During a recent Becker’s Healthcare webinar, sponsored by Personify Health, Erica Morgenstern, Personify Health’s chief marketing officer, moderated a panel discussion with five healthcare finance leaders about cost drivers and strategic pivots they’re adopting:
- Lynn Ansley, vice president, revenue cycle management, Moffitt Cancer Center (Tampa, Fla.)
- Scott Charles, chief financial officer, Personify Health
- Brian Maude, chief financial officer, Sanford Health Plan (Fargo, N.D.)
- Ernest Ngirimana, vice president and chief financial officer, Emory Healthcare (Atlanta)
- Luke Rockenbach, chief financial officer – Silicon Valley market, Sutter Health (Sacramento, Calif.)
Four key takeaways were:
- It’s critical to identify the 20% of people who are driving 80% of healthcare costs. From a population health management perspective, it’s essential to proactively mine member data to find those individuals before they need acute interventions. This is particularly important with value-based care. “With some of the new technology and advanced analytics, we’re seeing emerging trends and insights that will allow us to keep patients and the community healthier,” Mr. Rockenbach said.
- Managing the impact of high-cost drugs is now a boardroom issue. For healthcare payers and plan administrators, GLP-1s are a major cost concern. While the health benefits of these drugs are compelling, increased usage is driving up costs. “There is a lot of analytics work happening,” Mr. Ngirimana said. “Our doctors are around the table working with our administrators and data scientists to figure out the best way forward.” GLP-1s are one area where it’s important to leverage a pharmacy benefit manager (PBM) and step edits. “You want patients to feel supported on their journey. You also want them actioning behavioral change as they’re using GLP-1s, so they can get off these drugs at some point and maintain the progress they’ve made,” Mr. Charles said.
Immunosuppressive drugs like Humira are another source of increasing employee healthcare costs. Sanford Health Plan was an early adopter of biosimilars for Humira and it plans to take the same approach with Stelara. “Humira has been our MLR-type initiative, and the results have been significant,” Mr. Maude said. “As we see the spend go down, we pass that on to our groups.”
- To reduce the cost of oncology treatment, organizations are leveraging technology and different care settings. Aside from drug costs, one of the most expensive assets in oncology care is the people. Technology can help teams work smarter, not harder. “We’re trying to bend the cost curve by maintaining our FTE levels, even with substantial growth on the horizon,” Ms. Ansley said. “That has to be a very intentional effort that is based on the use of new technology.” Many novel cancer treatments are also starting to shift from the inpatient setting to outpatient or observation. “The key focus is predicting those trends and utilizing the clinical care setting in the smartest way, without sacrificing patient outcomes,” Ms. Ansley said.
- Personify Health takes an active approach to managing rising healthcare costs with support across benefit design, PBM partnership, stop-loss insurance and payment integrity. Additionally, Personify also actively engages members in their health proactively to improve outcomes and save costs with levers like care navigation, care advocacy, condition management and mental and physical wellbeing.
For more information, please visit Personifyheath.com.
