By Daniel G. Garrett, MS, FASHP, senior director of Medication Adherence Programs, American Pharmacists Association Foundation
Data on our country´s health care system seem to indicate it would be more accurate to call it a "sick care" system. More than 90 million people in the United States suffer from chronic diseases such as cardiovascular disease, cancer, and diabetes, which are among the most prevalent, costly and preventable of all health problems. Fewer than 50 percent of people with chronic health conditions receive care according to evidenced-based guidelines, yet these conditions account for 75 percent of the country´s medical care costs. And less than half of all prescriptions written, many for treating these conditions, are neither filled nor taken. It is no surprise that costs continue to escalate. A 2006 study by the Kaiser Family Foundation found that health insurance premiums increased 87 percent between 2000 and 2006, while earnings increased 20 percent. The average medical costs for a family of four rose 43 percent just between 2003 and 2007, averaging $14,500 (2007 Milliman Medical Index).
Managing Disease Through Collaboration
To fix the broken system, the North Carolina Center for Pharmaceutical Care worked with the city of Asheville, NC, to create a new approach to managing chronic disease for the city´s employees, dependents and retirees. In 1997, in collaboration with the local health care system, pharmacists and physicians, the city helped connect people with community-based health care to manage their health. Offering a voluntary health benefit to employees and dependents with diabetes, the city waived co-pays for diabetes medications and supplies for participants who agreed to work with a pharmacist coach. Specially trained pharmacists met with patients periodically for education and counseling, and worked in collaboration with physicians and diabetes educators. The pharmacist coach relationship encouraged patients to set goals and be accountable for results, while helping them build knowledge and confidence to manage their diabetes. The model, known as the Asheville Project, has proven to improve overall health and reduce absenteeism. The new tool will present the same types of information presented by the Health & Productivity Snapshot, but focused on your own company and work force. In addition, it will identify the effects of multiple, interdependent medical conditions and will help prioritize the conditions for you to focus on, based upon the prevalence of the medical conditions affecting your work force, the extent to which those conditions are untreated, and the amount of absences and presenteeism they drive for your employees.
Absence/Disability Benchmarking
Your company may have disability data but need industry comparisons of cost, durations and performance drivers to identify opportunities to better manage your programs. An effective benchmarking program must:
• Have a robust comparative database for multiple industries,
• Base results on national, standardized data, and
• Be inexpensive.
Experience teaches us that relatively few employers are able or willing to submit aggregate benchmarking data, so industry comparison groups are likely to be too small to promote robust comparisons. IBI solved this problem by gathering comparative data—more than 29,500 employer program units this year, comprising more than 3.1 million claims—from a member consortium of disability insurers and third-party administrators. This robust, standardized database allows comparisons to broad industry performance for workers´ compensation, short and long-term disability, and family and medical leave programs. IBI´s benchmarking reports also model your company´s absence-related lost productivity and its bottom-line impact in the context of your own financial results.
Health Management Requires Effective Measurement
As the principle payor for the U.S. health care system, employers should insist that the health-related benefits and services they furnish serve both the health and productivity needs of their work force and their own bottom-line goals. The key to knowing how to achieve those goals is access to the measurement tools necessary to look across programs and assess the full impact of existing and proposed health-related interventions. As employers seek ways to promote health and minimize waste without burdening employees, focused baseline, design and performance data must play a role in driving informed decisions to create a win both for employers and employees.
i Roland D. McDevitt, Ryan Lore, Melinda Beeuwkes Buntin, Cheryl Damberg and Hayoung Park. Research Brief: The CDHP Implementation Experience with Large Employers, Watson Wyatt Worldwide and The RAND Corporation, July 2007.
ii A Broader Reach for Pharmacy Plan Design, Integrated Benefits Institute, May 2007.
William P. Molmen is co-founder of the Integrated Benefits Institute, a national, nonprofit organization created in 1995. IBI provides measurement tools and databases across benefits programs, research and analysis, and a discussion and education forum. For more information about effective measurement solutions, visit www.benefitsintelligence.org and www.ibiweb.org, or contact Molmen at wmolmen[at]ibiweb.org, 415-222-7283.
