Real World Health Care Blog

Tag Archives: access

Live Updates from 15th Annual Patient Assistance & Access Programs

Because this blog is all about increasing access, lowering costs, and improving patient outcomes, we think there’s no better place for us to share ideas that work than to report live from the 15th Annual Patient Assistance & Access Program, in Baltimore, March 5-7.  Check back often as we publish updates from sessions, and follow all of the developments by following #PAP2014.

UPDATE 9:45  Resources for navigators: www.nationaldisabilitynavigator.org; patient advocacy groups such as AIDS Institute are publishing helpful sites.  Also marketplace.comment@cms.hhs.gov is a place you can send questions. This is monitored 24/7 with staff – not interns – but people who really know how to help.  These are triaged and go up to leadership when there are problems or trends.

UPDATE 9:40 Lessons learned:

  1. Partner’s are critical to success of ACA implementation; reach out early, often because plan selection often isn’t a one step process.  Patients need to come back many times before ready to sign up.  Very real “huge” health literacy gaps.
  2. Things to come: we are in closing days of enrollment.  March Madness may be a great opportunity for outreach; then we’ll reach out to those most in need; final week will be “here we are.”  So theme weeks continue.   After window closes Mar 31, you’ll soon start seeing promotion of the new window.

UPDATE 9:25 25 states and DC have indicated they will expand Medicaid.  About 85% of Americans already have minimum essential coverage.

UPDATE: 9:15 Health care law saved $8.9 M in drug costs for Medicare, said Janet Miller, Division of Strategic Partners, Office of Communications, Centers for Medicare and Medicaid Services.  2014 changes: no discrimination due to pre-existing conditions, annual limits on insurance coverage eliminated, small business tax credit increased; more people are eligible for Medicaid in some states.

Essential benefits include at least 10 general categories such as emergency services, hospitalization, maternity and newborn care, prescription drugs, mental health and substance abuse, lab services, preventive and wellness  services and chronic disease management.

Categories: Access to Care

Three Ways You Can Reduce the Impact of Cardiovascular Disease this American Heart Month

Most of the readers of this blog know that cardiovascular disease (CVD) is the number one killer of men and women in this country. According to the Centers For Disease Control and Prevention, CVD is a leading cause of disability, preventing Americans from working and enjoying family activities. Out-of-hospital cardiac arrests cause the deaths of an estimated 250,000 Americans each year. CVD costs the United States over $300 billion each year.

Joel Zive

Joel Zive

There are many small but significant actions we can take. Here is what you can do to make a difference: empower or continue to empower patients to take care of themselves.

1. Address the cost of heart medication

If the cost of your medicine is an issue, talk to your doctor or contact a patient assistance program that may be able to help with prescription co-pays.

2. Encourage healthy behaviors

Want people to eat better? Give them coupons for healthy food. Exercise? Give them coupons for short-term memberships to health clubs.

The stakes are higher in our country’s current health care landscape. With more people on health insurance than ever before, we need to do everything we can to empower people to seek help before an emergency and talk to their doctor about what they can do to take better care of themselves. This will have a direct effect on deaths from heart disease.

3. Ask your employer about Automatic External Defibrillators

There are instances in which individuals are dealt devastating genetic hands of cards. Recently, the Philadelphia Inquirer highlighted the plight of a Philadelphia family that had a genetic link to hypertrophic cardiomyopathy, a disease of the heart muscle.

For those who do experience heart issues, or even have a major event such as cardiac arrest, Automatic External Defibrillator (AED) devices can significantly increase the likelihood of survival. AEDs have been available for over 20 years, but in recent years, device makers have reduced the size and cost and increased usability of defibrillators, making public access defibrillation viable. “We believe ease of use is one of the most important qualities in an AED because the potential user may not be well-trained in resuscitating a victim of sudden cardiac arrest,” said Bob Peterhans, General Manager for Emergency Care and Resuscitation at Philips Healthcare. “This is consistent with the American Heart Association’s criteria for choosing an AED.”

While risk factors for CVD are often genetic, the majority of CVD is triggered by factors that are controllable: smoking, diet, and exercise. And this is where individual efforts need to be focused.

For more information on preventing CVD, check out the American Heart Association’s guidelines for taking care of your heart, which are broken down by age. The Centers for Disease Control and Prevention also offer an American Heart Month guide to controlling risk factors for cardiovascular disease. You may also want to check out The Heart Truth, a campaign from the National Institutes of Health to make women more aware of the danger of heart disease.

