Accessing medical and social resources for patients, heavy administrative burden, and lack of data integration are barriers to Medicaid managed care organization care coordinators’ job performance.
A score was developed to measure patient risk from payer utilization management policies and its relationship to real-world US commercial payer utilization management policies.
Payers should consider providing higher reimbursement rates and/or preferred pharmacy networking status for pharmacies that provide chronic medications in blister packs for patients.