Clinical team alignment top priority for payers
The transition to value-based care for payers is not about enrolling patients. In four separate meetings this year with major affiliated, yet independent payers, we heard differing needs and priorities:
1. More connectivity with practitioners.
2. A reduction of the cost and risk of non-compliant patients with chronic conditions.
3. Ability to demonstrate the provision of value to corporate plan sponsors.
4. Securing provider preference.
What do they all have in common? A need for clinical team alignment that drives spending down. What can managed care executives do for patients and plan sponsors that simultaneously wring out costs? Invest in resources and tactics that support the patient—clinician relationship, especially for chronically ill patients.
The crucible of value lies in the supporting the relationship between the clinician and the patient. Why? This is the top opportunity to impact the patient experience and demonstrate the importance of therapy compliance, including medication adherence. Yet the time per patient interaction for clinicians continues to shrink. Resources, human and technological, that fill the gaps in patient education, accelerate access to therapy and improve adherence are critical to improving outcomes, thereby maximizing the value of expenditures for payers and plan sponsors.
HIV and IBD
One of the aforementioned payers described the need for a solution to eliminate $20 million in avoidable costs among a population of less than 1,000 HIV patients. The top driver of those avoidable costs is therapy nonadherence. With a very high level of the HIV population living within 150% of the federal poverty level, prior authorization assistance and expertise within the 340B federal drug assistance program are critical to preventing progression from a now manageable chronic condition (HIV) to AIDS.
Stigma circumvention tactics, particularly those regarding medication, help ensure compliance. So, too, does the development of a trusting relationship between the patient and the patient support staff, including clinical pharmacists. These are two highly effective ways to maximize the value of HIV treatment.
As we reported last year, the University of Alabama’s 1917 Clinic, a Ryan White grantee, presented a study during the 10th International Conference on HIV Treatment and Prevention Adherence. The results showed that out of 157 patients with HIV whose viral loads were not suppressed prior to enrollment in enhanced medication management protocols, 103 have now achieved viral suppression.