June 19, 2018
New data from Quantum Health reveals that its Precision Specialty Pharmacy Management program reduced cost by 55 percent, or an average of over $80,000 per case annually, for members transitioning from insurance carriers to the company's consumer healthcare navigation model. These savings resulted from a site of care and transition analysis of patients already on specialty medications for Quantum Health's new January, 2018 clients.
Chief Medical Officer Dr. Dana Andrews attributes the results to the company's active collaboration with the members and their providers during the precertification process. "We look for 44 specialty medications when members onboard with us. We're able to quickly identify those who can receive the medication in a more cost-effective site of care, and once we've identified them, we have more than a 95 percent success rate at transitioning them to high-quality, more affordable sites."
For employer health plans and healthcare consumers alike, specialty Rx is a major cost-driver. Currently, only 1 to 2 percent of the U.S. population are treated with specialty medications, but those patients are driving nearly 40 percent of all drug spending. And experts are projecting costs to rise by 17.7 percent in 2018.
During its review of cases from new clients, Quantum Health identified 57 percent of members being treated by specialty medications could benefit from a change in the site of care. Of those cases, 96 percent were successfully transitioned to a more affordable alternative. For affected clients, the savings represents an immediate and long-term return on investment.
"Our program is called Precision Specialty Pharmacy Management because we collaborate with our members' providers on an individualized, case-by-case basis to maximize both the value and quality of their care," says Dr. Andrews. "It is hardwired into our pre-cert process. We have a high degree of certainty that these initial results are repeatable for our new clients and sustainable for all of our existing clients."