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Safety and Compliance Needed
[By Staff Writers]
A new report suggests that Consumer Directed-Health Care Plans and Pharmacy Benefits Plans [PBPs] must focus on safety and compliance.
The survey, done by the Employee Benefit Research Institute [EBRI], found that nearly 70% of those enrolled in consumer-directed health care plans (CD-HCPs) said that they considered costs when deciding to see a doctor or filling a prescription. This compared with fewer than 40% of those in a more traditional comprehensive health insurance plan.
Assessment
However, the survey also found that CD-HP enrollees were twice as likely to avoid, skip or delay healthcare services. Is anyone surprised; please opine?
Note: CD-HCPs: aka High-Deductible-Health Care Plans [HD-HCPs]
Conclusion
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Filed under: Drugs and Pharma | Tagged: High Deductible-HCPs |
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UHC and HD-HCPs
Did you know that United Healthcare [UHC] is expanding a program to lower out-of-pocket expenses for new subscriber’s to some of their HDHCPs if benchmarks for body mass, blood pressure, cholesterol and tobacco avoidance are met?
The pilot program is voluntary, but employees can earn deductible credits, while employers can save 12 percent to 20 percent annually on health care costs depending on plan type.
And so, is UHC getting “warm-n-fuzzy” in the face of its many recent debacles?
Elaine
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More on UHC
Read more scary stuff about UHC from this link.
http://www.thehealthcareblog.com/the_health_care_blog/2007/12/unitedhealth-cu.html
Anonymous
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History of HSAs and HD-HCPs
An interesting story-line by Matthew Holt:
Medicare and HSAs: Ready for their Close-Ups
http://www.spot-on.com/archives/holt/2006/01/health_care_policy_and_politic.html
Ann Miller RN MHA
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UHG Loses Court Ruling
Did you know that shareholders of United Health Group were granted class-action status by US District Judge James M. Rosenbaum, in Minneapolis, recently?
Shareholders allege improper backdating of stock options. The claim was first filed in 2006, and will no doubt take a few more years to resolve.
Those impacted by this ruling are urged to comment and opine?
Ann Miller RN MHA
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Specialty Pharma Costs
The upward spiral on Specialty Pharma costs will likely accelerate the pace at which patient-centered care will reshape the healthcare marketplace from “volume-based” to “value-based.” Facilitated by highly personalized care coordination, back-stopped by advanced analytics, and rewarded with a host of outcomes-based payment mechanisms, providers and systems that can adjust to that “new normal” will become dominant players.
From a purchaser perspective, the traditional focus on reducing costs of “components of care” and managing unit price through volume discounts for everything from drugs to hospital days, to office visits and diagnostic tests, needs to move rapidly and comprehensively towards a focus on “total cost of care” with a payment model that rewards cost reduction as long as quality benchmarks are maintained. And with the inevitable market entry of new medications like the PCSK9 class of drugs targeting extremely common conditions like hypercholesterolemia, the current Rx cost/value management mechanisms for Specialty Pharma will “fall short” quickly.
So… what’s next? In the new value-oriented paradigm, managing Specialty Pharma COST, will shift to managing Specialty and Non-specialty CARE overall and within a defined episode and/or population. Ironically, in some clinical scenarios, as has already been demonstrated for some types of cancers, the drug spend may actually increase, with the net savings in total cost of care being driven by reduction in avoidable hospital costs and other inefficiencies. What will the migration path look like? Hard to say. But absent government Specialty Pharma price controls, the added pressure of their rapidly skyrocketing costs will be one more catalyst for movement towards value-based care and payment models, creating new winners and losers in the healthcare marketplace.
Jeremy Nobel MD MPH
[Northeast Business Group on Health Executive Director, NEBGH’s Solutions & Innovations Center Faculty, Center for Primary Care, Harvard Medical School]
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