Rx trends 2015: Treating the highest-cost patients

NEW YORK — Some 10,000 Americans are turning 65 every day, swelling the Medicare rolls and increasing pressure on an already overstretched health system. Pharmacies are joining other health providers and insurers to help reduce costs of care for these newly minted seniors.

 

“The costliest 1% of all patients … consume 20% of the nation’s healthcare spending,” PricewaterhouseCoopers reported. “These numbers are prompting healthcare systems, insurers and others to adopt innovative care models that can pinpoint and better manage high-cost patients in lower-cost care settings, providing a more holistic suite of services that address behavioral, social and other issues that affect health-and-wellness.”

 

Seniors themselves are under pressure as costs rise. “For older Americans, 13% of their total living expenses go to healthcare, … and the need for chronic care is rising,” said former Walgreens CEO Greg Wasson. 

 

Health providers — including pharmacy operators — have several levers they can pull to bring down costs. Chief among them, according to IMS Health, are adherence programs to keep patients on track with their medications and out of hospitals. 

 

Plan payers also are driving “effective care coordination,” PwC reported, in a bid to “steer complex patients to lower-cost care settings.” Other strategies, it said, “include high-tech wearables, such virtual care as telemedicine and low-tech problem-solving, such as giving patients refrigerators for medicine storage.”