I am attending the Cigna National Producer Advisory Council meeting this week and I learned that Cigna’s trend objective is to match the increase in the Consumer Price Index (CPI). CPI is a measure of change in prices paid by urban consumers for a “market basket” of goods and services. That’s a pretty bold goal but as I thought about it I realized that until this is accomplished, the pressure on the status quo healthcare system will continue to increase.
In the past few years there has been a significant shift from discounted fee-for-service to value-based protocols. Research is coming out that measures the effectiveness of these programs. Intel Corporation’s Connected Care program is a shared savings model (on the value-based spectrum) where providers are rewarded on an upside-only basis for meeting metrics in cost and quality. This study showed statistically significant improvements in diabetic care and patient satisfaction.
Further along the value-based scale, shared risk programs were shown to reduce costs overall. A study of Medicare’s Pioneer program is showing early wins with an 8% reduction in hospitalizations and 6% fewer emergency department visits. Per beneficiary that’s an estimated $115 in net savings.
One study of the South Carolina Birth Outcomes Initiative and Healthy Texas Babies Initiative showed the effectiveness of non-payment programs, yet another payment model. These aptly-named programs refuse to pay for care they deem as possibly harmful or simply not needed. The study cites the reduction of early elective child deliveries, fewer neonatal intensive care admissions and lower costs overall.
A recent study published in the Journal of the American Medicine Association (JAMA) revealed changes in care access using data from Aetna from 2008 to 2015. Americans under age 65 are significantly reducing emergency room (ER) use and switching to less-costly settings of care for low-severity conditions. The results showed a 36% decrease in emergency room visits and a 140% increase in visits to other care settings (119% increase in urgent care; 214% increase in retail clinics; plus, a newly-emerging setting, telemedicine). The study concludes that these changes were driven primarily by a significant increase in cost for ER visits for low-severity conditions as compared with alternative settings.
It seems that the Cigna will acquire Express Scripts and CVS will own Aetna and hopefully these transactions will help find better ways to control exploding pharmacy costs. Alignment of interests is happening throughout the healthcare system and trends are definitely coming down… but are they coming down enough to meet the CPI goal? I hope so.