Drugs, Quality, and Satisfaction - Quality Improvement Initiatives by Managed Care Organizations

Instructor: Alan Bayham
Product ID: 700286
Training Level: Basic
  • Duration: 60 Min

recorded version

1x Person - Unlimited viewing for 6 Months
(For multiple locations contact Customer Care)
Recorded Link and Ref. material will be available in My CO Section

Training CD

One CD is for usage in one location only.
(For multiple locations contact Customer Care)
CD and Ref. material will be shipped within 15 business days

Customer Care

Fax: +1-650-963-2556


Read Frequently Asked Questions

This Pharmaceutical training will review the value that pharmacy claims data offers in the identification and tracking of many of these regulatory guidelines and accreditation standards.

Managed Care Organizations are under pressure to improve the quality of health care as measured by NCQA, URAC, HEDIS, and MMA. This presentation will review the value that pharmacy claims data offers in the identification and tracking of many of these regulatory guidelines and accreditation standards. In addition, pharmacy benefit structure directly affects members’ (patients) accessibility to prescription drugs which in turn impacts quality improvement initiatives. Also, Member and Provider (physician) Satisfaction surveys, such as CAHPS can be positively (or negatively) influenced by assess (or lack of access) to prescription drugs.

Areas Covered in the seminar:

  • How do pharmaceuticals "fit into" government regulations and accreditation standards regarding Quality Improvement Initiatives (QII’s)
  • How to design QII’s to maximize the value of pharmaceuticals and pharmacy claims data
  • How to structure pharmacy benefits to improve the effectiveness and efficiency of QII’s and to positively impact member and provider satisfaction

Who Will Benefit:

  • Managed Care Organizations: CEO’s, CMO, Accreditation Managers, Compliance Officers, Sales and Marketing Directors, Pharmacy Directors, Medical Directors, Health Services Directors, Quality Assurance Directors, Patient Satisfaction Managers
  • Pharmaceutical Manufacturers: CEO’s, Account Executives, Marketing Directors.

Instructor Profile:

Mr. Bayham, has over 30 years of pharmacy management experience in hospital, institutional, retail, pharmaceutical industry and managed care settings. He has directed various aspects of managed care, including Pharmacy Services, Member Services Call Center, Member Education, and Appeals and Grievances. He developed policies and procedures necessary to meet governmental agencies regulations and accreditation standards. His departments were vital components in the effort to provide quality health care, improve member and provider satisfaction, and control rising health care costs - ranking higher than the regional and national averages by the Medicare Consumer Assessment of Health Plan Survey (CAHPS) and contributing greatly to being ranked in the 90th percentile of all Medicare-Advantage Health Plans nationwide. As the Medicare QIO Part D Quality Assurance Consultant, Mr. Bayham is responsible for reducing inappropriate prescribing in elderly Medicare beneficiaries in Louisiana.

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