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Staff at Group Health Cooperative of Puget Sound have undertaken numerous strategies and community alliances in an effort to decrease violence in their community. Beginning with pilot programs and interventions for their own providers and enrollees, programs now focus on strengthening the community, controlling firearms, and supporting youth.

Critics today charge that managed care organizations, intent on reducing costs to ensure survival and profitability, have forsaken public health. In fact, managed care and public health face common challenges and share common interests. Public health problems ultimately affect managed care enrollees and increase the cost of their care. Managed care organizations, then, must help reduce community-wide health risks. Public health agencies, traditionally responsible for population health, today face serious challenges due to budget reductions and public indifference. The article to follow proposes a model for mutually beneficial collaboration between managed care and public health. Programs linking managed care with public health in the Puget Sound area illustrate this model's feasibility and value.

Group Health Cooperative of Puget Sound (Seattle, WA) believes that wise purchasing practices contribute both to cost efficiency and high quality healthcare delivery. At Group Health Cooperative, we came by this belief through a variety of forces all pushing for healthcare reform--legislative-, market-, and consumer-driven forces. At nearly fifty years of age, Group Health Cooperative of Puget Sound is the oldest health maintenance organizations (HMO) in the country. As in the beginning, Group Health is still a consumer-governed cooperative that has grown to over 400,000 enrollees, 44,000 of whom are seniors. The Co-op has a mixed staff/group/network physician model. Its 1994 budget was over $1 billion, with Medicare revenue accounting for about 30% of the budget. For nearly its first four decades, Group Health was just about the only show in town. If you wanted prepaid healthcare or independent consumer oversight for quality of care, you joined Group Health. But by the mid-1980s, there were over twenty other managed care competitors. Some were local health plans with a sideline managed-care business, but, increasingly, competitors included huge, national, for-profit corporations. In addition, two other streams of change pressured healthcare in the Seattle area and elsewhere--legislative and market reform. In Washington, legislative reform started in 1989 with the Basic Health Plan, a program to aid the working poor by subsidizing their healthcare insurance premiums based on financial need.(ABSTRACT TRUNCATED AT 250 WORDS)

The outpatient drug use review experiences by pharmacists at a large health maintenance organization with on-site pharmacies were investigated. Pharmacists were asked to document the nature of potential drug therapy problems encountered, drug involved, review activities undertaken, and process-outcomes. Patterns of pharmacists intervention were observed over 1 year. Results indicated that the number of problems detected increased substantially during the months immediately following the introduction of problem recording and feedback procedures. During the latter months, the number of prescriptions with problems approximated 4 per 100 dispensed prescriptions. Drug interactions of a moderate nature and drug underuse were the most frequent problem types encountered. Most were not serious and usually resulted in a cautionary or counseling message given to patients by pharmacists. The next most frequently occurring type was drug overuse problems, and, after that, problems concerning some aspect of the prescribing decision. In 9 per cent of all problem interventions and in 44 per cent of prescribing-problem interventions, the outcome of the pharmacist intervention was a change in drug, strength or directions for use. The average amount of pharmacist time per problem intervention varied from 6.0 to 7.8 minutes across problem types. This approximate a pharmacist labor cost of $0.06 per dispensed prescription, given a problem encounter rate of 4 per 100 dispensed prescriptions.