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.

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
© 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
© 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
© 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
© 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
© 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