The Intersection of Healthcare Affordability and Value-Based Care

Miriam Paramore, President, OptimizeRx; a HIMSS Interoperability Showcase Collaborator

Transparency around healthcare costs can avoid the kind of sticker shock that we’ve all experienced, myself included. During a recent visit to a dermatologist, the doctor prescribed me a topical cream which cost just $7, a fact I learned while filling the prescription at the pharmacy. When the doctor decided to later switch me to an ointment—the same medication, just a different formulation—the cost was $300. I called to tell her that it was too expensive, and the doctor admitted she had no idea of the cost of either treatment. Of course, neither did I.

Healthcare costs continue to rise, and the upward trajectory impacts both patient experience and outcomes. Within the framework of value-based care, all stakeholders are looking for greater transparency around cost to improve care coordination and better engage patients. More knowledge in real time means fewer surprise charges, less stress and a greater assurance that patients will adhere to recommended care.

What’s needed now is better utilization of data resources to connect the dots between healthcare costs and those impacted—namely, doctors and patients. The good news is that the industry has the tools to make healthcare costs—and savings opportunities—accessible to doctors at the point of care. Armed with this information, they are better equipped to partner with patients in their care and prescribe affordable treatments, improving the patient experience while driving better health outcomes.

Twenty years ago, healthcare providers were first given the ability to digitally access patient insurance records—allowing instant transparency around medical insurance coverage. However, only recently did the same access become available on the pharmacy insurance side. Now, healthcare providers, pharmacies and insurance claims share one seamless system created by connecting the dots of the previously siloed systems. This is an example of a major shift in connectivity that must be better utilized to improve the patient experience around healthcare costs and medication adherence.

Here’s how it can work. Using enterprise platforms for digital health, a doctor entering a prescription into her EHR gains immediate access to the cost of a preferred medication, based on that patient’s pharmacy insurance coverage, and any associated manufacturer coupons. The doctor then informs the patient of both the cost and potential savings of a particular treatment while the patient is still in the exam room—allowing price to be at least one important determinant in guiding the treatment decision alongside patients. Already, there are more than $7 billion worth of drug manufacturer coupons produced. Yet, only 10% of them are ever redeemed.

Why are so few patients taking advantage of these savings? There are many reasons.

  1. Information about discounts is buried in the small print of advertisements.
  2. Doctors aren’t mentioning the available discounts.
  3. And, of course, sick patients don’t think to spend time researching possible coupons.

We know that doctors are eager to discuss healthcare costs with their patients. In a recent survey of 642 physicians, 73% indicated that they feel the patient’s responsibility for cost is important when making a prescribing decision. Price transparency and drug savings represent one high impact area that has potential to notably improve the outlook on medication adherence and patient outcomes. And technology now allows us to make that information available right at the point of care where it will be utilized.

Too often, patients are left to discover the high price of their healthcare while standing in line at the pharmacy and have to decide in that moment whether they can afford a particular treatment. Half of all U.S. adults say they or a family member skipped or delayed care because they couldn’t afford to pay. Three in 10 (29%) say they did not take their medicines as prescribed in an attempt to manage costs.

By utilizing available technology, we can minimize these surprises and provide patients with treatment options they can afford. Doctors and patients alike are looking for greater transparency and the information is already available. By making healthcare costs visible to everyone in real time, we can reduce stress, add value, and greatly improve the patient experience. That’s a system that works better for everyone.

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