Managed Markets Summit

Laura Beerman, director, customer segment analysis, Decision Resources Group, presented a discussion that highlighted the early results of accountable care organizations (ACOs). She said that while the Pioneer ACOs created a large initial buzz, their cost savings has varied widely.

In a panel discussion moderated by Neil Minkoff, MD, CEO of FountainHead HealthCare, panelists examined the current state of healthcare exchanges, both public and private. Panelists included Dennis Falci, MBA, director, US managed markets training, sales training and leadership development, Sanofi-Aventis SA; Thomas Kaye, director of consulting pharmacy, Prescription Formulary Exchange, LLC; and Sheri Sellmeyer, vice president, market analysis, HealthLeaders-InterStudy, a Decision Resources Group Company. They analyzed the current benefit models required by public exchanges, and the rising popularity of the private counterparts, offering a glimpse into the new healthcare marketplace now unfolding.

Health information technology (HIT) was the focus of a discussion led by Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for HIT, US Department of Health and Human Services. In his Managed Markets Summit 2014 keynote address, Health IT and Reform: The Road to Right Care, Dr Mostashari touched upon the obstacles and shortcomings in our nation's healthcare landscape, and asserted that more prominent usage of HIT would help to alleviate fiscal concerns and affect better outcomes in patient care.

Raulo S. Frear, PharmD, general manager, OmedaRx, says pharmacy benefit managers are aligning benefit designs for delivery system reform in a few ways. With respect to the delivery system reform, if you look at ACOs as a specific example, our experience has been that the ACOs are not really ready to talk about different benefit designs, Dr Frear says. They're still learning what it means to accept risk and that means risk across a lot more areas than just pharmaceuticals.

Ed Pezalla, MD, MPH, national medical director for pharmacy policy and strategy, office of the CMO, Aetna, says payers and health plans are preparing for patient-centered care by utilizing digital tools. Everything from virtual people to cost search tools are used to assist employed and general patient populations. Dr Pezalla says many of these tools will also be used in the public and private health insurance exchanges to help people make decisions as they purchase health plans.

Neil Minkoff, MD, CEO, FountainHead HealthCare, discusses the impact that formulary has on both employer and consumer choice in the health insurance exchanges.

Dennis Falci, MBA, director, US managed markets training, sales training and leadership development, Sanofi-Aventis SA, says it's no secret-Health Insurance Exchanges are a hot topic in health news.

Laurie Wesolowicz, PharmD, director, pharmacy services clinical, Blue Cross Blue Shield of Michigan (BCBSM), says that clinical evidence and other factors can drive formulary decision-making. Evidence can influence the value and coverage recommendations for drugs covered under the pharmacy (formulary) and medical benefits.

Farzad Mostashari, MD, visiting fellow, Brookings Institution, former national coordinator for health information technology (HIT), US Department of Health and Human Services, says we need to have payment reform to support the success of HIT.