Monday, June 28, 2021

Blues-Funded Startup Aims to Boost Value-Based Drug Pacts

by Leslie Small

Five major Blues affiliates — Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc. and Independence Blue Cross — on June 22 launched a startup company, Evio, that aims to "offer innovative medication solutions to patients, providers and customers."

Evio's three chief goals:

  • Continuing "the evolution toward value-based care and enhancing outcomes-based contracting in the pharmacy space, especially on high-cost drugs,"
  • "Using evidence and data from real patient experiences to ensure the right medication gets to every patient, where, when and how they need it," and
  • "Developing new, and enhancing existing, partnerships that leverage the innovation happening in the pharmacy and broader healthcare, technology, and analytics sectors today — to improve affordability, outcomes, and experience for patients."

Experts' views:

  • "Value-based reimbursements for drugs provide a great opportunity to reduce costs," says Brian Anderson, a principal with Milliman, Inc. However, "these approaches are challenging to set up, monitor and report on. The goal needs to be to eliminate waste in the system and overprescribing. Once these areas are addressed, the key is to incentivize value-based payments for outcomes and care management."
  • "Part of me says that this is an attempt by the Blue Cross folks to standardize some kind of value-based purchasing arrangement in a way that would work over multiple plans, which probably would make it more effective," says Jeff Myers, senior vice president of market access and reimbursement strategies with Catalyst Healthcare Consulting, Inc.

Blues plans' dedication to lower drug costs:

  • The Blue Cross Blue Shield Association and 18 Blues affiliates — including the most recent addition, Anthem, Inc. — have joined Civica Rx, a not-for-profit organization founded by health systems that works to address shortages and price hikes for generic medicines.

From RADAR on Drug Benefits

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