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New study finds payer cost savings for patients with comorbidities
Continuing a patient-support emphasis that it has had for years, the CVS Health Research Institute has published a report in the latest issue of Am. J. of Managed Care on a longitudinal study of non-Medicare patients with comorbidities—in this case, high cholesterol, hypertension and diabetes. “Among those with 3 or more conditions, annual savings associated with becoming adherent were $5341, $4423, and $2081 for patients with at least diabetes, hypertension, and high cholesterol, respectively. The increased costs for patients in this group who became nonadherent were $4653, $7946, and $4008, respectively,” say the study authors. Patients with fewer than the three comorbidities had lesser savings. Payers (who are the CVS Health PBM business clients) could save $38-63 million per 100,000 covered lives, based on preliminary analysis of the dataset, which consisted of over 857,000 patients.
"There is extensive evidence supporting the relationship between better adherence, improved health outcomes and reduced healthcare costs, but efforts to improve medication adherence, while effective, can be costly," said Troyen Brennan, MD, chief medical officer of CVS Health, in a statement. "We are now trying to better understand how to maximize health care resources to have the greatest impact on adherence and provide the maximum benefit for payers and patients. This research indicates that targeting adherence interventions to patients based upon their adherence history and comorbidities would result in greater cost savings and a better use of healthcare resources."
From around when the Affordable Care Act was passed in 2010, there has been a growing consensus among payers, providers and the pharma industry that adherence is an opportunity for controlling healthcare costs. The problem, then and now, is identifying successful interventions, and aligning incentives to get the parties to support the effort. The pharma industry’s incentive is obvious: better adherence makes for higher pharma sales. ACA makes better adherence a goal for providers and hospital systems, in part through the “meaningful use” requirements of funding electronic health record (EHR) systems, as well as direct payments. For CVS Health, the adherence topic positions it well with payers, showing better management of their costs and justifying their ongoing business relationship.
CVS Health also noted that it has recently introduced the Care 1-on-1 branded service, which connects patients to a dedicated pharmacy team to manage their conditions; and that it is using predictive analytics to anticipate which patients will need the most support for adherence.