Making the Case for Health Care Instead of Sick Care: Hickory Springs Manufacturing
(audio recording included)
Daniel G. Garrett, Executive Director, American Health Care Educational Foundation
Rick Miller, Senior Vice President, Wells Fargo Insurance Services of Virginia, Inc.
The Asheville Model® of patient care has evolved and been replicated to encompass multiple chronic conditions over the past decade. Hickory Springs Manufacturing Co. has leveraged the Asheville experience to develop new ways to help 9,000 employees and dependents lower their risk for diabetes-related complications. Named The Hickory Project, this case study showcases both clinical and economic results.
Real-world Strategies to Improve Medication Compliance and Persistence
(audio recording included)
Richard J. Bruzek, PharmD, Vice President of Pharmacy Services, HealthPartners
Correct medication use is dismal at best. Why don't people use their medication properly? What are the costs to patients, employers and society? Improvement is possible through various efforts and interventions as well as with lifestyle and behavior changes. Real-world examples illustrate ways to improve medication compliance and persistence.
HR Perspectives Track
Conquering the Landscape: Pharmacy Cost Containment Strategies in a Mid-sized Mining Town
Robert C. Arnew, Project Coordinator for Health Care Initiatives, Vale Inco – Ontario Division
Lucio M. Fabris, B.Sc. Phm., CAE, President, Med-I-Well Services Ltd.
Drugs drive benefit costs. This session describes the experience of a major employer within a single-industry, mid-sized Canadian city. An innovative, comprehensive strategic approach curbed drug expenditures, maintained plan member and health care provider satisfaction, while improving appropriate drug use, all within the confines of a collective agreement.
The Value of Financial and Quality Auditing to Drug Benefit Plan Sponsors
Michael J Tocco, RPh, MEd, President, Integrated Pharmacy Solutions
There are currently two waves coming together in the pharmacy benefit arena: quality improvement initiatives and required financial and service auditing sparked by the Centers for Medicare and Medicaid and the Medicare Part D Program. Plan sponsors who understand quality initiatives and realize the scope and benefit of financial pharmacy claim auditing will have incredibly strong tools to manage cost and quality of service of the pharmacy benefit.
Multiple Employer Welfare Association Case Study of Developing and Implementing a Value-based Benefit Program
Kathryn Harris, PharmD, Vice President, Aon
Mark Weinstein, CPA, Esq, LLM, MPH, Executive Director, Independent Colleges and Universities Benefits Association (ICUBA)
The Independent Colleges and Universities Benefits Association (ICUBA) is a Florida-based multiple employer welfare association comprised of 11 colleges. ICUBA recognizes that future efforts to manage health care and prescription drug costs must involve a more intense focus on health promotion, data-driven value-based benefit design, consumerism, and chronic disease management. Review ICUBA’s process for taking value-based inventory of its current health care plan and identifying opportunities to improve members’ perceived value of their health care benefit. Discuss processes for collecting data and evaluating program success.
Industry Trends Track
Modeling Value-Based Pharmacy Benefit Designs
Iver A Juster, MD, Senior Vice President, Health Informatics, ActiveHealth Management
Value-based drug benefit programs are becoming increasingly popular. Identify the key program design features that build purchaser value. Explore a modeling framework that illustrates the cost and savings implications of value-based drug benefit design programs. Review a reporting format to illustrate program impact on adherence, savings and cost. PBMs can support program value reporting by providing specific data elements.
What Group Health Can Learn from Workers’ Compensation: Managing Drug Spend and Disability Without Copays and Formularies
Joseph Paduda, Principal, Health Strategy Associates
Harvey J. Hanel, PharmD, Pharmacy Director, Workforce Safety & Insurance of North Dakota
Workers’ compensation pharmacy benefit managers (PBMs) have helped payers reduce pharmacy cost inflation every year for the past five years, while helping claimants return to work. Joseph Paduda, principal of Health Strategy Associates, which conducts the Annual Survey of Prescription Drug Management in Workers’ Compensation, will discuss how this has happened. He will highlight the market’s evolution, the true cost drivers in comp pharmacy and ways to control these costs. This case study session describes how the use of sophisticated PBM tools, including clinical and utilization management, claimant outreach, analytics and outcomes analysis have helped payers dramatically reduce their drug spend.
Assessing Drug Utilization Trends in Consumer-driven Health Plans
Steve Johnson, PharmD, BCPS, Senior Director, Clinical Consultative Services, Prime Therapeutics
Matt Hermes, PharmD, Senior Director, Pharmacy Management, Blue Cross and Blue Shield of Illinois
Since 2005, enrollment in high deductible health plans (HDHPs) has increased steadily. While HDHPs may encourage judicious use of medicines by incentivizing members to make cost-effective choices, it is unclear how drug utilization differs among HDHP and traditional benefit design enrollees. This presentation presents case study findings to compare and contracts key pharmacy metrics in HDHP plans to a benchmark population.
Managed Care Pharmacy Perspectives Track
Implementation of New HIPAA Standards for Pharmacy
Catherine Graeff, RPh, MBA, Senior Vice President, Communications and Industry Relations, National Council for Prescription Drug Programs
There are new Health Insurance Portability and Accountability Act (HIPAA) rules and National Council for Prescription Drug Program standards. Discuss how these new rules and standards impact Medicaid, Medicare Part D and commercially insured groups. Explore the impact of these new standards on the plan sponsor, patient, pharmacy and pharmacy benefit manager.
Case Study Examples for Medicare Part D Compliance
Danny R. Moriarty, Director, Benefits Design & Effectiveness, Peabody Energy
Andrew J. Thomas, Director, Medicare Business Development, CVS Caremark
Managing Medicare Part D benefits continues to vex the industry with ongoing changes in government requirements. Discuss the pros and cons of employer options for Medicare Part D coverage in today’s challenging economic environment. Employers will present case studies of their approaches for the retiree drug benefit and how they comply with CMS requirements. The implications of Medicare Improvements for Patients and Providers Act (MIPPA) and the impact on employers also will be reviewed.
