Distributed Evidence for Value-Based Insurance Design

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Distributed Evidence for Value-Based Insurance Design Michael C. Sokol, MD, MS Corporate Medical Director Merck & Co., Inc.

Higher Prescription Co-Pays Associated with Lower Medication Adherence Kessler RC, Cantrell CR, Berglund P, Sokol MC. The impacts of co-installments taking drugs adherence amid the initial two years of physician endorsed sedate treatment. Diary of Occupational and Environmental Medicine. 2007;49(6):597-609.

Relationship amongst Income and Medication Adherence Chernew M, Gibson TB, Yu-Isenberg K, Sokol MC, Rosen AB, Fendrick AM. Impacts of Increased Patient Cost Sharing on Socioeconomic Disparities in Health Care. Diary of General Internal Medicine. 2008;23(8):1131-1136.

Employer Example-Service Industry Purpose of study: Examine the effect of bringing down Rx co-pays taking drugs adherence 5 sedate classes concentrated on: ACE/ARBs, beta blockers, diabetes meds, statins, breathed in steroids Prospective, pre/post think about with control aggregate Time period: 2004 (pre) and 2005 (post) Both intercession and control bunches utilized same infection administration programs Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM. Effect of Prescription Co-installments on Medication Adherence in the Context of a Disease Management Program. Wellbeing 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. Effect of Prescription Co-installments on Medication Adherence in the Context of a Disease Management Program. Wellbeing Affairs. 2008;27(1):103-112.

Financial Outcomes of Intervention Program prompted to decreased utilization of nondrug human services administrations, counterbalancing costs connected with extra utilization of medications supported by the program Thus, the intercession equaled the initial investment (or even spared cash) A focused on mediation, concentrating on high-chance patients, would be significantly more great "Circuitous" funds, for example, profitability increases, could assist balance the extra medication spending Chernew ME, Shah M, Wegh A, Rosenberg S, Juster IA, Rosen AB, Sokol MC, Yu-Isenberg K, Fendrick AM . Confirm that Value-Based Insurance Can Be Effective. Wellbeing Affairs. Web Exclusive Jan 2010.

Employer Example-City of Asheville, NC Purpose of study: To evaluate the diligence of results for up to 5 years taking after the start of group based pharmaceutical look after patients with diabetes Education by guaranteed diabetes teachers, drug specialist follow-up utilizing planned conferences, clinical appraisal, objective setting, checking, and community tranquilize treatment administration with doctors. Diabetes remedy co-pays and diabetic supplies deferred for program cooperation Longitudinal pre−post accomplice think about Time period: 1997-2001 Cranor CW, Bunting BA, Christensen DB. The Asheville Project: Long-term clinical and financial results of a group drug store diabetes mind program. J Am Pharm Assoc. 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 monetary results of a group drug store diabetes mind program. J Am Pharm Assoc. 2003;43:173-84.

Employer Example-Large Manufacturer Purpose of study: Examine the effect of prescription adherence on hospitalization hazard and human services cost 4 illness states concentrated on diabetes, hypertension, elevated cholesterol, heart disappointment Retrospective, observational study Time period: 1997-1999 Diabetes 3,260 patients in associate Average age was 54 years of age 45% female Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Effect of medicine adherence on hospitalization hazard and human services cost. Medicinal Care . 2005;43:521-530.

Higher Medication Adherence Associated with Lower Total Health Care Costs Diabetes Costs 10000 P< 0.05 $55 9000 8000 $165 $285 7000 $404 Rx $ Average consumptions per quiet every year ($) 6000 Medical $ $763 5000 4000 $6,959 $6,237 $8,812 $5,887 $3,808 3000 2000 1000 0 1-19% 20-39% 40-59% 60-79% 80-100% Adherence level (% Days supply/1 year) Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Effect of drug adherence on hospitalization hazard and human services cost. Medicinal Care . 2005;43:521-530.

Higher Medication Adherence Associated with Lower Hospitalization Rate Diabetes Hospitalization Risk 35 30 30* 25 Risk (%) 26* 25* 20 20* 15 10 13 5 0 40-59 60-79 1-19 20-39 80-100 Adherence level (%) *Indicates that result is essentially higher than result for 80-100% adherence aggregate ( P <0.05). Contrasts were tried for medicinal cost and hospitalization chance. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Effect of drug adherence on hospitalization hazard and social insurance cost. Restorative Care . 2005;43:521-530.