Read more Real World Health Care heart health-related posts:

Are you taking steps to prevent cardiovascular disease? If you, a family member, or a friend has CVD, what is working for treatment? Share your experiences and insights in the comments section.

(Medical) Home is Where the Care and Cost-Savings Are

The word “home” has many connotations: the building in which you live, the place you come from, and even the end point of a game. Now, there is a new type of home: The Patient-Centered Medical Home (PCMH).

Linda Barlow

Linda Barlow

PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted – and cost-effective – model for how primary care should be organized and delivered, encouraging providers to give patients the right care in the right place, at the right time and in the manner that best suits their needs.

“The magnitude of savings depends on a range of factors, including program design, enrollment, payer, target population, and implementation phase,” explains Michelle Shaljian, MPA, Chief Strategy Officer of the Patient-Centered Primary Care Collaborative (PCPCC). “Most often, the medical home’s effect on lowering costs is attributed to reducing expensive, unnecessary hospital and emergency department utilization.”

When the Affordable Care Act (ACA) was signed into law in 2010, medical homes got a boost because of numerous provisions that increased primary care payments, expanded insurance coverage and invested in medical home pilots, among other programs.

The model has been adopted by more than 90 health plans, dozens of employers, 43 state Medicaid programs, numerous federal agencies, hundreds of safety net clinics and thousands of small and large clinical practices nationwide since then. Among the results:

  • In Michigan, Blue Cross Blue Shield – the nation’s largest PCMH designation program — saved an estimated $155 million in preventative claim costs over the first three years of implementation.
  • CareFirst Blue Cross Blue Shield in Maryland reported nearly $40 million savings in 2011 and a 4.2 percent average reduction in expected patient’s overall health care costs among 60 percent of practices participating for six or more months.
  • In New York, the Priority Community Healthcare Center Medicaid Program in Chemung County saved about $150,000 or 11 percent in the first nine months of implementation, reduced hospital spending by 27 percent and reduced ER spending by 35 percent.
  • In Pennsylvania, Pinnacle Health achieved a zero percent hospital readmission rate for PCMH patients versus a 10-20 percent readmission rate for non-PCMH patients.

The PCPCC is the leading national coalition dedicated to advancing PCMH. According to PCPCC, the medical home is an approach to the delivery of primary care that is:

  • Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preference, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is accountable for a patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients access services with shorter wait times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

According to Melinda Abrams, Vice President of Patient-Centered Primary Care Program at the Commonwealth Fund, to have the greatest impact, a medical home must be located at the center of a “medical neighborhood” inhabited by hospitals, specialty physicians, physical therapists, social workers, long-term care facilities, mental health professionals and other service providers. She notes that it is the role of the primary care provider to coordinate care and make sure that patients don’t slip through the cracks, or receive tests or procedures they’ve already had – a particular concern for patients who see multiple doctors.

The National Committee for Quality Assurance (NCQA) – a non-profit, independent group dedicated to improving health care quality – accredits and certifies a wide range of health care organizations and is the leading national group that recognizes PCMH with the most widely adopted model. Currently, there are almost 5,000 NCQA Recognized PCMHs across the country.

Other organizations with PCMH recognition programs include Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, and URACVideos from the American Association of Family Physicians (AAFP) feature family physicians who discuss practice redesign aimed at lowering costs, maximizing staff expertise and improving patient care.

“Practices seeking to initiate a patient-centered medical home will find that an assessment process is very helpful to understand where they are,” said Shaljian. “Some practices have electronic health records, a very strong history of team-based care, and strong connections with specialists, hospitals, and other stakeholders in the community, while others do not. Some are deeply affected by an internal culture of quality improvement, which makes a huge difference in how successful some medical homes are.”

Want to learn more about PCMH? Visit the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality content-rich Resource Center.

How can health care continue to move the nation to PCMH? And how can the model tackle its number-one challenge: the current fee-for-service payment system?

More Patients Choosing Hospice “Comfort Care” Option

In today’s health care environment, so much attention is paid to preventing and eradicating disease to improve health outcomes. But for patients facing terminal illness or life-limiting conditions, accessing quality care can be a frightening and lonely challenge.

Linda Barlow

Linda Barlow

That’s where hospice comes in as an option for more and more people. A unique philosophy of care, hospice enhances quality of life for many patients and strengthens the health system’s quality of care by saving critical resources.

