While the rapid evolution of modern medicine offers innovations in patient care, the resulting advancements are placing a fair amount of stress on our existing service delivery and payment models.
A prime example is orphan drugs — defined by the FDA as drugs and biologics for the safe and effective treatment, diagnosis or prevention of rare diseases/disorders that affect fewer than 200,000 people in the U.S., or that affect more than 200,000 persons but are not expected to recover the costs of developing and marketing a treatment drug. (more…)
We wanted to share an article from The Atlantic by David Epstein that deeply resonated with us. It is long, but we encourage you to take the time to read it, and share it with others you care about. The piece does a great job of encapsulating a number of our longtime concerns as healthcare consumers and consultants regarding unwarranted, and sometimes even harmful, treatments that are commonly provided to our plan members. (more…)
Dear Mr. President:
First of all, congratulations on your stunning victory. You’ve re-written the playbook on how to get elected president. Your campaign strategy and tactics will be studied by scholars and politicians alike for years to come.
What you are now reading is an “open letter.” It’s addressed to you, but also intended to have a wider readership. We know you’re dealing with a number of pressing matters right now, but we want to make sure that you are aware of an important issue impacting the health of our people, and our nation’s finances. (more…)
“You know, just about everybody out here is on painkiller drugs. They’ll steal it right out of your mail box.” That’s what one of our consultants was told by his aunt, who resides in semi-rural Portage County, Ohio. The same statement could be made to most benefits managers across the country, whether their aunts reside in a pastoral rural setting, the Ritalin-infested suburbs or the inner city. It may be easy to consider drug abuse – especially of prescription opioids – as “society’s problem.” But it is a problem for nearly all plan sponsors, particularly if it’s not high on their agenda. (more…)
Coupons providing discounts off the purchase price of goods and services have long since found a permanent and important place in shoppers’ purchase planning since Coca Cola offered the first American discount coupons in 1888. From canned vegetables to golf course tee times, the lure to shoppers of using a discount coupon is that they will pay a lower price for the purchase of the named good or service. Many of these are what economists call price elastic, meaning that sales will increase when the purchase price is lowered, and decrease when the price is raised. (more…)
Many benefits managers are data-hungry. They know that intuition may lead to insight but also that probability and not mere possibility requires evidence. So, they pour over charts and tables from their TPAs, PBMs and advisors, looking for relationships between variables like health plan cost, usage, medical conditions, places of service and the differential effectiveness of providers. Often, the data analysis focuses on plan member cohorts: are our costs coming from one plant or division more than others? Is there a greater prevalence of chronic disease in certain geographical areas? Benefits managers are always trying to understand why things are the way they are, so that they can take action where it will have the greatest impact on cost and usage. In this search for meaningful correlations, there is good reason for benefits managers to use the old phrase, “follow the money,” in a way that most probably have not. (more…)