Rising Pharmacy Costs – Strategies to Address – Webinar Recap

By | HCEG Top 10, Pharmacy, Sponsor, Webinar Series | No Comments

It’s no secret that rising pharmacy costs are a serious challenge for the health plans, health systems, sponsors and individuals on the hook for paying for them. Our healthcare executive members ranked “Addressing Pharmacy Costs” as #9 on the 2018 HCEG Top 10 list.

How Can Health Plans and Health Systems Address Rising Pharmacy Costs?

On Wednesday, November 13, 2017, Pete Biagioni, Managing Partner at Cumberland Consulting Group, and Marcia Lambert, Partner at Cumberland Consulting Group presented “Strategies to Address Rising Pharmacy Costs,” Cumberland Consulting Group’s entry in this month’s HCEG Webinar Series. 

The webinar provided attendees with a lot of great insight and information on the following:

  1. An overview of trends in growth of pharmacy costs
  2. Pharmaceutical Distribution Channels
  3. Drivers of specialty pharmacy spend
  4. Drug cost management strategies
  5. What strategies health plans and health systems can implement to address rising pharmacy costs

Trends in Rising Pharmacy Costs

Rising pharmacy costs trends Specialty Pharmaceuticals Management Strategies Distribution Reimbursement System Provider Administered, Outpatient Prescription Drugs

Specialty Pharmaceuticals – a 95% increase in just two years!

Pete Biagioni kicked off the presentation by highlighting that prescription drug spending is now the largest category in healthcare benefit spending – outpacing specialty care, inpatient and outpatient costs. Pete added that not only is prescription drug spending the largest healthcare expense but it’s also the fastest-growing category of benefit spending!

Largest contributor to increases in rising pharmacy costs are Specialty Drugs – with a 95% increase* in just two years!

How Drug Prices are Determined in the United States

One interesting part of the presentation was Marcia Lambert’s overview of the Pharmacy Distribution and Reimbursement System for Patient-Administered vs. Provider Administered, Outpatient Prescription Drugs in the U.S.  Several very detailed and informative slides were shared.  These slides identified the product flow, contractual arrangements and financial payments between the myriad of entities involved with pharmacy distribution in the U.S.

Specialty Pharmacy Trends & Drivers of Specialty Pharmacy Spend

A good part of the presentation covered specialty pharmaceuticals, which are growing at a CAGR of 17% as more products are being developed to treat orphan diseases and provide newer therapies. Some specialty pharmacy trends include:

  • As more specialty drugs are dispensed, a shift away from the buy-and-bill system (reimbursement through medical benefit) to the pharmacy (reimbursement through prescription drug benefit) can be expected.
  • As SPs gain more revenue and market share, they’ll come under more scrutiny and attempts at cost containments from payers.
  • The healthcare system’s grudging acceptance of high-priced orphan disease drugs has given manufacturers more incentive to develop low-volume SP drugs.
  • The high cost of SP’s will demand more Value-Based/Outcomes-Based evidence

Pharmacy Cost Management StrategiesRising pharmacy costs trends specialty pharmacy Management Strategies Distribution Reimbursement System Provider Administered, Outpatient Prescription Drugs

The Cumberland presenters provided an overview of traditional Strategies to Manage Rising Pharmacy Costs and then dived into a LOT of detailed information on the pros and cons of newer, novel strategies for managing pharmacy costs including:

  • Comprehensive Medication Review / Medication Therapy Management
  • Specialty Pharmacy Coordination & Management
  • Outcomes-based Contracting
  • ‘DIR’ Fees – Direct and Indirect Reimbursement

The Future – Pharmacy Trends and Government Intervention

This rapid paced presentation moved toward its conclusion with Pete Biagioni sharing a few slides listing some ways that government intervention might impact prescription drug prices. And the webinar completed with a short listing of future trends for prescription drugs in the U.S. The entry of Amazon and mega deals like CVS buying Aetna being two likely major impacts.

