Managed Care State of the Industry 2018

“It’s no surprise that value-based care/population health management was voted as one of the biggest challenges. Many organizations across the U.S. are talking about value-based care and population health management but few are gaining traction in the implementation.”

-Cynthia Hundorfean, president and CEO of Allegheny Health Network (AHN)

“Due to the increasing burden of policy changes and government requirements from the current administration, life is more difficult for Medicare and Medicaid health plans.”

-Perry Cohen, PharmD, chief executive officer of The Pharmacy Group and the TPG family of companies

Other survey responses included: “Overall affordability for payers,” and “Maintaining or achieving profitability and growth.”

“The results of this question are encouraging in that the majority of respondees indicate that their organizations have moved forward with efforts in this area. As these models proliferate, all stakeholders across the healthcare system should benefit via more team-oriented approaches to patient care; more integrated data and analytics capabilities; and an enhanced ability to measure patient outcomes. With time, many believe (myself included) that this model offers us the greatest likelihood of improving cost-efficiency in healthcare while simultaneously driving higher degrees of quality of care and empowering people to lead healthier lives.”

-David Calabrese, RPh, MHP, senior vice president and chief pharmacy officer at OptumRx

“I agree with the results, in addition to a focus on value-based care, there is a huge push to create a differentiated experience for the patient. Consumers across all industries are demanding a differentiated and streamlined experience and the healthcare industry has a lot of room for improvement.”

-Hundorfean

“Clearly the wide disbursement in responses here is indicative of the challenges we face as an industry in managing costs while preserving proper access and clinical quality within the specialty pharmacy ... Effective management of the rapidly-expanding specialty market will require a highly diverse, multidimensional set of tools and strategies.  As has been well-demonstrated to date, there remains no ‘magic-bullet’ approach in this area, and this will continue to remain one of the biggest challenges, if not ‘the’ biggest challenge, facing payers and pharmacy benefit managers into the future.”

-Calabrese

Other survey responses included: “Integrated PBM's with Medical Benefit Insurers” and “Expanding the 340B program.”

“I’m not surprised that the ‘challenge of change’ tops the list, given our collective tendency to cling to the status quo. I also continue to believe that government mandates will, to a large extent, drive the pace of change, as CMS and other governmental agencies can be very effective motivators.”

- Douglas L. Chaet, FACHE, chief managed care officer, Sentara Healthcare, and chairman, American Association of Integrated Healthcare Delivery Systems

Other survey responses included: “Understanding the current healthcare model and what needs to be done to change it,” “An ability to make a real difference in improving patient outcomes,” and “Expecting innovation from a conservative industry.”