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Scenario for Managed Care

This scenario is an example process performed by a managed-care account manager and by a sales representative. Your company might follow a different process according to its business requirements.

The managed-care account manager and the sales representative are employees of a large pharmaceutical company.

Managed Care Account Manager Maintains HMO Account Data

The managed-care account manager is responsible for a nationwide HMO account. His job is to influence the HMO so that it buys more of his company's drugs.

His first task when he is assigned this account is to enter data about the account, such as enrollment and spending data, information about the individual health plans offered by the account, and formulary lists for each plan.

Of particular interest to him are the members of the P & T committee; these are contacts who he wants to influence.

Sales Representative Reviews and Enters HMO Account Data

The sales representative is responsible for detailing the company's drugs to physicians in her territory. She makes professional calls and influences the prescription habits of the physicians she calls on.

Before she meets with a physician, she wants to know about the health plans that the physician is affiliated with. Of particular interest to her is whether the drugs she details are on the plans' formularies. Furthermore, if the physician happens to be on the P & T committee, it is most important that she know this so that she can discuss her approach in advance with the account manager.

Managed Care Account Manager Prepares a Business Plan for the HMO Account

The account manager's relationship with the HMO can have significant impact on his company's sales revenues. The account manager plans his approach carefully. He creates a business plan for the account. It contains information about the account, including formulary, key contact, and associated account information, SWOT analysis, and finally his objectives with relation to the account for the coming year.