ne and a half years ago, with its self-insured health plan on the verge of
insolvency, Florida’s Polk County School District phoned Walgreens Health
Initiatives (WHI) for help. "We were in a death spiral of deficits," says Steven
Henderson, director of risk management and insurance. "Average national
health-care costs were escalating at 15 to 20 percent annually, but our fiscal
constraints forced us to operate with the same or less funding than the year
before." Getting additional funds from the cash-strapped state or county tax
sources was not an option. Neither was reducing benefits in this unionized work
environment.
WHI came to the rescue with a comprehensive strategy to manage the District’s
$9 million pharmacy expenses. Consequently, Polk County School District’s
pharmacy costs increased less than 1 percent last year.
That amazing feat was accomplished with an innovative, comprehensive program
of cost avoidance that actually improves care for the health plan’s 18,000
members. First, WHI took a "very assertive approach with our pharmacy program,"
implementing a three-tiered co-pay plan that encouraged plan members to use
generic medications rather than more expensive brands when possible. With an
aggressive campaign, generic utilization increased from 32 to 42 percent, saving
the school district approximately $650,000 per year. Increased mail order
utilization and pharmaceutical rebates saved additional dollars.
To further cut costs and provide quality patient health, WHI recommended a
Step Care Therapy program. It promotes the use of lower-cost medications as a
first line of defense in treating certain conditions. Higher-cost medications
are covered only when a patient’s profile indicates that the first-line agent is
not recommended or has been unsuccessful.
Although cost-avoidance is certainly a goal, so is improving plan members’
health, because, Henderson says, Polk County has "abnormally high levels of
renal failure and many co-morbidity factors such as obesity and hypertension."
To address this, WHI instituted a disease-management program for asthma,
diabetes and other conditions. The program involves patient and physician
intervention and pharmacist interaction to minimize emergency room and physician
visits and improve overall health. WHI supplemented the District’s extensive
wellness programs with specific programs targeting early diagnosis and disease
prevention. "Consequently," Henderson says, "our members are taking a much more
active, consumer-minded role regarding their health."
WHI also monitors prescriptions concurrently, in real time, alerting
pharmacists to potentially adverse drug reactions based on a patient’s condition
or other drugs the patient is taking. It even checks for patient compliance and
other therapeutic criteria.
As a result of these and other pharmacy management programs, WHI
has "kept us from having to raise member pharmacy co-pays this year," Henderson
says, "and has played a major role in helping to return our health plan to
solvency." In light of today’s health insurance environment, that’s nothing
short of miraculous.
= Member Only
