Insurers, Innovation, And Technology: Delivering Cost Savings Through Transparency

posted by AHIP

on December 10, 2018

Every day, millions of patients around the country rely on medicines to keep them healthy. But out-of-control drug costs are making it harder and harder for employers to provide the affordable, accessible health coverage hardworking Americans need – and deserve.

One health insurance provider, Blue Shield California (BSCA), recognized the impact excessive drug prices were having on employers and patients. They talked to patients and doctors about how best to work together to address the challenge. And while they realized there’s no silver bullet to bring down health care costs, they all agreed one thing could go a long way to help: transparency.

The hidden costs of prescription drugs worried everyone. Doctors said they would like to know – but often have no way to find out – the price of a drug before they prescribe it. And patients said they didn’t feel they had other options other than what a doctor prescribed them. So when the price of that drug was too high for patients to afford? Well, they just didn’t take it.

But BSCA found something else – something encouraging: when physicians have access to information about drug costs and lower cost alternatives, they can make careful and informed decisions that deliver the best, most affordable care for patients.

So BSCA decided to take that knowledge one step further. They reached out to Gemini Health – a technology startup founded by health care IT gurus – with the goal of turning data into knowledge to deliver cost savings and better health for patients.

The tool they came up with serves as a database for doctors, providing a host of information in an intuitive way so doctors can understand exactly what every drug will cost a patient. For every listed prescription drug, the database includes:

  • Lower-cost alternatives and cost comparisons
  • Estimated total costs for patients – with and without rebates and coupons
  • Pre-population of electronic prior authorization forms for the select drugs that require it

Eventually – after the initial implementation period – the database will also allow private doctors and hospital administrations to analyze:

  • How much in savings they’ve delivered to patients
  • Reduced hours spent on pharmacy prescription rejections
  • Improved patient satisfaction on drug costs

The database is currently in use by several offices across the state, and BSCA expects it to be available to all health care providers in California within three years. Even just early results show considerable savings and a better dialogue with patients. And the program’s just one example of how insurers are using innovative technology to deliver better care.