Highmark plan sponsors who offered integrated medical and pharmacy benefits are seeing notable savings compared to those with carve-out pharmacy benefits, according to a new study.
The study, conducted independently by HealthScape Advisors, found that group customers with integrated benefits saved an average of between $150 and $230 per member per year on the back of higher member engagement and better care coordination.
The analysis is based on three years of claims data, from 2017 to 2019, Highmark said.
In addition to savings, the study found that group clients who offered integrated benefits saw the length of hospital stays reduced by 3.9% and that members were 14% more likely to engage in chronic care management programs.
"The story is getting stronger and stronger as more and more organizations are talking about the value of integration," Sarah Marche, senior vice president of pharmacy services at Highmark, told Fierce Healthcare.
The study found that the plan sponsors whose population had higher health risk scores saw the greatest savings, on average saving 11% per member per year more than those with carve-out pharmacy benefits.
She said that integrating medical and pharmacy benefits gets at a number of healthcare challenges, including care coordination. As a growing number of drugs are now billed through the medical benefit, having access to the full spectrum of a patients' coverage makes it easier to track the therapies they're using.
For patients, navigating and understanding their benefits also becomes easier when the two are integrated, she said. Waiting on their health plan, pharmacy benefit manager, physician and pharmacist to communicate about different medications can lengthen the care process significantly.
"Healthcare, in general, is already so complicated and separating those benefits, when you can much more strategically think about a patient’s care when they’re together, makes it that much more confusing for a patient," Marche said.