Jan 28 2010
ActiveHealth
Management (ActiveHealth®), a subsidiary of Aetna (NYSE:
AET), today announced the publication of a paper in the February issue
of Health Affairs. The paper demonstrates that properly
structured value-based insurance design (VBID) programs can be effective
at increasing adherence to drug regimens for specific chronic medical
conditions without increasing overall costs. The analysis also suggests
that, by targeting outreach to members who need it most, additional cost
savings can be achieved, not only in averting serious health events but
through fewer disability days, less absenteeism and greater worker
productivity.
“Impact Of
Decreasing Copayments On Medication Adherence Within A Disease
Management Environment”
The ActiveHealth program, currently available to employers and health
plans, can couple a VBID incentive with a disease management program.
When individuals with chronic conditions engage in disease management
nurse coaching, they are eligible for reduced co-payments on their
medications. The program is designed to remove financial barriers to
medication compliance and encourage individuals to participate in nurse
coaching.
“As employers face increased pressure to keep their health care costs in
check, increasing copayments are often considered as a way to lower
employers’ costs. However, the increased financial barrier to employees
may lead to negative and more costly health events for the employee and
employer. Programs that combine disease management and VBID are proving
effective at helping employers slow the rate of growth in health care
spending, while offering employees valuable benefits that help them stay
well and productive at work,” said Stephen Rosenberg, M.D., senior vice
president for Outcomes Research at ActiveHealth, and an author of the
paper.
Highlights of the Health Affairs paper
Methods
-
In January 2005, a large employer reduced copayments for five classes
of drugs used to treat serious chronic conditions: ACE Inhibitors and
beta blockers used to treat high blood pressure and other heart
disease risk factors, diabetes medications, statins which help lower
cholesterol and inhaled corticosteroids, used to help manage asthma.
-
The employer reduced copayments for generic medications from $5 to $0,
preferred brand name drugs from $25 to $12.50 and non-preferred brand
name drugs from $45 to $22.50.
-
All patients who were already taking these medications were eligible
for enrollment in the VBID program and the reduction in copayments.
Copay relief was also available to people who were not currently
taking the medications but were identified as patients who would
benefit from its use, once their doctors agreed and provided
prescriptions.
Results
-
The VBID program increased adherence to medications by three
percentage points, resulting in an average increase in pharmacy costs
to the employer of $7.75 per employee, per month.
-
But, as a result of this program, the employer reduced its costs for
other (non-drug) health care services like hospital admissions by the
same amount, so that there was no overall increase.
-
The analysis shows that better compliance with medications can avert
serious or catastrophic health events, leading to reduced costs and
potentially healthier and more productive employees.
Programs Built on Patented Technology
ActiveHealth’s patented technology, the CareEngine® System,
powers Active Disease ManagementSM and ActiveHealth’s VBID
program, which is known as Active Benefit DesignSM. The
CareEngine creates a personal health profile for each individual using
claims and other data, and compares the profile to the evidence-based
literature. As part of this process, the CareEngine identifies the
individuals whose clinical profile indicates they could most benefit
from disease management nurse coaching, as well as the individuals who
would most benefit from a medication included in the incentive program.
Program medications were selected based on the large body of
evidence-based medical literature documenting their cost effectiveness
in the treatment of common chronic conditions.
The paper was written by Michael E. Chernew, professor in the Department
of Health Care Policy at Harvard Medical School, Iver A. Juster, senior
vice president for Informatics at ActiveHealth, Mayur Shah, formerly
employed at ActiveHealth, Arnold Wegh, senior informatics analyst at
ActiveHealth, Stephen Rosenberg, senior vice president for Outcomes
Research at ActiveHealth, Michael C. Sokol, corporate medical director
for Merck and Company, Kristine Yu-Isenberg, associate director in
Regional Outcomes Research at Ortho-McNeil Janssen Scientific Affairs
and A. Mark Fendrick, professor in the Division of General Medicine at
the University of Michigan.
The current paper complements an earlier study published in
Health Affairs by researchers from ActiveHealth, Harvard Medical School
and the University of Michigan. That study showed that lowering co-pays
for certain classes of drugs improves medication compliance. The study
demonstrated that ActiveHealth’s VBID incentive can be effective in
increasing compliance with important medications and can complement
ActiveHealth’s disease management program.