Published Evidence for Value-Based Insurance Design Michael C. Sokol, MD, MS Corporate Medical...

Published Evidence for Published Evidence for Value-Based Insurance DesignValue-Based Insurance Design

Published Evidence for Published Evidence for Value-Based Insurance DesignValue-Based Insurance Design

Michael C. Sokol, MD, MSCorporate Medical Director

Merck & Co., Inc.

Higher Prescription Co-Pays Associated with Lower Medication Adherence

Figure 4. Projected cumulative probability of medication termination over the study period among patients with diabetes who differed in size of baseline copayment but did not experience any change in copayment

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Kessler RC, Cantrell CR, Berglund P, Sokol MC. The effects of co-payments on medication adherence during the first two years of prescription drug treatment. Journal of Occupational and Environmental Medicine. 2007;49(6):597-609.

Relationship between Income and Medication Adherence

Chernew M, Gibson TB, Yu-Isenberg K, Sokol MC, Rosen AB, Fendrick AM. Effects of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care. Journal of General Internal Medicine. 2008;23(8):1131-1136.

Employer Example- Service Industry

Purpose of study: Examine the impact of lowering Rx co-pays on medication adherence

5 drug classes studied: ACE/ARBs, beta blockers, diabetes medications, statins, inhaled steroids

Prospective, pre/post study with control group Time period: 2004 (pre) and 2005 (post) Both intervention and control groups used same disease

management programs

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs. 2008;27(1):103-112.

Lower Prescription Co-Pays Associated with Higher Medication Adherence

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Impact of Prescription Co-payments on Medication Adherence in the Context of a Disease Management Program. Health Affairs. 2008;27(1):103-112.

Financial Outcomes of Intervention

Program led to reduced use of nondrug health care services, offsetting costs associated with additional use of drugs encouraged by the program

Thus, the intervention broke even (or even saved money)

A targeted intervention, focusing on high-risk patients, would be even more favorable

“Indirect” savings, such as productivity gains, could further offset the additional drug spending

Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Evidence that Value-Based Insurance Can Be Effective. Health Affairs. Web Exclusive Jan 2010.

Employer Example- City of Asheville, NC

Purpose of study: To assess the persistence of outcomes for up to 5 years following the initiation of community-based pharmaceutical care services for patients with diabetes

Education by certified diabetes educators, pharmacist follow-up using scheduled consultations, clinical assessment, goal setting, monitoring, and collaborative drug therapy management with physicians.

Diabetes prescription co-pays and diabetic supplies waived for program participation

Longitudinal pre−post cohort study Time period: 1997-2001

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. pharmacy diabetes care program. J Am Pharm Assoc.J Am Pharm Assoc. 2003;43:173-84. 2003;43:173-84.

Higher Medication Adherence Associated with Lower Total Health Care Costs

Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and economic outcomes of a community pharmacy diabetes care program. pharmacy diabetes care program. J Am Pharm Assoc.J Am Pharm Assoc. 2003;43:173-84. 2003;43:173-84.

Employer Example- Large Manufacturer

Purpose of study: Examine the impact of medication adherence on hospitalization risk and health care cost

4 disease states studied- diabetes, high blood pressure, high cholesterol, heart failure

Retrospective, observational study Time period: 1997-1999 Diabetes

– 3,260 patients in cohort– Average age was 54 years old– 45% female

Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43:521-530.

Higher Medication Adherence Associated with Lower Total Health Care CostsHigher Medication Adherence Associated with Lower Total Health Care Costs

Adherence level (% Days supplyAdherence level (% Days supply // 1 year)1 year)

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($) P< 0.05P< 0.05P< 0.05P< 0.05


$8,812$8,812$8,812$8,812 $6,959$6,959 $6,237$6,237 $5,887$5,887 $3,808$3,808

$55$55

$165$165$285$285 $404$404

$763$763

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1-19% 20-39% 40-59% 60-79% 80-100%

Rx $Rx $

Medical $Medical $

Diabetes Costs Diabetes Costs

Higher Medication Adherence Associated with Lower Hospitalization Rate

30*30*26*26* 25*25*

20*20*

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55

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2020

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1-191-19 20-3920-39 40-59 60-79 80-10080-100

Adherence level (%)Adherence level (%)

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*Indicates that outcome is significantly higher than outcome for 80-100% adherence group (P<0.05). Differences were tested for medical cost and hospitalization risk.

Diabetes Hospitalization Risk

Published Evidence for Value-Based Insurance Design Michael C. Sokol, MD, MS Corporate Medical...

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