The Official Medtipster Blog

www.Medtipster.com Source: Employee Benefit News – By Kathleen Koster – 8.18.2010

According to a new survey by National Business Group on Health, more than half (53%) of large U.S. employers plan to revise their 2011 health care benefit programs in the wake of health care reform legislation and anticipated large benefit cost increases next year.

Also considering the provisions of the Patient Protection and Affordable Care Act, 19% of respondents are scaling back changes they planned to make while an equal number are making no changes.

The remaining respondents were still undecided pending further review of the final regulations.

Among employers who will be making specific changes to their health benefit plans to comply with the new law, 70% said they will remove lifetime dollar limits on overall benefits while 37% said they will make changes to annual or lifetime limits on specific benefits.

Approximately one-fourth will remove annual dollar limits on overall benefits while 13% reported they will remove pre-existing condition exclusions for children.

The survey, based on responses from 72 of the nation’s largest corporations representing more than 3.7 million employees, was conducted in May and June 2010.

“While the health reform law has forced employers to evaluate their health care benefit strategies and decide whether to comply with the law or lose grandfathered status, they haven’t lost sight of the fact that controlling rising costs remains one of, if not, their highest priority. They have to foot the bill, not the government,” says Helen Darling, president of the National Business Group on Health. 

“In fact, with cost increases expected to accelerate next year, many of the plan design changes employers are making are being done to help curb those increases, as they have to do every year,” she adds.

Employers estimate their health care benefit costs will jump to an average of 8.9% next year, compared with an average increase of 7% this year. To help curb those increases employers plan to use a wider variety of cost-sharing strategies.

According to the survey, 63% of employers plan to increase the percentage employees contribute to the premium, up from 57% who did so this year, while 46% plan to raise out-of-pocket maximums next year compared with 36% this year.

In order to further mitigate costs, employers are shifting to consumer-directed health plans. In fact, 61% of plan sponsors will offer a CDHP in 2011.

While the most common type of plan employers will offer is a high-deductible plan combined with a health savings account (64%), the survey found a large spike in employers moving to a full replacement plan.

Among employers offering a CDHP, the number moving to a full replacement plan doubled from 10% this year to 20% in 2011.

“Consumer directed health plans are living up to their expectations as a way to help save employers money and put employees in greater control of their health care.  In fact, offering these plans was the most often-cited tactic by employers to control costs.  We fully expect that employer interest in CDHPs, and especially full-replacement plans, will continue to increase in the future,” says Darling.

As the health reform law makes Medicare Part D benefits richer as the “doughnut hole” closes between now and 2020, 5% of employers plan to drop retiree health coverage in 2011 while 60% are considering doing so in the future.

In attempt to cut costs with wellness initiatives, 41% of employers offered premium discounts for completing health assessments while 22% offered premium discounts for participating in tobacco cessation programs.

In addition, one in four (25%) of plan sponsors plan to raise the co-pay or co-insurance for retail pharmacy prescription drug benefits while 21% plan to do the same for mail-order pharmacy benefits.

Copies of the survey report can be found at www.businessgrouphealth.org.

www.Medtipster.com Source: Managed Healthcare Executive, by Mari Edlin – 7.22.10

Patients who do not follow their medication regimens cost the U.S. healthcare system an estimated $290 billion a year, or 13% of total healthcare expenditures, according to the New England Healthcare Institute. In addition, those with low levels of medication adherence spend nearly twice as much as those who have better adherence.

Non-adherence is widespread; only about half of all U.S. patients take their medications as prescribed by their physicians, according to the Congressional Budget Office.

The Patient Protection and Affordable Care Act promotes medication adherence indirectly through several provisions including incentives to establish patient-centered medical homes and accountable care organizations as well as innovative payment models, as highlighted in a recent study in the April 28 issue of The New England Journal of Medicine.

Ann Arbor, Mich.-based HealthMedia, a health coaching organization, provides behavioral support intervention digitally. The company’s recent survey found that consumers receiving a tailored cholesterol management guide resulting from personalized responses to questions related to hyperlipidemia—their understanding of the condition, perceived barriers to medication adherence and their attitudes and beliefs—fared better than a control group.

The control group received behavioral advice from one interactive-voice-response telephone call without personalization in addition to a general cholesterol management guide delivered through the mail.

The experimental group also received reminders to refill prescriptions, tips for overcoming adherence barriers and encouragement to follow up with their doctors. Adherence was based on the use of a statin.

