1
© 2013 Roger Green and Associates, Inc.
Managing Healthcare Costs Today and in the Future
a brief survey for
Reimburseme...
2
© 2013 Roger Green and Associates, Inc.
Fifty-two on-line interviews conducted August 8 - 12
 26 Medical Directors; 26 ...
3
© 2013 Roger Green and Associates, Inc.
Most payers have plans to use new strategies to manage
rising healthcare costs
C...
4
© 2013 Roger Green and Associates, Inc.
Plan consider most of their efforts to be “somewhat
successful”
7%
17%
33%
86%
1...
5
© 2013 Roger Green and Associates, Inc.
There is a disconnect between what plans are doing today
and what they have hear...
6
© 2013 Roger Green and Associates, Inc.
Payers expect aggressive management of oncology
spending to increase rapidly ove...
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Health Payer Council Survey

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The Health Payer Council, headed up by Roger Green and Associates, Inc. (RG+A) takes a look at the perceptions medical directors and pharmacy directors of different cost management and payer strategies. Take a look.

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Health Payer Council Survey

  1. 1. 1 © 2013 Roger Green and Associates, Inc. Managing Healthcare Costs Today and in the Future a brief survey for Reimbursement and Access 2013 August 13, 2013
  2. 2. 2 © 2013 Roger Green and Associates, Inc. Fifty-two on-line interviews conducted August 8 - 12  26 Medical Directors; 26 Pharmacy Directors  Covering all major categories of lives  ~60M Commercial lives  ~18M Medicare lives  ~9M Medicaid lives  All active members of Health Payer Council® STUDY BACKGROUND n= 52
  3. 3. 3 © 2013 Roger Green and Associates, Inc. Most payers have plans to use new strategies to manage rising healthcare costs COST MANAGEMENT STRATEGIES 41% 35% 33% 15% 11% 26% 21% 20% 23% 14% 20% 23% 11% 23% 31% 11% 10% 19% 27% 13% 2% 11% 17% 12% 31% 0% 50% 100% Drug Capitation in Oncology Differential ASP Reimbursement Performance Bonuses for Treatment Pathways Wean Physicians off Reliance on Drug Revenue Pharmacy Benefit Techniques for Infused Medicines and Biologics Cost Management Strategies (n= 52) Not in foreseeable future Within 1-2 years Drawing board Pilot programs Actively engaged 44% 39% 36%
  4. 4. 4 © 2013 Roger Green and Associates, Inc. Plan consider most of their efforts to be “somewhat successful” 7% 17% 33% 86% 100% 66% 67% 17% 7% 0% 50% 100% Pharmacy Benefit Techniques (n=15) Performance Bonuses (n= 8) Wean Physicians off Reliance on Drug Revenue (n= 6) Differential ASP Reimbursement (n= 6) Success Rates of Cost Management Strategies Very successful Somewhat successful Somewhat unsuccessful Not successfual at all
  5. 5. 5 © 2013 Roger Green and Associates, Inc. There is a disconnect between what plans are doing today and what they have heard is most successful  Payers consider pharmacy benefit controls and expanding these controls their most successful current strategy (43%) “Moving medical infusables to the pharmacy benefit to better control spending”  Pay for performance (21%) and capitation/ bundling (17%) are reported as the most successful technique payers have heard of “Member incentives to follow national guidelines” “Bundled payments. Need to take the goal out of utilization and into outcomes” SUCCESSFUL STRATEGIES n= 52
  6. 6. 6 © 2013 Roger Green and Associates, Inc. Payers expect aggressive management of oncology spending to increase rapidly over the next three years 49% 69% 0% 40% 80% Within 1 year Within 3 years Peer plans aggressively managing oncology costs (n= 52) CURRENT AND FUTURE STRATEGIES 46% 37% 15% 2% Use of Cost Management Techniques (n= 52) Not Using Any Using 1 Using 2 Using 3

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