Supporting those who choose comfort care with pain and symptom management rather than curative care, it is designed to neither hasten nor postpone death. Hospice is provided in the patient’s home, hospital, extended care facility or residential care homes. Individual insurance plans vary in terms of coverage guidelines.

According to the National Hospice and Palliative Care Organization (NHPCO), an estimated 1.65 million patients received services from hospice in 2011.

“It is important for patients to understand that hospice is as much a part of the health care system as the birthing process,” says Barbara J. Westland, RN, BSN, Director/Administrator, BJC Hospice. “We are there to bring you into the world and we will be there to support you in your journey through hospice until the end.”

Because hospice focuses on care rather than cure, patient outcomes are measured in more qualitative ways, focusing on issues like pain relief within 48 hours of admission, avoiding unwanted hospitalizations and avoiding unwanted cardiopulmonary resuscitation (CPR). And according to NHPCO, family caregivers who had the support of hospice report less instances of serious depression in the six months following the death of their loved one.

In addition to serving the physical, emotional, spiritual and practical needs of patients and their families, hospice also saves money. In fact, research published in the March issue of Health Affairs found that hospice enrollment saves money for Medicare – from $2,561 to $6,430 per patient, depending on the length of care – and improves the quality of care across a number of different lengths-of-stay.

“If 1,000 additional beneficiaries enrolled in hospice 15 to 30 days prior to death, Medicare could save more than $6.4 million,” notes the study’s authors. “In addition, reductions in the use of hospital services at the end of life contribute to these savings and potentially improve quality of care and patients’ quality of life.”

J. Donald Schumacher, NHPCO president and CEO, points to a study on the benefits of hospice from a cost and quality of care perspective:

“Hospice can reduce the number of intensive care visits, hospital readmissions and other services, which not only saves health care system dollars, but also contributes to a higher quality of life,” he says.

“With the aging population, we expect to see the hospice population growing,” Westland says, noting that between 2000-2007, the number ofhospice patients nearly doubled and the number of providers grew by 45 percent. “Hospice offers a choice for the final journey that is selected by some, but not right for everyone.”

Despite evidence that hospice provides many benefits some critics question whether the implications of market competition and commercialization driving this form of care are ethically consistent with the delivery of health services. In an article that appeared in the Journal of Law, Medicine and Ethics during the summer of 2011, the authors argue that hospice care should be considered with great caution:

“The conflicting interests inherent in the incentive structures of for-profit health care endeavors demand careful scrutiny,” they say. “This is particularly important in the end-of-life hospice context.”

What do you think? Share your experiences and thoughts with us.

This is Not Your Father’s Oldsmobile, Nor Your Child’s Social Network

David Sheon

David Sheon

Does social networking conjure images of teenagers who share seemingly worthless online videos of watermelons dropped from atop buildings? Well get this:

Americans OVER age 45 represent the largest percentage increase in social media usage in the past year, now up to 38 percent in 2012, compared to 31 percent in 2011 (Source: Edison Research).

What does this mean for improving health care outcomes?  At least one analysis finds a prolific growth in online patient communities, where peers help one another find solutions, determine the right time to go to the doctor, and essentially crowd source solutions to their problems.

Many social networks specifically for patients have launched using a number of different business models.  Here are just a few:

  • Inspire has social networks for patients with various diseases and health conditions, each sponsored by health organizations.
  • The Mayo Clinic has created a platform for patients with various diseases, not limited to the 500,000 patients treated at the Minnesota-based hospital system annually.
  • Patients Like Me is a web-based portal for patient-to-patient communication that was started by two brothers at MIT.  They pledge complete transparency in terms of funding sources.
Are social networks resulting in better outcomes or improved access? Any success
stories out there you’d like to share? What are some of the best sites for connecting with others who have similar health conditions?

Categories: Access to Care

Heroes Needed: Apply Within

We’re taking a departure today from our coverage of what works in American health care to ask for your help.

Patients want us to re-open our Breast Cancer Fund at HealthWell, but we can’t successfully do that until we identify several key companies or organizations to partner with us in this effort.

When HealthWell’s Breast Cancer Fund was open, thousands of Americans battling breast cancer found new hope to live healthier lives. Nearly 17,000 insured breast cancer patients received the financial assistance they needed so that the surging cost of treatments was not a barrier to accessing critical care.

As HealthWell prepares to re-launch its massive Breast Cancer Fund, we are expanding our call to action. We are seeking partners to help us make a real, positive difference in the lives of insured patients who often struggle to afford critical treatment including medications.

