The Value of Medication Adherence

Encouraging members and their dependents to take their prescriptions as directed by their doctor or pharmacist has long been a concern for health plans. As the Covid-19 pandemic continues to spike in most parts of the country, the problem has intensified, with experts estimating that the increased cost to our healthcare system may be nearly $300 billion annually.

Traditional challenges of rising costs and a failure to read and understand health information have been exacerbated by the fear of in-person doctor visits. Overcoming these issues requires increased communication and support because there is no doubt that when people fail to take their medications as prescribed, health plans often end up dealing with higher claim costs down the road.

A Higher Level of Support

Providing a high level of support can help many members avoid serious medical
complications in the future. Collaborating with a PBM or member advocate to send a
text message when a refill is due can be a big help. Some plans offer a lower copay as an
incentive to fill prescriptions on time.

Taking the time to understand a member’s needs and concerns can go a long way in
increasing medication adherence. While concerns about using generic alternatives,
copay assistance programs and transportation are common, addressing language barriers,
disabilities and other social factors are measures that can make a big difference.
Providing a higher level of support will not only produce higher quality outcomes, but
lower pharmacy benefit costs as well.


New Rules for Drug Pricing

drug-pricingTwo final rules related to the President’s promise to lower the cost of prescription drugs were recently announced by President Donald Trump. The first, known as the “most favored nation” rule, would lower the price of 50 Medicare Part B drugs to those paid by other wealthy countries. This pricing would apply only to Medicare beneficiaries. The second rule, intended to simplify drug pricing and pass available discounts to consumers, would eliminate the rebates drug manufacturers currently pay to Pharmacy Benefit Managers (PBMs) on higher priced brand name prescription drugs. Interestingly, in another recent action, drug manufacturers filed a lawsuit to stop the Trump administration from allowing states to import certain prescription drugs. Their suits argue that the last-minute steps by the President would expose the public to safety risks while not achieving any significant economic advantages for the public.


Technology and Diabetes Care

diabetesAs COVID-19 has made medical office visits challenging, CDC has recommended digital diabetes care supported by connected continuous glucose monitoring (CGM) systems. According to CDC, when remote monitoring is combined with proper medication adherence and personalized coaching, employees with diabetes are able to receive the constant, long-term oversight needed to maintain a higher quality lifestyle.


Working Remote = Working More

remote-workingAccording to a video conferencing company, employees working remotely have been logging about one extra day a week as the lines between work and home continue to blur. While some have saved commuting time, others are simply extending their workday. Despite some challenges, many people are enjoying greater flexibility and feeling just as productive when working remotely.


Lowering Stress Takes Creativity

You don’t have to dig very deep to discover higher stress levels due to the pandemic. To combat the problem, many companies are taking creative steps to help employees relax. While some are providing a free day each quarter, others are doing it monthly. From “you days” to “disconnect and recharge” days, these are must-take days where everyone is free to enjoy a break without feeling guilty or worrying about what they may be missing.


Member Education: A Year-Round Job

member-educationAs a health plan sponsor or HR professional, you’ve no doubt witnessed the introduction of new tools or applications intended to help plan members become better healthcare consumers. Unfortunately, these efforts often fall a little short of expectations. After decades in self-funded health plan administration, we can say that while these programs were well designed, the education associated with them was not.

Today, a health plan cannot achieve company objectives unless members buy into the utilization strategies. What can a plan do to engage members in ways that will make a difference? Education and incentives can be a winning formula – here are a few ideas.

    • From coping with Covid-19 to open enrollment, employers were forced to communicate differently in 2020. Company-wide gatherings and annual health fairs were replaced by more frequent zoom conferences and digital events. As a result, employers trimmed content and focused on critical topics. While personal meetings will likely return as the fear of gathering subsides, the lessons learned in the past 10 months will improve employee education in the future.
    • Regardless of how your plan chooses to incentivize members, rewards must be tied to member engagement. One option is to share plan savings with members who lower claim costs by choosing high quality, low-cost providers. This often requires that the plan negotiate in advance with hospitals or centers of excellence that are efficient for certain procedures. Giving a member a percentage of the savings realized by the plan can go a long way to boost overall engagement.
    • Some plans reward members who consult with HR before selecting a healthcare provider for an elective procedure. This helps members use their benefits to their best advantage and controls overall plan costs.

Regardless of how you proceed, it’s important to realize that education requires time to plan and resources to execute. Whether you choose virtual lunch and learns, monthly podcasts by HR or something different altogether, it takes repetition to make a positive difference.


Rules for Pooled Plans

healthcareAs a way to give small businesses the opportunity to offer their employees a workplace-based retirement savings option that is easy and inexpensive to maintain, the Department of Labor moved to establish rules for Pooled Employer Plans or PEP. According to the law, pooled plan providers will need to register with the Labor and Treasury secretaries in advance and once registered, can begin operating PEPs as early as January 1, 2021. The goal for the option, which was made possible by the Secure Act of 2019, is to make saving for retirement cost-effective for more employees throughout the U.S.


PBMs for Better or Worse

variouspillsWith enrollment in Medicare Part D and specialty drug costs exploding, it’s no surprise that forecasts predict 7 percent annual growth for PBMs over the next several years. Two trends noted in the report were the continued acquisition or startup of PBMs by insurance carriers and the need for employers to better understand their options when comparing proposals.


What to Expect from Virtual Health

sip-telehealthResearchers define virtual health as continuous, connected care delivered using digital and telecommunication technologies. Healthcare consumers can think of virtual health as telemedicine and video doctor visits, remote patient monitoring, asynchronous communication, medication adherence and provider-facing solutions such as virtual consults and second opinions.

To consider the future impact of virtual health, the Deloitte Center for Health Solutions surveyed clinicians and healthcare executives, with most agreeing that a fourth or more of all outpatient, preventive and long-term care will move to virtual delivery over the next 20 years. Physicians expect to be spending more time in face-to-face interactions with their patients as virtual assistants handle appointment scheduling, prescription orders and transfer of clinician notes into electronic medical records. Nearly 75 percent of respondents see improved clinical outcomes resulting from home-based monitoring and faster, easier access to health plan information helping members and providers alike. Finally, patients can expect virtual physician visits to save them valuable time compared to physical office visits.


Anyone Can Lower Stress

woman at deskIf 2020 wasn’t everyone’s most stressful year, it has to rank among the top for sure. From hardship created by the Coronavirus to unrest in our biggest cities, virtually everyone’s routines have been disrupted. Whether you’re working from home or transitioning back to the office, here are some steps you can take to improve your mental health.

Mini-Meditation: Even 5 minutes of meditation can help erase negative thoughts and improve your attitude. The people around you will benefit from your improved mood too. If you want something to clear the mind, there are plenty of apps you can access with your mobile device.

Try Tangibles: Meetings and projects will always be there, so why not designate one 10 to 15 minute time slot to turn off your digital devices and do something different. Write a note or journal entry, make notes on a new project or pick up the phone and call a friend or family member just to say hello.

Celebrate Success: Whether you take a few minutes to recognize an accomplishment of your own or congratulate a co-worker on a recent achievement, make “bravos” a small part of your week. Celebrating or sharing our accomplishments can go a long way, especially in challenging times.