Better Quality, Higher Value
Maximizing quality and value means taking action to ensure employees and their families get the best care. Ultimately, the best care is also the most cost-efficient care.
In the pursuit of the best care, we have a long way to go from the current state. But there are steps employers can take right away to get closer – like expert medical opinion (EMO) programs, high-cost claims management, and specialty Rx solutions. Beyond that, with potentially greater impact, are value-based care and network strategies.
SPECIALTY DRUGS OUTPACING ALL OTHER MEDICAL COST
Survey results confirm what employers already know – prescription drug cost is driving medical cost, and specialty drugs are driving them both. Annual spending on specialty drugs nearly doubled in just four years (between 2011 and 2015), and with hundreds of new drugs coming to the market over the next few years, it will get worse before it gets better.
More than half of large employers are now steering employees to specialty pharmacies, most often by excluding certain drugs from the retail drug or medical plan, or by offering lower cost-sharing for drugs obtained through the specialty pharmacy.
EXPERT MEDICAL OPINION
One relatively simple step towards higher-value care is to implement an expert medical opinion program, that makes it easy for employees to seek second opinions and advice about treatment. Employers with these programs in place were asked to indicate their objectives for the program, and the great majority believe EMO can help with all 3 points of the triple aim – lower cost, better quality, and a better experience for patients with complex conditions.
CENTERS OF EXCELLENCE
Nearly half of large and midsized employers (500 or more employees) make COEs available to employees for orthopedics, cardiology and oncology, and 41% offer COEs for women’s health (infertility and pregnancy). For complex medical care, working with the most experienced, best-qualified doctors can make a huge difference in both outcomes and cost. To make using a COE an easier choice for employees, employers may pay for travel or even provide a cash bonus. Some make it mandatory for certain conditions.
For employers ready to take on a bigger step for potentially bigger impact, there are ACO, PCMH
Those employers that provide employees with incentives to use VBC providers are more likely to be able to measure performance and to report positive outcomes: 55% have seen cost savings; 51% have seen quality improvements
Providing COEs and using a VBC strategy both send a positive message to employees – it says the employer cares