By becoming a strategic partner with the HealthWell Foundation, your organization will help thousands of Americans who face medical bills they can’t afford.  Beyond the incredible satisfaction of knowing that you played a role in persuading your organization to help us re-open this fund, you’ll gain a cause marketing partner that will support your efforts to build and shape your brand to new audiences.

When you work with us to empower patients, you will leverage a unique opportunity to win exclusivity, naming rights and more.

With one in eight women in the U.S. expected to develop breast cancer during her lifetime, the need for timely, life-sustaining care is outpacing our health system’s ability to assist patients. More and more Americans are in desperate need of immediate financial relief to afford deductibles, co-pays and premiums, yet many have few places, if any, to turn for assistance.

Women like Linda in Powell, Tenn., illustrate exactly why support for the Breast Cancer Fund at HealthWell is needed. When Linda realized just how expensive her breast cancer medication would be, she was scared. As a self-employed grandmother of two, she faced a $5,500 deductible for her insurance premium alone. Additional costs for mammograms, colonoscopy, endoscopy and lab work were all out-of-pocket and she wasn’t sure how she would make ends meet.

That is, until she discovered the Breast Cancer Fund at HealthWell, a lifeline that enabled her to afford the treatments she needed to remain cancer-free two years after her diagnosis.

“My patient advocate gave me a list of several foundations to contact which I did,” Linda said. “The first turned me down because they said we went $50 over our salary. The second turned me down because I had a deductible. Then I heard from HealthWell. We couldn’t believe we had found help. We just had to cry. I am so thankful. Every time I have my prescription filled it still amazes me. Not many good things have happened to us.”

The fund’s incredible track record of success in offering assistance to patients in need is exactly why we must reopen it now.

The HealthWell Foundation believes that no patient – adult or child – should go without health care because he or she cannot afford it. As demand for medical treatments increases while associated prices continue to spike, we want the Breast Cancer Fund at HealthWell to once again provide timely, critical copay and premium assistance and expanded services to breast cancer patients.

These services went far to ease the strain felt by patients covered under Medicare, Medicaid, private insurance and employer-sponsored plans with incomes up to 400% of the federal poverty level.

Strengthening the financial safety net for more patients begins with teamwork. Together we can be part of the solution, harnessing our resources to make access to quality medical treatment a reality for more Americans battling breast cancer. Please contact us if your company may be interested in partnering with us to re-open this vital fund.

The HealthWell Foundation sponsors this blog because we are innovators in finding solutions to overcome hurdles in the American health care system. The thousands of women at work right now trying to clear the hurdle of breast cancer deserve everything we have to give.  Join us.  We have so much yet to do.  And you could make a difference in so many lives.

Categories: Cost-Savings

It Takes a Community for Effective Disease Prevention and Management

To help stem the tide and high cost of persisting disparities in U.S. health care, providers are leveraging Community Health Workers (CHWs) as critical players in improving health outcomes by successfully linking “vulnerable” patient populations to better care. Living in the communities where they work, CHWs understand what is meaningful to those communities, communicate in the language of those they serve, and incorporate cultural buffers to help patients cope with stress and promote health outcomes.

As the CDC reports, growing evidence supports the involvement of CHWs as a critical link between providers and patients in the prevention and control of chronic disease:

  • They help high-risk populations, especially African-American men in urban areas, to control their hypertension.
  • They enable diabetic patients to reduce their A1C values, cholesterol triglycerides and diastolic blood pressure.
  • Their interventions improve knowledge about cancer screenings as well as screening outcomes.
  • Their interventions help patients reduce the severity of asthma.

Many Americans – especially those with low incomes, have no insurance or face other socio-economic barriers to primary care – often distrust the health care system, or lack the resources and awareness needed to take charge of their health. As a result, they wait until health issues and chronic disease escalate enough to drive them into the emergency department, where they receive short-term solutions that drive up the total cost of health care.

CHWs are changing that, community by community. Examples of CHW programs – both at home and abroad – abound. One is Penn Medicine’s IMPaCT Program.

IMPaCT (Individualized Management for Patient-Centered Targets) pairs patients in need of extra support with relatable neighbors and peers (people who have shared language, ethnic and geographic backgrounds) to assist them in navigating the medical system and identify the underlying causes of illness.

