Aetna announced it will offer a value-based insurance plan that will eliminate or reduce member co-pays on common heart attack medications as a means to up patient medication compliance in order to keep high-risk patients healthier and out of the hospital.
Even with the lower out-of-pocket spending on prescription and other health services, the costs for plan sponsors should not rise because hospitalizations will likely decrease.
Aetna's step towards value-based insurance design (V-BID) adds momentum to the growing chorus to make the approach a significant part of the insurance landscape to improve care and lower costs. The payer also funded a study to demonstrate how reducing barriers to effective treatment influenced patient behavior.
Aetna's Rx Healthy Outcomes program will be available in January 2013 to commercial self-insured large customers or employers, the company announced Nov. 14. The payer said it expects to expand the program to fully insured plans and other health conditions.
Value-based design is an approach for offering health benefits that seek to enhance patients' clinical outcomes and control healthcare costs by influencing their behavior. The concept is that by reducing barriers to high-value services and providers through lower costs and patient incentives, V-BID plans can achieve improved health outcomes while controlling costs, said Dr. Mark Fendrick, internist, professor and director of the Center of Value-Based Insurance Design at the University of Michigan.
See also: Healthcare IT crucial to value-based insurance design; HealthyU insurance plan to pay cash rewards for healthy behavior]
"Now that Aetna has demonstrated clear evidence that removal of barriers improves medication adherence and patient health, lowers patients' out-of-pocket costs and does not increase total spending, it makes sense that such a program should expand to most Americans," Fendrick said.
"We are seeing both private and public insurers adopting V-BID principles of removing barriers to high-value care across the entire continuum of medical services, wellness, screenings, medication and therapies and even hospital choice," he added.
Failure to take prescribed medications is a leading cause of the estimated 325,000 annual recurrent heart attacks. Yet most activities that are designed to boost the quality of care for patients with heart attacks are aimed at physicians improving prescribing practices at the time of hospital discharge, according to Dr. Niteesh Choudhry, one of the authors of the study in the recent New England Journal of Medicine.
Accroding to Lonny Reisman, MD, Aetna's chief medical officer, cardiac medications are now well established in greatly reducing a patient's chances of having a second heart attack and living longer. Patients need to follow the treatments recommended by their physicians to get the best clinical outcomes.
"Still, only about 40 percent of patients follow the medication regimen after having a heart attack," he said. With evidence about patient behavior, health plans can target the hurdles that thwart the resolve of high-risk members to stick to their treatments and take their medications, he added.
The study conducted by Brigham and Women's Hospital, Harvard Medical School and Aetna involved 5,900 patients who were followed over 13 months following hospitalization for a heart attack. Even with the increased adherence to medications because of the lack of co-pays, overall adherence "remained low," Choudhry said.
Only 10.5 percent of the patients took all three medications as prescribed. That may be due to a lack of understanding about the prescription treatment or complexity because patients may be taking a number of medications for other conditions also and they need to be coordinated.
Still, "an intervention that reduces patients' financial burdens without changing overall spending and with possible clinical benefits is a rarity in health care and suggests that eliminating cost sharing for secondary prevention … may be cost-effective," Choudhry said.
To help further increase medication adherence, Aetna has said it will expand personalized support for its heart-medication members with a care manager to assure that patients take their medications following hospital discharge and answer any questions the patients may have.
Plan sponsors such as employers Marriott International and L-3 Communications have expressed interest in the new program. Helping employees avoid serious health events will result in fewer disability days, less absenteeism and greater productivity.
Other health plans have established programs based on V-BID principles targeted at specific conditions, such as UnitedHealth Group's Diabetes Health Plan, Fendrick said.
"Instead of making it difficult for patients to fill their prescriptions to get their eyes examined and see a nutritionist, barriers were removed for patients to get these potentially life-saving services, and, not surprisingly, they do it more often than when the barriers are not in place," he said.