The Recording, The Content and More Insight from Cumberland Consulting Group

The above is just a portion of the information presented by our sponsor partner Cumberland Consulting Group. You can learn more about “Strategies to Address Rising Pharmacy Costs” by reviewing the entire recording of the webinar available here.  If you’d like more information or if you have any questions on the content of this webinar, please feel free to contact Cumberland Consulting Group. You may also want to follow Cumberland on Twitter.

*Per CMS 2014  fact sheet: https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html

 

Recap of Webinar: ‘Care Redesign: Lowering Costs While Improving Patient Outcomes’

By | HealthEdge, Sponsor, Value-Based Care, Webinar Series | No Comments

As more Accountable Care Organizations (ACO) are formed and as value-based reimbursement arrangements between payers and providers expand, the need for assessing non-traditional drivers of health outcomes, leveraging payer, provider and community resources and enhancing collaboration between patients, providers and payers are becoming key to improving outcomes and managing costs.

Our Thursday, October 26, 2017, Harry Merkin, VP of Marketing at our sponsor partner HealthEdge teamed up with Barbara Berger, VP of Care Management at First Care Health Plans, to present “Care Redesign: Lowering Costs While Improving Patient Outcomes,” HealthEdge’s entry in this month’s HCEG Webinar Series.  The webinar presented innovative, real-world examples of how First Care Health Plans is improving member outcomes and lowering their cost of care via three primary approaches:

  1. Collaborating with providers and health systems
  2. Partnering with community resources
  3. Making critical information available to key stakeholders

Addressing Discontinuances of Care

Barbara shared that, while the high volume, time-sensitive nature of healthcare delivery often leads to a discontinuance of care delivery and management between the silos in which payers and providers often operate, the increased data sharing associated with the emergence of ACO’s and value-based reimbursement and care models are helping to align care provided by providers and health plan payers. Examples of balancing the proper people, processes and technologies were shared.

Population Assessments and Social Determinants of Health

Barbara emphasized the importance of carefully and thoroughly assessing an individual’s health care, behavioral and social needs as part of a periodic, recurring population assessment and how doing so can have a key, beneficial impact to healthcare outcomes.  And with “Social Determinants of Health” forming the basis (bottom) of Maslow’s Triangle of Needs, First Care is starting to include an assessment of member’s social determinants of health in their population assessment program. Factors such as the following are included in the population assessment:

  1. Access to Healthcare Services
  2. Access to Food
  3. Access to Local Community Resources
  4. Access to Transportation Options
  5. Public Safety
  6. Financial Status

After Barbara shared her insight on this currently popular topic, Harry Merkin stated: “The phrase ‘social determinants of health’ is no longer a buzzword!”

Addressing Social Determinants of Health

Barbara shared an overview about First Care’s “Expecting the Best Maternity Program” that combines case management and utilization management to complement care provided by physicians while guiding and supporting members – and their family – through member pregnancies; particularly high-risk pregnancies.

Besides services such as assistance with locating medical providers, toll-free 24/7 access to a clinician and a package of select products and services aimed at supporting pregnant women, the program also includes an innovative “Nurse-Family Partnership” where a First Care nurse is paired with an expecting family to help the patient and her immediate family members understand and manage the pregnancy. First Care nurses regularly reach out to ask questions on how the pregnancy is progressing and answer any questions the patient and family may have.

The program has resulted in a significant per decrease in NICU maternity admissions.

The Recording, The Content and More Insight from HealthEdge

The webinar presented three considerations for payer-provider population health programs:

  1. Be methodical about population assessment
  2. Integrate People, Process and Technology with Providers
  3. Use value-based contracts to align vision of member/patient care

You can learn more about how collaborating with providers and health systems, partnering with community resources and making critical information available to key stakeholders can improve outcomes and lower costs by checking out this recording of the webinar and these few slides from the presentation. If you would like more information or if you have any questions on the content of this webinar, please feel free to contact HealthEdge too.

More Information

HealthEdge Website

HealthEdge on Twitter

First Care Website

First Care on Twitter

If you’re not a HCEG member and would like more information on becoming a member, please see this page or email Juliana Ruiz.