“Lower income patients tend to poorly manage chronic disease and have worse health outcomes than other patient populations,” explains Dr. Shreya Kangovi, Director of the Penn Center for Community Health Workers, which houses the IMPaCT program. “They are less likely to get preventive care and more likely to end up in the hospital. This scenario leaves health care practitioners frustrated, because they can’t move the needle on health outcomes. And it makes it difficult for the health system to meet its quality targets.”

Dr. Kangovi notes that many patients served by IMPaCT didn’t have a relationship with a primary care physician prior to joining the program.

“There is a lot of focus today on reducing hospital re-admissions,” she says. “But before we can reduce re-admissions, we need to make sure patients have a substitute for the emergency department.”

She shared the story of “Ben,” a young man with a bad case of lupus and no insurance. Ben had been visiting Penn’s Emergency Department regularly for lupus flare-ups. There, he received steroids and pain medications before being sent along his way. Thanks to IMPaCT, Ben was set up with a primary care doctor who understands his health problems, and placed Ben on a better medication regimen. Not only does Ben now feel better, he has more trust in the health care system that he sees as an ally, she says.

IMPaCT currently serves about 500 patients via two programs – one for hospitalized inpatients and one for primary care outpatients. The program’s CHWs meet with patients upon admission to the hospital to set short-term goals and identify pathways to solving their clinical and socioeconomic hurdles. They advocate for patients during their hospitalization, then work with them during discharge and beyond to get them connected to resources in their community. On the primary care side, patients work with their IMPaCT partner over six months to break long-term health goals down into smaller, achievable steps.

“Once patients leave the hospital, real-life issues intervene,” Dr. Kangovi says. “IMPaCT’s community health workers address these health and life issues on the ground, and do so much better and at a much lower cost than clinically trained personnel.”

Are CHWs making a difference where you live? How are they helping to reduce costs and improve access to health care?

Categories: Access to Care

Filling the Financial Gap When Health Insurance Isn’t Enough

You can’t escape the headlines: rising expenses and high unemployment. And even for the employed, a sharp reduction in health benefits – coupled with a steep increase in out-of-pocket costs, including deductibles, copayments and coinsurance – is making access to life-saving and life-sustaining therapies out of reach for many Americans.

For some individuals and families, these out-of-pocket expenses can total thousands of dollars each month – much more than many folks earn.

When people in these circumstances need help, many turn to Patient Assistance Programs (PAPs), while others apply for financial assistance through independent non-profits such as The HealthWell Foundation. PAPs – which are offered by state governments or drug makers – are designed for those who cannot afford the cost of medication. Groups like Partnership for Prescription Assistance, NeedyMeds, RxAssistRxOutreach, and the National Center for Benefits (provided by the National Council on Aging), empower individuals to sort out their options and get connected to the PAP that’s right for them, sometimes even helping applicants fill out their paperwork.

What do all these organizations have in common? They focus on addressing the financial strains confronting individuals with health insurance who need important medical treatments but cannot cover their associated out-of-pocket costs and premiums.

Individuals like Marianne of Tarpon Springs, Florida, for example. For Marianne, living frugally her whole life didn’t help. Even though she had health insurance, paid all her bills on time, and once earned a good living as a librarian, the 70-year-old breast cancer survivor could not afford the medicine she needed to keep the cancer from coming back.

With no other alternatives to the $500-a-month life-saving medicine, the fixed-income senior citizen didn’t know where to turn. Until her doctors pointed her to the HealthWell Foundation.

Two years later, and thanks to the financial assistance she received from HealthWell, the still-healthy Marianne travels, cycles, and enjoys the life that continues to “delight and amaze” her.

“I am so fortunate,” she says. “I’ve always been glad to give back to others, and now that I’ve needed the help, I know just how precious it is to receive the kindness and compassion of others.”

Marianne is one of many Americans who benefit from organizations like HealthWell, which has provided copayment assistance to more than 164,000 patients since 2004. Without these critical funds, many of those living with chronic and life-altering illnesses would not have the treatments they need in order to live healthier lives.

No child or adult in the U.S. should go without health care because he or she cannot afford it.

How can charitable copayment assistance organizations partner with businesses, government and other stakeholders to achieve lower costs for health care treatment?

The HealthWell Foundation sponsors this blog.

Get the conversation going in the comments section.

Categories: Cost-Savings

Hospitals, Physicians Embrace Strategies To Reduce Cost of “Frequent Flyer” ER Visits

Pardee Memorial Hospital in Hendersonville, N.C., shaved nearly $405,000 from its Emergency Room (ER) expenses over a one-year period thanks to an integrated program that its founder calls a “patient-centered medical home on steroids.”

