Rx trends 2015: Managing the newly insured

NEW YORK — If its goal of expanding health coverage to more Americans is fully realized, the Affordable Care Act could end up pulling as many as 30 million more people into the ranks of the newly insured. That means rising prescription counts and more patients at pharmacy counters and in drug store aisles, but it also poses challenges in managing and educating patients about their benefits.

 

The growth of Americans newly covered by health and prescription benefits — roughly 10 million as of mid-2014, according to estimates — is coming both from those who enroll through health insurance exchanges set up under the ACA and from those newly eligible for coverage in states that have expanded Medicaid. PricewaterhouseCoopers predicts that “ACA insurance enrollment will grow rapidly in 2015 and 2016” as more Americans and more states understand and embrace Obamacare coverage options, “providing a window of opportunity for companies to attract new healthcare consumers.”

 

To cope with the new flood of patients, PwC urges providers and health plans to apply big-data technology and coordinated care to reach patients with the right treatment plans and points of access “through coordinated use of health-risk assessments, disease management and social support programs.” 

 

Insurers are already promoting new collaborative care initiatives driven by health systems, physicians, pharmacists and clinicians to manage newly insured patients cost effectively, said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “We’re [supporting] … significantly increasing care coordination and disease management,” she said.