The findings indicate that 74.4% of the experimental patients vs. 60.7% of the control group showed six-month prevalence rates. In addition, the experimental group had medication possession rates (MPRs) over 80%, which is considered optimal from a population standpoint, while the MPR for the control group is 38.9%.

CIGNA is trying to ward off non-adherence before it gets out of control. Last year, the insurer developed CoachRx, an interactive Web site that helps members using CIGNA Home Delivery Pharmacy identify their barriers to medication adherence and then provides solutions to stay on track. It is one more program in the health plan’s tool kit for finding gaps in care. Approximately 5,000 customers have used CoachRx services—either through the Web-based portal or the pharmacist consultation hotline—indicating an increase in engagement of 20% month over month.

In addition to having access to a clinical pharmacist, members can schedule automated medication reminders and record their own messages to be relayed by text, phone or email. The program also offers educational materials, discount coupons to offset drug costs and free pill boxes to organize medication, all based on a member self-assessment.

“Many programs are one-size-fits-all, but we realize that it is critical to study how different people react and what drives them,” says Yi Zheng, assistant vice president, pharmacy clinical programs for CIGNA. “If we understand barriers, then we can personalize solutions. The result is an individualized approach around their issues connected to adherence.”

CIGNA utilizes what Zheng calls “onboarding packets” to encourage proper use of a medication when it is first prescribed. They address the drug’s use, treatment goals and possible side effects to help avoid repercussions in the future.

STOP PROCRASTINATING

Express Scripts, a pharmacy benefits manager (PBM) headquartered in St. Louis attributes $106 billion in wasteful spending to non-adherence to therapy. The PBM is segmenting members into personality categories to address specific non-adherence patterns, including “sporadic forgetter,” “active decliner,” and “refill procrastinator.”

Those classified into the sporadic forgetter group, for example, perceive therapy positively but periodically forget to take medications. The active decliner group does not consider therapy effective. The refill procrastinators view therapy positively and will take their medications if they are readily available.

“People often do not respond to things rationally,” says Bob Nease, chief scientist for Express Scripts, “which is why it is important to figure out why people do what they do regarding adherence. However, we need keener instruments to understand behavior and determine how to intervene.”

Nease says that the PBM has developed strategies to address certain kinds of behavior. For refill procrastinators, mail delivery and automatic refills can potentially increase adherence. For active decliners, physician or pharmacist intervention can provide supporting education to encourage them to continue taking medication as prescribed. Adherence reminders, text messages, email and phone calls can help sporadic forgetters.

Express Scripts conducted a randomized trial of 35,000 patients to determine what kinds of messages rang true. The rate of medication possession rose from 7% for patients who received no messages to 8.8% for those who received messages containing references to negative effects of missing doses of prescribed medication, as well as information from someone who could be regarded as a respected source or authority (a chief medical officer, for example).

“The effectiveness of messages is in the wording and in gaining permission to offer advice, which is as important as incentives,” Nease says.

The PBM found that messaging is most effective for high-risk patients.

CVS Caremark, a PBM and retail pharmacy chain based in Woonsocket, R.I., also is studying the motivators behind adherence.

“We want to pinpoint barriers,” says Bari Harlam, senior vice president, member experience.

Research focuses on why prescriptions are often filled but not picked up at the pharmacy (typically forgetfulness and financial barriers), why patients prematurely stop taking medications, which medications show the highest level of non-adherence, and the relationship between behavioral science and adherence.

“We have found that the most successful communications are those that are sensitive, prevention-oriented, appeal not just to members but also to their sense of control, and utilize the most effective channel,” Harlam says. “No one communication delivery system is right for everyone.”

FINDING GAPS IN CARE

Exploring medication adherence, Prime Therapeutics, a PBM located in St. Paul, Minn., studied the adherence rate between 30-day prescriptions acquired at a local pharmacy with 90-day supply either through retail or mail and found that those receiving the three-month supply were 40% less likely to have adherence problems. Patients were on medications for hypertension, diabetes and high cholesterol and were followed for a year and a half.

“The extended supply was definitely the determining factor rather than the channel of delivery,” says Pat Gleason, director of clinical outcomes assessment for the PBM. He calls the 90-day supply an “easy, low-cost way” to help keep patients with chronic conditions on their medications. The study shows that extended-supply patients have an adherence rate from seven to 10 percentage points higher, depending on the type of medication and the follow-up period.

On the other hand, Express Scripts promotes its mail service, which increases adherence up to eight percentage points, as the most effective intervention program to reduce non-adherence.