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Generics reduce drug costs, but monitoring lags: NBCH

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Health care plans have reduced pharmaceutical costs by dispensing generics more often, but they could do a better job of monitoring whether plan members take their medication as prescribed, a report by the National Business Coalition on Health concludes.

There also is continued overuse of certain expensive, and often unnecessary, diagnostic test procedures, such as those used to determine cardiac stress, according to NBCH's “2010 eValue8” survey.

The survey and evaluation tool is used by health care purchasers to assess and manage the quality and efficiency of the nation's health care plans.

The “2010 eValue8” survey, which was released Tuesday at the NBCH's 15th Annual Conference in Washington, found generic drugs accounted for 75% of prescriptions dispensed by health maintenance organizations and 68% by preferred provider organizations, a 2.5% improvement since 2008. Some plans have achieved generic dispensing rates exceeding 85%.

However, only 33% of health plans reported having optimal monitoring of depression medication adherence; only 5% reported optimal plan monitoring of substance abuse medication adherence; and 49% of plans reported optimal monitoring diabetes and coronary artery disease medication adherence, according to the study.

In the area of diagnostic test procedures, some health plans conducted relatively few tests, perhaps as low as two per 1,000 members, while others conducted a significant number, as high as 99 per 1,000 members.

NBCH's “2010 eValue8” also found that health plans' identification rates of chronic conditions were low, averaging just 2% for members who are obese and 0.5% for members who are tobacco users. This was attributed partly to a low rate of personal health assessment completions that averaged just 3% among the members of health plans being evaluated.

Similarly, participation rates for various behavioral health disease management programs were at or below 5% of the estimated prevalence of alcohol problems and less than 20% of the estimated prevalence of depression, according to the survey.

This year's survey also found that health plans are paying doctors more to provide higher quality care, with 67% administering incentives to physicians for better performance and 58% offering financial incentives based on either clinical process or outcome measures.

The annual “eValue8” survey asks health plans to submit responses and documentation on their performance in the following clinical areas and administrative processes, or domains: health plan profile, including the plan's accreditation status and how it works with employers to promote safe and effective care; consumer engagement; physician performance measurement; pharmaceutical management; prevention and health promotion; behavioral health and chronic disease management; and member identification. The information is verified and scores are tabulated so purchasers can compare their health plans against regional and national benchmarks. Participants included 28 HMOs and 36 PPOs.

Ensuring Solutions, a division of the George Washington University Medical Center, analyzed the data, and the Centers for Disease Control and Prevention in Atlanta also contributed to the content.

While the top-performing 15% of responding health plans are included in the report, five plans garnered the top HMO and PPO spots across the various domains: CIGNA New York, HealthPartners Minnesota, Kaiser Permanente Northern California, Kaiser Permanente Northwest and Kaiser Permanente Southern California.

For more information about NBCH's “2010 eValue8” survey, visit www.nbch.org/News.

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