CalOPTIMA Is Putting Patients on Digital Track

The managed care industry loves using computers to keep tabs on your doctor.

Among other things, the industry is increasing its use of electronic tracking of drugs that doctors prescribe.

That, for instance, is why CalOPTIMA--the Orange County agency that manages health care for more than 210,000 residents on government assistance--is negotiating a contract with Pharmaceutical Care Network. The Sacramento outfit, owned by the California Pharmacists Assn., will gather health care data, monitor doctors’ prescription patterns, pinpoint patients on regular prescriptions, track costs and recommend improvements in care.

The data collected by the network can help avert possible prescription errors that can cause hospitalizations and even death, said John Skhal, the network’s chief executive.

Pharmaceutical Care will do its tracking through electronic connections with pharmacies. When a CalOPTIMA patient requests that a prescription be filled, the pharmacist submits the claim by dialing up the network, which runs an electronic check to make sure that the patient qualifies for coverage through CalOPTIMA, the drug is on the agency’s approved list and that it doesn’t conflict with another medication the patient is taking. The network, which uses Microsoft Windows-based software, reports back to the pharmacist and also banks the data for analysis.

The contract, effective Oct. 1, will increase the number of health-plan members the network handles to more than 1.5 million nationally. The network, which employs 80 people, mostly in Sacramento, expects its annual revenues will jump to $170 million this year from $140 million last year.

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Barbara Marsh covers health care for The Times. She can be reached at (714) 966-7762 and at [email protected].