At Abarca, we believe that healthcare can be awesome—and we are in constant pursuit of new ways to make that possible. We are using innovative contracting agreements with pharmaceutical manufacturers to bring a new level of accountability to prescription benefits. We have developed novel approaches to formulary management and plan design that achieve better outcomes, lower costs, and deliver a better experience.
But, even with all of this innovation, sometimes old-fashioned common sense is the most powerful tool we have. That’s why we firmly believe in what is commonly referred to as “the patient trifecta.”
Although the term was coined by the Institute of Medicine just 15 years ago, it refers to principles that are more than a century old, including:
- Patient engagement. Patients should be actively involved in decisions about their own healthcare. It relates to big choices — do I need to get the additional scan or test — and small ones — should I have dessert again tonight. Sadly, too often people are passive about their healthcare options and leave decisions up to their doctor or to chance.
- Adherence. This is one of the most vexing problems in healthcare. Too many patients start a treatment regimen recommended by their doctor, but fail to keep at it. They stop taking the medication, cancel the follow-up appointment, or give up on the diet. As we often say, the only medications that work are the ones that are taken. But, sadly, many people don’t take theirs as recommended by their physician.
- Better Outcomes. Seems obvious, right? You go to the doctor or follow a medical regimen to get better. But today this refers to using research and evidence-based based medicine to design treatment plans and closely track each patient’s outcome.
For Abarca, the patient trifecta isn’t just another “here today, gone tomorrow” trend–there have been enough of those in healthcare. The trifecta is fundamental to everything we do. Here are a few examples.
Power to the patients
Our award-winning disease and medication therapy management (MTM) programs use a team approach. Our clinical experts, the pharmacist, physician, and patient all work together to track a member’s progress; make sure he or she follows the prescribed treatment plan; identify less expensive, therapeutically equivalent alternatives; and measure outcomes.
Though we use predictive analytics to precisely target our interventions, it’s still a labor-intensive approach. But well worth it. Our MTM programs boost patient engagement, adherence, and result in much lower costs.
Redefining Specialty Pharmacy
One area that our commitment to the patient trifecta — and to finding a better way — is particularly evident is in our specialty pharmacy program.
Although a relatively small percentage of members utilize specialty pharmacies–these include members with cancer, rheumatoid arthritis, or MS, for example–they tend to have the most complicated conditions and drive costs for the entire plan. In fact, about 1% of members incur about 40% of total costs.
In many ways, our approach to specialty is very different than that of our industry peers. We use key performance indicators to rank participating pharmacies by their ability to help patients manage their conditions, stay adherent and engaged, and achieve better outcomes. And we provide incentives for them to provide personalized care at lower costs.
Sure, it’s very data-driven. But it is also a real partnership that can be very personal. We work closely with the pharmacies, providers, plans, and members to achieve greater levels of engagement and higher adherence rates.
We think of the patient trifecta as a new approach to achieve a timeless goal: Members who are engaged and informed, who have partners to support them on their way to getting well and staying healthy. And we are all in.