Entry-level Competencies Needed for Managed Care Pharmacy ...

49 Evaluate medication-use patterns in a specified patient
population
Items meeting neither threshold:
2 Understand the differences between health care
delivery models (PPOs, ACPs, integrated systems,
patient-centered medical homes)
*3 Describe the macro- and micro-economics associated
with health care and how health care is financed
4 Outline the general provisions of Medicare Parts A, B,
C and D, and Medicaid, including coverage of
medications
9 Identify the major factors influencing drug costs for a
managed care organization (e.g., pharmacy costs, drug
pricing methodologies, contracts/rebates, discounts)
**10 Describe in a general way the factors involved in
processing eligibility and claims for prescription drugs
and related services in a managed care organization
11 Explain the role of quality organizations and
accreditation agencies in ensuring quality of managed
care operations (including the quality of patient care
and the quality of pharmaceutical products and
devices purchased by the organization)
12 Identify and describe the steps involved in the drug
distribution process, form the manufacturer to the
ultimate consumer (including physicians, nurses,
pharmacists and patients) and the prescription
reimbursement flow from managed care provider to
pharmacy and the patient
13 Explain how state and federal laws and regulations are
integrated into the operation of a managed care
organization
**15 Explain the general structure and functions of
alternative health-care delivery options, including
integrated health systems, accountable care
organizations, and patient-centered medical homes
82.7 4.17 5
61.4 3.68 4
48.4 3.39 3
Rejected,
replaced
with alt.
wording
71.6 3.93 7
55.1 3/98 5
53.2 3.66 3
53.0 3.72 5
Combined
with #18
below
75.5 3.71 4
56.7 3.82 4
52.6 3.52 3
*18 Discuss the principles of quality management 72.5 3.96 4
21 Identify several major factors that contribute to drugrelated
82.5 3.89 6
fraud and abuse
22 Identify several major factors that contribute to drug 84.5 3.89 5
waste
**31 Apply project-management skills 60.4 3.97 3
36 Develop educational materials and correspondences
for patients and caregivers (at the appropriate level of
81.0 3.96 6
49