PNS111 SURVEY RESULTS OF CONTEMPORARY U.S. HEALTH PLAN POLICIES: NEW CHALLENGES, DIGITAL TECHNOLOGIES, VALUE-BASED CONTRACTING, AND COMPARATIVE EFFECTIVENESS RESEARCH

Abstract

Gain a better understanding of current health plan management and tools. Online interactive survey of U.S. health plan officers with differences (>2%) from prior surveys reported. 85 survey respondents. The most financial impact of new therapies from Oncology combination therapy (68% of plans), followed by CAR-T, and therapies for atopic dermatitis and Alzheimer’s disease. Challenges to biosimilar use: product substitution=36.5%, formulary management=23.1%, financial=19.2%, education=13.5%, supply chain=5.8%, systems=1.9%. To combat opioid abuse: 50.8% are enacting more restrictive prescribing restrictions, 39.7% following local restrictions; 4.8% are Prior-Authorizing all opioid prescriptions,3.2% advocating alternative pain management and 1.6% limit indications. Most plans cover physical therapy 94.3%, psychotherapy 73.6%↓12.1%, chiropractic care 77.4%↓6.3%. Alternative care covered by 30.2%↓6.5%, gym memberships by 41.5%↑6.8% and 11.3%↑9.3% cover medical marijuana. Most plans support some digital health programs with 32.2%↑22% expecting them to raise costs, 25.4%↓18% to lower costs, 42.4%↓17.6% to be budget neutral. Common uses: messaging 70.7%↓9.3%, telemedicine 69%↓9.2%,web-programs 62.1%↑8.8%, personal health records 44.8%↑6.1%, consumer apps 39.7%↓3.9%, disease management applications 29.3%. Applications include: lifestyle+stress 52.7%↑17.9%, exercise+fitness 56.4%↑8.3%, reminders+information 60%, diet+nutrition 40%↑14.9%, Healthcare Providers/Insurance 41.8%↑7.2%, Disease-specific purposes 47.3%, Women’s Health+Pregnancy 30.9%. Value Based Contracting (VBC) is being used for services in <45% of plans, for pharmaceuticals only 41.5%↓5.3%. Areas for prescription drug VBC included Oncology, HCV, Specialty products. Prescription VBC is expected to increase to 49% in 2019. 86.3% believe Evidence Based Medicine (EBM) is commonly used in coverage decision making and 42%↑21% expect to regularly utilize Comparative Effectiveness Research (CER) in formulary decision making by 2018; 41.2%↑8.8% believe they obtain usable CER today. CER information is expected to affect clinical guidelines, value of care, and medical/pharmaceutical benefit management. Managed care plans adopt tools to better manage member health. Digital Health and VBC use growing (slower than expected), CER for EBM continues to show promise and needs better information.