages

    First, let us analyze General Practice Affiliates’ current financial position. The income and expenses report shows a net revenue of $230,250. The net revenue is obtained after expenses, including taxes, of the company have been subtracted from revenue (Paterson, 2014, p. 124). The balance sheet shows a $306,180 in retained earnings. Retained earnings represent stakeholders’ equity (Paterson, 2014, p. 128). Retained earnings are usually invested back in the form of inventory or debt payments (Albrecht, Stice, Stice , & Swain, 2008). General Practice Affiliates’ cash flow analysis shows that the practice invests in new equipment. However, General Practice Affiliates mainly used cash during 2012. The main source of cash from operations came from depreciation expense, which is not a reliable source of funding (Paterson, 2014, p. 130). Accounts receivable increased by $50,000, while accounts payable only increased by $10,000. In addition, cash flow analysis shows a balance sheet data that is affected by future transactions (Paterson, 2014, p. 128). General Practice Affiliates choose to stretch the time to pay suppliers instead of paying its bills. ...

    Read More

  • Kaiser Permanente

    999 Words  | 2 Pages

    The health care organization with which I am familiar and involved is Kaiser Permanente where I work as an Emergency Room Registered Nurse and later promoted to management. Kaiser Permanente was founded in 1945, is the nation’s largest not-for-profit health plan, serving 9.1 million members, with headquarters in Oakland, California. At Kaiser Permanente, physicians are responsible for medical decisions, continuously developing and refining medical practices to ensure that care is delivered in the most effective manner possible. Kaiser Permanente combines a nonprofit insurance plan with its own hospitals and clinics, is the kind of holistic health system that President Obama’s health care law encourages. It still operates in a half-dozen states from Maryland to Hawaii and is looking to expand...

    Read More

  • Aetna Case Analysis

    2154 Words  | 5 Pages

    Aetna, Inc. was established in 1853 and offers health insurance options for purchase. The main product portfolios include health insurance products with medical, dental, pharmacy, behavioral health, group life and disability plans. This essay will analyze the company’s structure and environment and provide recommendations on strategies that the company could take to improve performance.

    Read More

  • Case Study: Merck & Co.

    1303 Words  | 3 Pages

    Background: Merck & Co. is an American pharmaceutical company and one of the largest pharmaceutical companies in the world. In 1971 the United States approved the use of an MMR vaccine made by Merck, containing the Jeryl Lynn strain of mumps vaccine. In 1978 Merck introduced the MMR II, using a different strain of the rubella vaccine. In 1997 the FDA required Merck to conduct effectiveness testing of MMRII. Initially it was over 95%; to continue the license; Merck had to convince the FDA that the effectiveness stayed at a similar rate over the years.

    Read More

  • CareGroup IT Case Study: The Network Collapse

    1683 Words  | 4 Pages

    McFarlan, F. Warren. CareGroup. Ed. Robert D. Austin. N.p.: Harvard Business School, 2005. 1-22. Print.

    Read More

  • Novaris Pharmaceuticals Case Study

    738 Words  | 2 Pages

    Being presented with the problems in the implementation of the SAP ERP system, it is evident that Novartis Pharmaceuticals requires a comprehensive action plan that resolves key issues and the underlying problem. Refer to Exhibit A for a graphical representation of the action plan.

    Read More

  • Most Significant Issues Facing Health Care Organizations

    1334 Words  | 3 Pages

    Formed in 1998, the Managed Care Executive Group (MCEG) is a national organization of U.S. senior health executives who provide an open exchange of shared resources by discussing issues which are currently faced by health care organizations. In the fall of 2011, 61 organizations, which represented 90 responders, ranked the top ten strategic issues for 2012. Although the issues were ranked according to their priority, this report discusses the top three issues which I believe to be the most significant due to the need for competitive and inter-related products, quality care and cost containment.

    Read More

  • The Power and Benefits of Monopolies in the Pharmaceutical Industry

    1993 Words  | 4 Pages

    ... middle of paper ... ... Six years later, in 2001, the majority of their income came from services to pharmaceutical companies (Martinez). This shows a definitive shift in the conduct of PBM’s.

    Read More

  • Business Analysis: WellStar Health Systems

    1338 Words  | 3 Pages

    WellStar Health Systems is currently the preeminent and largest health care provider in Metro Atlanta. WellStar Health Systems is a not-for-profit institution that is composed of 5 hospitals and an abundance of physician groups. Physician specialty groups included within WellStar are: ENT, Psychiatry, Endocrinology, Pulmonary Medicine, Infectious Disease, General Surgery, Rehabilitation, Pathology, and Rheumatology. WellStar’s organizational design is composed of internal and external factors that define the organization’s size, organizational structure, and processes. Internal and external factors are the basis for influencing managerial conclusions in decision-making. These factors vary from organization to organization and are the rationale for understanding WellStar’s strengths, weaknesses, opportunities, and threats. Understanding these variables is a necessity for the sake of WellStar’s survival

    Read More

  • Fraud and Abuse in the Healthcare System

    913 Words  | 2 Pages

    Healthcare services have been on the rise for over 10 years now. According to a 2012 consumer alert, the industry provided $2.26 trillion in payments for more than four billion health insurance benefit claims in the year 2011(Fraud in Health Care). The bulk of the claims and the mainstream of fraud and abuse stem from the Medicare system professionals, who are knowledgeable about the process and persuade new clients into handing over their pertinent information in hopes of deception and illegitimate claims. Multiple and double billing, fraudulent prescriptions, are some of the major flaws in this organization that has made the healthcare services industry curdle. (AGHAEGBUNA, 2011) This is a non-violet crime and is often committed by very educated people including business people, hospital, doctors, and administrators.

    Read More

  • An Interview with a Doctor

    1080 Words  | 3 Pages

    Medicine, medical supplies, and medical treatment are multi-billion dollar industries crucial to the wellbeing of the public. Doctors and other members of the health-care industry do their best to provide excellent care for the nation’s sick and injured, while scientists and researchers work to develop new drugs and technologies to fight disease. We often view medical care as a basic human right; something that all persons, rich or poor, should have access to in times of need. But despite our notions of what healthcare should be, those who make a living in this industry, specifically owners of firms, must contend with the same economic questions facing businesses in any industry. To learn more about this vast service industry, I interviewed Dr. Martin Slez, a dentist/oral surgeon and owner of a medical practice that provides both general care and specialized treatments for oral diseases. Of the topics discussed, firm goals, pricing, costs, and technology stood out as particularly interesting and unique facets of the organization, as they differed considerably from those in other industries.

    Read More

More about Prime Therapeutics Executive Summary

Open Document