title: Group practice strategies to manage pharmaceutical cost in an HMO network.
abstract: OBJECTIVE
  To evaluate the prevalence of various pharmaceutical cost management strategies used by group practices within a managed care network and their relationship to drug costs among enrollees. STRATEGIES STUDIED: Care management (gatekeeping, practice profiling, practice guidelines, case management), techniques for maintaining clinic medication records, and policies regulating physician interaction with pharmaceutical sales representatives (PSRs).
  
  
  METHODS
  Cross-sectional survey of primary care group practice organizations (n = 103) affiliated with Blue Cross Blue Shield of Minnesota in early 1996.
  
  
  METHODS
  Multivariate linear regression analysis was performed on corresponding claims data for members continuously enrolled in these practices from January 1 to December 31, 1995 (n = 76,387), using the patient as the unit of analysis.
  
  
  RESULTS
  Substantial variation in strategy prevalence was observed; this variation was thought to influence pharmaceutical costs. Seventy-six percent of practices had medication lists in outpatient medical records, 53% had policies limiting pharmaceutical detailing, and 44% had patients assigned to primary care gatekeepers; however, only 10% used outpatient nurse case managers. Use of outpatient nurse case managers (P < .010), primary care physician gatekeeping (P < .002), policies to control pharmaceutical detailing (P < .001), and medication lists and outpatient charts (P < .001) was found to be independently associated with lower pharmaceutical expenditures. Significant colinearity was found between group size and the strategies studied.
  
  
  CONCLUSIONS
  Significantly lower pharmaceutical costs per member per year were observed in the groups reporting primary care gatekeeping, outpatient medication records, outpatient case managers, and policies regarding physician interactions with PSRs.
authors.affiliation: Center for Practice Improvement and Outcomes Research, Creighton University, Omaha, NE 68131, USA. kgalt@creighton.edu
authors.forename: K A
authors.initials: KA
authors.lastname: Galt
authors.forename: E C
authors.initials: EC
authors.lastname: Rich
authors.forename: J E
authors.initials: JE
authors.lastname: Kralewski
authors.forename: P D
authors.initials: PD
authors.lastname: Turner
authors.forename: T S
authors.initials: TS
authors.lastname: Bernhardt
authors.forename: B
authors.initials: B
authors.lastname: Dowd
authors.forename: R
authors.initials: R
authors.lastname: Feldman
authors.forename: A
authors.initials: A
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D054598:Blue Cross Blue Shield Insurance Plans; D002648:Child; D002675:Child, Preschool; D003363:Cost Control / Q000379:methods; D003430:Cross-Sectional Studies; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D006123:Group Practice / Q000191:economics*; D006279:Health Maintenance Organizations / Q000191:economics*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009937:Organizational Objectives; D011320:Primary Health Care / Q000191:economics*