Mini-Summit III: Insurance Benefit Design and Cost Sharing for Payment Reforms
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1 Mini-Summit III: Insurance Benefit Design and Cost Sharing for Payment Reforms The National Pay For Performance Summit Designing and Implementing Healthcare Solutions That Work August 25,
2 Safeway Overview Fortune 100 company Sales: $41.1 billion Operating profit $1.2 Scope of business Stores 1,694 Manufacturing Plants 32 Distribution Centers 18 U.S. and Canada Employees 180k Non-Union 30k Union 150k 2
3 Making a Market in Health Care Provide access / choice to competitively priced and high-quality care Provide price information and quality metrics to inform and enhance consumer choice, and encourage shopping behavior Use defined contribution benefit design or reference pricing approach to motivate smart choices Members enabled make informed, active choices with their physician about their care and related costs Balance to manufacturer and others marketing and pricing efforts 3
4 The Market Sweet Spot Commodity Sweet Spot Value Able to Shop 4
5 Our Market Priced Drug Design ILLUSTRATIVE ILLUSTRATIVE Omeprazole 20mg Typical Plan Design ($10/$30/$45) Total $ Plan $ EE $ $14 $4 $10 Nexium 40mg $166 $121 $45 Omeprazole 20mg Our Plan Design Total $ Plan $ EE $ $14 $4 $10 Nexium 40mg $166 $4 $162 Lansoprazole 30mg $16 $6 $10 Lansoprazole 30mg $16 $4 $12 5
6 Safeway s Program Options ILLUSTRATIVE ILLUSTRATIVE Options 1 Keep Nexium 40mg $ Current Formulary You pay for 30-day prescription of Nexium 40mg $ Switch to therapeutic alternative $10.00 Omeprazole 20mg OR Switch to therapeutic alternative $10.00 Lansoprazole 30 mg 3 Request and receive exception approval $45.00 for Nexium 40mg Note: Assumes a typical 3 tier Rx structure 6
7 Price Transparency via our Medicine Cabinet And s/Faxes this information to your physician for consideration Patient Specific Dosage and Quantity Lower Cost Alternative Why is this the Lower Cost Therapeutic Alternative Drug? Explains the cost comparison and clinical comparison 7
8 Pharmacy Program Impact Addressed over 60 therapeutic categories Savings per category exceeds 50% of spend Total savings of 18% - 20% of plan spend 85% of consumers switch to lower-cost prescriptions 3% of impacted prescriptions request program exceptions 8
9 Price Variation in Medical Procedures Cost Per Procedure - Greater SF Bay Area MSA Low Cost High Cost $28,887 $15,773 $7,245 $913 $3,664 $887 $1,010 $3,039 MRI Spine Colonoscopy Diagnostic CT Scan Abdomen Knee Arthroscopy 4:1 8:1 16:1 10:1 High Cost : Low Cost Multiple 9
10 Price Variation for a Specific Procedure Colonoscopy Cost Per Procedure Greater SF Bay Area MSA Room & Supplies Professional Medications Diagnostics $7,245 $5,596 $2,876 $3,333 $3,769 $887 $1,249 $1, Representative sample: 8 out of 41 facilities Diagnostic Colonoscopy Providers 10
11 Safeway s Medical Program Commodity Program Criteria Low complexity / outcome variation Value Sufficient variation and cost Accessible to process intervention Time to shop Low administrative complexity Can be adjudicated by plan and communicated to members Program Results 550 labs implemented 70 imaging procedures implemented On track to achieve 3% savings on total medical cost Expanding procedures to achieve 5% savings next year 11
12 Mini-Summit III: Insurance Benefit Design and Cost Sharing for Payment Reforms The National Pay For Performance Summit Designing and Implementing Healthcare Solutions That Work August 25,
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