Disease management program PDF

UNIVERSITY OF BOTSWANA
SCHOOL OF PHARMACY
MANAGED CARE ROTATION -PHA 327
REPORT
FACILITY: ASSOCIATED FUND ADMINISTRATORS
Mr. Mompati Letsweletse
201100183
Rotation period 21-25 June 2021
Submission date: 26-07-2021

TABLE OF CONTENTS
1.0 OBJECTIVES.............................................................................................................................................................2
2.0 INTRODUCTION......................................................................................................................................................2
3.0. DISEASE MANAGEMENT PROGRAM (DMP)........................................................................................................2
3.1 COMPONETNTS AND ACTIVITIES OF DMP......................................................................................................3
3.2 DMP key elements..............................................................................................................................................3
3.3 Activities undertaken in DMP............................................................................................................................3
4.0 PHARMACEUTICAL BENEFIT MANAGEMENT.....................................................................................................4
4.1 key Components of PBM....................................................................................................................................4
4.2 Activities undertaken in PBM............................................................................................................................5
5. PERSONAL EXPERIENCE SUCCESS AND CHALLENGES.........................................................................................6
RECOMMENDATION.....................................................................................................................................................6
6. CONCLUSION.............................................................................................................................................................6
REFERENCES.................................................................................................................................................................7
APPENDIX.....................................................................................................................................................................8
1. AFA managed care organogram.............................................................................................................................8
2 (Managed care checklist).........................................................................................................................................9
3.0 DETAILED students assigned work.....................................................................................................................11
1 | P a g e

1.0 OBJECTIVES
 The role of managed care at AFA Botswana
 The activities undertaken at AFA Botswana
 The role of different departments at AFA managed care
 Personal experience, success and challenges encountered
2.0 INTRODUCTION
AFA was founded in 1990 as a Fund Administration specializing in medical aid administration
for both government and private institutions. Since then, the company made huge impact toward
providing high-level health management services. The success of this area of AFA’s business is
facilitated by the Managed Care program. In the early 2000s, while the country was experiencing
the severe effects of HIV/AIDS, the demand for a tool to avoid misuse of funds and regulate
funds arose managed care organization was born out of this necessity. This is accomplished
through the use of risk management systems, which identify the causes of loss, analyze, control,
and finance the risk, and finally ensure quality control. Managed care activities and services have
since grown in size, with 16 employees providing the following services: pharmaceutical benefit,
disease management program, hospital services management benefit underwriting for the
schemes they administer It is made up of a multidisciplinary team of pharmacists and pharmacy
technicians, nurses, doctors, and information technology personnel. The purpose of this paper is
to present the report for the experiential attachment at Associated Fund Administrators (AFA)
Botswana (Managed care), as guided by the objectives listed below.
3.0. DISEASE MANAGEMENT PROGRAM (DMP)
Disease management programs at AFA managed care is a structured treatment plans that aim to
help people better manage their chronic disease and to maintain and improve quality of life.
DMP department exist to help manage chronic patient and reduce risk often posed by these
conditions .DMPs are run with the general goal of improving medical treatment in the long term..
People with chronic illnesses are more likely to use health-care services, such as hospital and
2 | P a g e

physician visits, as well as prescription drugs As a result, health-care costs rise, putting a strain
on both individuals and the medical-aid scheme.
3.1 COMPONETNTS AND ACTIVITIES OF DMP
Activities undertaken under this program by the pharmacist include reviewing chronic
applications to ensure that the plans are clinically appropriate, cost effective, delivered the most
appropriate channel hence preventing unintended side effects and fund misuse. Pharmacist
interact with other health professionals to ensure that the patients are holistically managed. They
also stall chronic disease progression hence avoiding complications which lead to
hospitalizations. They perform pre-authorization of chronic benefit management of non-
communicable diseases, full disease management of HIV and reviews x-formulary (open
formulary) chronic medicines. Pre authorizations for chronic disease applications and chronic
benefit management programs. Counselling chronic patient on adherence to improve clinical
outcomes.
3.2 DMP KEY ELEMENTS
A fully functional system to manage patients; AID for AIDS (to manage HIV patients) and the
iMED system for other chronic illnesses systems in place to manage patients and simplify the
work
Guidelines for Evidence-Based Practice; Guidelines are used to motivate for inclusion of
products in the formulary, and also helps the pharmacist to educate other professional on what to
use that would benefit the patient guidelines mostly used are from reputable countries
Models of collaborative practice;Made up of different clinicians which work hand in hand to
ensure that the patients gets the best service from different professionals working together
Patient self-management education; Patients are encouraged and taught to become part of the
treatment, this is done by monitoring patient s response to the prescribed regimen
Process and outcomes measurement; Clinical parameters are used to mainly monitor the
response.
3.3 ACTIVITIES UNDERTAKEN IN DMP
Some of the activities that were assigned to the student are listed below.
3 | P a g e