Payers, Patients Save With Value-Based Chronic Disease Management

Highmark’s value-based care agreement with drug manufacturer Boehringer Ingelheim reduced the overall cost of care for adults with type 2 diabetes, providing more affordable chronic disease management and decreasing payer spending.

Through the analysis of pharmacy and medical claims for adults with type 2 diabetes and known cardiovascular disease, researchers found that patients who took Boehringer Ingelheim’s anti-hyperglycemic medication Jardiance® experienced lower medical costs.

When compared to adults who took other anti-hyperglycemic medications, annual medical costs for patients on Jardiance dropped 30 percent. When considering medical and pharmacy costs, there was an overall 20 percent reduction in total cost.

Launched in 2018, the value-based care agreement was designed to evaluate the total cost of care for in-scope patients with type 2 diabetes on Jardiance, a product in the Boehringer Ingelheim and Eli Lilly and Company alliance portfolio.

With the observed reductions in total medical and pharmaceutical costs for patients and payers, Kayse Reitmeyer, Highmark’s Manager of Pharmacy Contracting, said that the firm is pleased with how the agreement has improved chronic disease management for members by lowering out-of-pocket costs.

“Highmark is committed to developing solutions that provide access to treatments that improve outcomes and reduce the total cost of care for chronic conditions like diabetes and heart disease, which have a huge impact on our members and on our healthcare system,” said Reitmeyer.

“The reduction in medical costs seen in this analysis may stem from fewer medical and hospital interventions related to diabetes and heart disease for Highmark members in the Jardiance group,” continued Reitmeyer. “We are pleased with the results of our outcomes-based agreement with Boehringer Ingelheim, and we look forward to applying these insights to continue ensuring access to products that provide both clinical and cost savings benefits for our members.”

Jardiance is an oral prescription medicine that can reduce the risk of cardiovascular death in adults with type 2 diabetes who have known cardiovascular disease when paired with healthy diet and exercise habits.

“The results of our outcomes-based agreement with Highmark demonstrated that Jardiance can help reduce the economic burden of type 2 diabetes and cardiovascular disease, underscoring its value to the healthcare system,” said Christine Marsh, senior vice president of Market Access at Boehringer Ingelheim Pharmaceuticals, Inc.

“We are proud of our unique partnership with Highmark and our efforts show how pharmaceutical companies and payors can work together to ensure people living with these chronic, debilitating conditions get the best, guideline-directed care while lowering total medical costs,” Marsh continued.

Due to complications linked with diabetes like high blood sugar, high blood pressure, and obesity, cardiovascular disease is the leading cause of death associated with diabetes.

These chronic conditions place a huge financial burden on patients and payers alike. Annual medical expenses for people with diagnosed diabetes in 2017 was $237 billion, which represents a 26 percent increase from total medical costs five years prior. By 2035, experts predict that costs for cardiovascular disease will rise to more than $1 trillion.

Value-based care agreements that incorporate zero copay programs may help decrease total chronic disease spending as well. A study published in the American Journal of Managed Care found that overall spending for members and payers decreased when a zero copay program that covered a broad set of drugs for multiple chronic diseases was implemented.

On average, healthcare spending dropped by 18 percent (around $205 per member per month). In particular, medical costs saw an average decrease of 25 percent (about $195 per member per month).