A study conducted in part by ActiveHealth Management has found that a value-based insurance design program can increase compliance on the use of certain medications for chronic conditions if coupled with reduced co-payments.
The study, published in the most recent edition of Health Affairs, was jointly designed by New York-based ActiveHealth, Harvard Medical School and the University of Michigan, conducted between 2004 and 2006 and involved two large employer groups.
Using ActiveHealth's CareEngine health management system, the study identified members in the groups that would benefit from reduced co-pays for five drug classes: ACE inhibitors and ARBs, beta-blockers, diabetes medications, statins and inhaled steroids. The drugs were identified as cost-effective in the treatment of common chronic conditions such as hypertension, heart disease, kidney disease, elevated cholesterol, diabetes and asthma.
According to officials, the study identified a "statistically significant increase" in the use of the first four drug groups when co-payments were reduced by 50 percent for branded drugs and eliminated for generic drugs.
"This study demonstrates that ActiveHealth's value-based insurance design program can be effective in increasing compliance with important medications, and can complement our disease management program," said Stephen Rosenberg, MD, senior vice president for outcomes research at ActiveHealth and a co-author of the study. "This finding is significant, since cost containment approaches that increasingly shift costs to patients can cause decreased compliance with potentially life-saving medications. VBID programs reduce one significant barrier to compliance."
The study comes on the heels of last month's roll-out of Aetna's Rx-Savings program, an incentive program under which co-payments for individuals enrolled in self-funded benefit plans who have high-risk clinical profiles and are taking medications for chronic conditions are paid in whole or in part by their employer. The program, which involved Marriott International as a pilot customer, identified eligible members through ActiveHealth's CareEngine System technology. ActiveHealth is an independent subsidiary of Aetna.
"It is imperative that the right incentives are in place so that consumers don't face inappropriate financial barriers to accessing related care," said Lonny Reisman, MD, ActiveHealth's CEO, in a press release announcing today's study results. "ActiveHealth's VBID program offers a unique pairing of fiscal responsibility and clinical precision. Rather than choosing between cost and quality, the goals of all stakeholders are aligned to help improve health and lower costs."
ActiveHealth's CareEngine System disease management program used available claims data (diagnoses, procedures, medications and lab results) as well as data obtained from members and their personal health records to pick viable candidates for the study. It not only identified members currently taking one or more of the target medications, but members who should be taking those medications, per evidence-based guidelines, and scanned for contraindications to any medications already being used.
In January of 2005, one of the two employers in the study voluntarily reduced co-pays for the five classes of medications, cutting co-pays for branded drugs in half and eliminating the $5 co-pay for generic drugs, while the other employer didn't change any co-pays. Letters were sent to each member identified by CareEngine, as well as their prescribing physician, about the reduction in co-payments as well as the importance of the medication involved. A list of all members involved in the VBID program was also sent to the pharmacy benefit manager.
"Health insurers and self-insured employers partially offset their costs of insurance by requiring co-payments, coinsurance or deductibles," said Ed Pezalla, MD, national medical director of Aetna's Pharmacy Management program, during last month's roll-out of Rx-Savings. "However, they incur the costs of illness if a patient suffers further complications from chronic illness. This program offers real opportunities for promoting better care and reduced waste while promoting consumerism."