Coordinated Medical And Drug Benefits Linked To Employers Saving Health Care Expenses

Medical and pharmacy benefits managed by WellPoint’s affiliated health plans are linked to lower medical costs of $8 to $16 per employee monthly compared to those without an integrated pharmacy program, according to an independently verified analysis of members in WellPoint’s health plans.

The analysis shows that the integration and coordination of medical and pharmacy benefits, as well as other factors, are generally associated with lower medical costs compared to employers who do not have WellPoint affiliated health plans’ integrated pharmacy programs.

“When both medical and pharmacy benefits are managed by WellPoint’s affiliated health plans, there’s a consistent approach to a member’s care,” said Ken Goulet, WellPoint executive vice president for commercial business. “Coordinated pharmacy and medical benefits help improve the health of members, which can lead to lower medical costs from things like fewer inpatient days, ER visits and doctor visits.”

WellPoint health plans’ coordinated benefits include:

• A drug list developed to help improve the health of members and reduce total costs
• Gaps-in-care messaging from timely and accurate pharmacy, medical and lab data that engages both members and their doctors to better coordinate care
• Coordination of medical and pharmacy programs to help ensure programs are based on same goals and have resulted in increased compliance with evidence-based guidelines
• Alignment of medical and pharmacy policies that help save in overall healthcare costs rather than shift costs from one benefit to the other

“For example, WellPoint’s affiliated health plans send customized care notes to members about preventive screenings and drug options,” said Goulet. “Unlike employers that offer our health plans’ medical benefits and carve out their pharmacy benefits, we can identify members’ doctors and send the same message to them to make sure they are aware of potential gaps in care and to assist them in their patients’ care.”

The WellPoint analysis was independently verified by Michael B. Nichol, Ph.D., professor of health policy at University of Southern California.