Last week, Express Scripts published a report on opioid / strong painkiller use/abuse which is a national health care problem, The report which is worth reviewing goes into more details on the talk that the FEHBlog heard at an Express Scripts conference in October. Solving this problem requires provider buy-in in the FEHBlog’s view, e.g, better prescribing practices, more patient oversight.
Also last week Cigna and Safeway published a study on the successful application of reference pricing to clinical laboratory charges. Reference pricing is a benchmark approach that can be use with in-network providers. Reference pricing encourages the plan participants to pay attention to the price of health care services.
The study involved two groups of employees enrolled in a Cigna health plan so that the researchers could draw credible conclusions about the effectiveness of the benefit design. The first group comprised Safeway employees who had a reference-based pricing benefit for lab services. The second group comprised employees of various employers who did not have this benefit but lived in the same community and received the same lab services as the Safeway employees.
Members of the first group had access to an online shopping tool that showed information about the cost, location and type of lab services in their geographic area based on the application of the reference-based pricing benefit. They also received educational information about this benefit. The result: Individuals with the reference-based pricing benefit demonstrated a 20% increase in selection of lab services below the reference price compared to those without the benefit (69% vs. 57%).
“This study is an important first step, but we can’t conclude from it that the benefit alone drives the greatest behavior change,” Cigna’s Aube said. “Though not specifically demonstrated through this study, we do know that communication and education are essential to all of Cigna’s consumer-directed efforts. Our hypothesis is that it is a combination of benefit structure, with effective education and messaging, that presents the greatest opportunity to change behavior.”
“We looked at very early data for this analysis,” said Safeway’s Dr. Bradley. “The understanding of reference pricing along with adoption of online tools to inform the consumer has increased significantly since the early days of 2011. Thoughtful application of reference pricing warrants consideration as a mechanism to improve value in health care and help individuals reduce their costs for certain services.”