The program, Bridges to Health, helped its uninsured participants reduce their ER visits from an average of seven per year (at a typical cost of $14,004 per person) to three per year (at an average cost of $2,760 per person). Another indicator of success: 10 participants secured employment and six previously homeless members found places to live by the end of the first year.

It’s estimated that non-urgent Emergency Department (ED) visits cost the U.S. about $4.4 billion annually. At Pardee Memorial Hospital alone, 255 frequent users (“frequent flyers”) of the ED racked up more than $3 million in unpaid medical bills. Frequent flyers account for up to 40 percent of total ER visits nationwide.

Bridges to Health decreases ER expenses by providing this patient population with primary care, behavioral health services and a nurse case manager through bi-weekly health clinic visits.

“Many of these people just went to the ER because they were in pain or scared,” said Dr. Steve Crane, a family physician who started the program. “You see them going back so many times because their real issues are not supposed to be treated in the ER and are not taken care of.”

The Pardee Bridges to Health free clinic integrates medical checkups and group therapy, with doctors providing treatment and patients offering one another tips ranging from how to obtain legal assistance to saving money on food and shelter. In this way the program addresses the two main problems seen in these patients: lack of social support and access to regular primary care.

Although the results of the program are promising, Dr. Crane cautions that the patient group is small and that it only works for participants who attend the clinic meetings.

Another example of how hospitals can lower frequent flyer ER visits is in the story of Providence St. Peter Hospital (Olympia, Washington). The first step was to join a special community program called the Emergency Department Consistent Care Program and CHOICE, a unified program involving five area hospitals and a non-profit regional coalition of health care providers.

This collaborative effort resulted in ER visits among frequent flyers shrinking by about 50 percent, for a cost savings of nearly $10,000 per patient. That translated to a $2.2 million reduction in ED and inpatient expenses over two years at Providence St. Peter’s alone.

This program flags patients who visit the ED at least twice in one month or four times in six months then examines their cases for narcotic dependency, mental health issues and other factors. The program team uses that data to identify patients, then develops individual care plans and offers the assistance of primary care physicians, clinicians and specialists skilled in the patients’ particular needs.

What’s key to the success of the program? It effectively coordinates efforts with other hospitals in the area, according to its administrative coordinator, ensuring that frequent flyers get a consistent message wherever they go.

What approaches should be pursued to provide more efficient care systems while decreasing readmissions for frequent flyers? Encourage more doctors to keep their offices open longer? Leverage mental health coalitions that focus on continuity of care instead of short-term fixes?

Tell us what you think.

Categories: Cost-Savings

Express Scripts Provides Roadmap to Improve Health Care, Reduce Costs and Streamline Delivery of the Medicine Patients Need

You might be in a “utilization management program” and not know what that means or why it matters to your health. Offered by a variety of employers across industries, utilization management programs are designed to help patients evaluate their health care options and make decisions about the type of services they receive.

So how do these programs impact the delivery of specialty medications for cancer, HIV, inflammatory conditions, multiple sclerosis, and more?

MedAdNews.com reports that a new study from Express Scripts demonstrates how such programs can increase efficiency by ensuring that more patients who need safe, affordable and effective medications can access them.

As spending on specialty drugs continues to increase (18.4 percent in 2012, up from 17.1 percent in 2011), finding the most effective ways to improve the delivery of patient care, reduce cost and eliminate waste is more important than ever. Combining innovations from CuraScript and Accredo, Express Scripts draws upon Health Decision Science – which integrates behavioral science, clinical science, and actionable data – as a springboard to achieve just that.

Building upon this scientific, results-driven approach, Express Scripts provides care targeted to specific areas of patient need through Accredo’s Therapeutic Research Centers as part of its Specialty Benefit Services. Here, a broad array of health care providers integrate pharmacy and medical data to offer what Express Scripts describes as comprehensive patient care that strengthens coordination of services, boosts transparency, and produces solutions.

“It’s really about appropriateness and the right thing for a patient who really deserves safe and effective and affordable medication and ruling out waste. What our plans are most interested in is continuing to be able to afford to provide a benefit. This again was a great example of by doing the right thing that patients were able to save a significant amount of money and again preserve affordability,” said Glen Stettin, M.D., senior VP, clinical research and new solutions at Express Scripts.

Does your employer use a multiple cost management program for specialty drugs? If so, what type? If not, do you think your employer should? What might be some advantages or disadvantages?

Categories: Access to Care