The rising number of chronic conditions increases the need for innovative health care solutions. Now, more than ever, we must prioritize patient engagement to help improve health outcomes while also effectively managing costs.
Today, 60% of Americans are living with a chronic condition, such as cancer, diabetes and heart disease, among others, with 40% suffering from two or more chronic conditions. Overall, these conditions are one of the leading drivers of the country’s $4.1 trillion annual health care costs.
Tackling prevalent and often complex conditions requires member-centric, value-based solutions that drive better outcomes while reducing spend.
Transforming patient engagement with health tools
When chronic conditions go unmanaged, it may result in disease progression, comorbidity development and increased health care expenditures that stem from emergency department (ED) visits and hospitalizations.
Related: Three of the biggest drivers of health care costs
Value-based care solutions help plan sponsors to give their patients the tools and support needed to manage conditions on their own terms while staying up to date on their care. These tools range from coaching to condition-specific digital resources, like a cellular connected scale for weight loss. They complement a care strategy of routine check-ups, screenings, and patient education, driving meaningful clinical outcomes.
Managing medication spending
Driving patients to the most cost-effective and clinically appropriate medication is another way that value-based solutions reduce expenses. A potential scenario could be approval of a generic medication that offers the same effectiveness as a brand-name medication, or a biosimilar approved as a substitute for an original product.
At the end of the day, value-based solutions guide patients toward the most cost-efficient treatment via several strategies such as:
- Early discontinuation reimbursements
- Indication-based management (a type of utilization management that considers the patient’s response to therapy)
- Current marketplace dynamics
- Future trends
Such evaluation helps ensure patients have access to the right medication at the right price. As a result of employing value-based care solutions, plan sponsors can:
- Reduce costs and eliminate waste
- Improve patient adherence to medication and persistence with treatment
- Improve the total cost of care through higher rates of therapy completion and compliance with clinical guidelines
Maximizing health plan value through better outcomes
Patients benefit from education and support to help them take medication appropriately, ensure medications work as intended and improve their overall health. When plan sponsors provide these resources, they improve health outcomes and achieve savings. In 2023, SafeGuardRx paid over $388M directly to clients – the highest value yet. Other outcomes include:
- Improving medication adherence – The Evernorth SafeGuardRx platform encourages adherence through outreach to patients along with coaching to discuss their medication. As a result of these outreaches, the number of patients filling their prescription within 30 days increased by 31% in 2023. Moreover, adherence outreaches attributed to an almost 2.5% increase in anticoagulant medication adherence for patients enrolled in Cardiovascular Care Value program vs. non-enrolled patients. Lastly, in 2023, patients enrolled in Inflammatory + Atopic Conditions Care Value program had a 1.2% higher medication adherence rate than non-enrolled patients.
- Supporting patients' weight loss journeys – Now more than ever, patients are reliant on health tools they can access from anywhere. There are a variety of digital tools and support available through SafeGuardRx programs. 43% of members taking GLP1s and utilizing Omada for Prevention for at least 7 months lost a minimum of 10% of their body weight, with 1 in 4 of these members achieving over 15% in body weight loss. More specifically, members enrolled in the Weight Management Care Value program lost 170,000 pounds in 2023.
- Increasing therapy completion rates – 18.2% of enrolled patients at risk for heart attack or stroke started potentially life-saving statin therapy in 2023 because of the specialized support they received through SafeGuardRx. Additionally, therapy completion rates are nearly 50% higher for patients enrolled in Hepatitis Cure Value program vs. non-enrolled patients.
As the population of patients with chronic conditions and comorbidities continues to grow, the necessity of value-based solutions becomes clear. By empowering patients with tools that help them take charge of their health and protecting plan sponsors through cost-containment strategies, value-based solutions not only address current healthcare challenges, but they also pave the way for a healthier and more sustainable future.
