Poindexter's Points:
Advanced Plan for Health's News and Updates

August 2018
New Client Welcome
We are very pleased to share that S&S HealthCare Strategies, Ltd., a well-respected and innovative Third-Party Claims Administrator has added APH’s Poindexter analytics to their solution portfolio. They will utilize APH’s Poindexter analytics platform to deliver longitudinal and predictive health data visibility and insights to their clients for improved performance and more effective population health management. Read more in our joint press release below:

APH Publications
APH strives to publish content that covers industry issues, common Poindexter findings, related research and best practices. We’re pleased to be able to share our White Papers and eBooks to support client and partner insight and research needs.
APH’s latest eBook, “Employer-Driven, Analytics-Powered Health & Wellness Programs” was written to guide entities looking to improve health plan and financial outcomes through employer-driven health and wellness program solutions. The eBook is a comprehensive resource on research and best practices employers need to know to develop a health and wellness solution based on strong analytics to identify targets as well as to measure results. 
Click here to download this new eBook , or email marketing@mypoindexter.com and we d be happy to send you a copy.
Did You Know?
APH has an extensive library of materials you may use to share the Poindexter value-prop with your downstream clients and prospects as needed. Collateral copy, Poindexter demo videos, PowerPoint slides, best practice guides, proposal language and Q&As and more. 

We are available to work consultatively with your teams to weave these into your current marketing and sales support processes. APH sales resources are also available as needed to support sales demos and also join your client summits and gatherings.

We want to be sure you know we are here to support you in featuring APH and Poindexter as a competitive differentiator!
If you’d like to get more details and support in these areas, reach out to Yvonne Daugherty at yvonnedaugherty@mypoindexter.com
Recap From The Road
Our Denis Cremin was a delegate at the July Health Care Administrators Association (HCAA) TPA Summit 2018   in Minneapolis. The event was attended by over 350 HCAA members and covered many topics relevant to Third Party Administrators, self-Insured employers and benefit brokers.

Denis shared his key take-aways from the Summit:

Top topics included: Building Value-Based Networks that big box plans won't rent to Self-funded TPAs; Next steps with Association Health Plans; ERISA Fiduciary Duties; TPA Best Practices & Avoiding Common Pitfalls; and How direct to Primary Care can change the future.

One presentation with strong interest was a presentation by Michael Staab and Greg Madsen of Innovative RX Strategies, LLC The title of their presentation was “New Found Money-Taking Advantage Of Pharma Programs To Lower Specialty Drug Costs”. Their presentation detailed how Specialty drugs are the fastest growing component of a plan sponsors drug benefit. They explained that specialty drugs are expected to represent 40-48% of an employer’s drug spend, while only representing a small fraction of overall pharmacy claims. Additionally, of the 7,000 potential drugs in development, 80 percent of these are classified as specialty.

They added that with the advent of high deductible plans and higher co-pays for members, many participants could not afford their share of the costs to obtain these drugs. So along came big Pharma to the rescue with the Patient Assistance Program (PAP) – which provides free or low cost prescription drugs to qualifying individuals.
A key learning is that with many of these specialty drugs, members will reach their deductible quickly increasing overall utilization.  

The member may get the brand name drug for the same price as the generic, however, the plan sponsor will have to pay the remainder – which increases the cost to the employer as they pay for a branded instead of a generic or biosimilar. So, what looks like a helping hand for the participant may result in added costs for the plan sponsor. 

They went on to say that coupons and rebates are only for the branded products and not the generics. To get a better understating, we were referred by the speakers to an article in USA Today titled “Drug Co-Pay Groups: Critical Patient Charities or fronts for drugmakers .” Unlike, coupons PAPs do require proof of need. As noted in the presentation, as of 2015, 7 of the 10 largest grant making foundations were Pharma PAPs.

How then can employers ensure that they are not being taken advantage of? The presenters provided the following strategies:

  • Dispense As Written (DAW) Penalties whereby the plan participant takes on the additional cost
  • Step Therapy where members to first use generics or pay full price for the brand drug
  • Out Of Pocket Protection (OOP) - which only credits the actual amount the participant paid
  • Variable Co-Pays, which will raise members’ co-payments to match the manufacturer’s coupon – thus reducing the net claims cost

The presenters also advised to be weary of games PBMs play; such as including the value of the coupon in the ingredient cost and then charging the employer the total ingredient cost. Another tactic is to not cover the specialty drug so that the participant will have to use a PAP or foundation. This results in the specialty drug appearing free to the plan.

Finally, the speakers stated it should be noted that members must be put on notice on how the plan sponsor will treat copay assistance programs as it relates to the members out of pocket maximums. This language should be included in the Summary Plan Design (SPD).
For any questions related to Denis’ experience and learnings at these conferences, please feel free to reach out to us at (888) 600-7566 or marketing@mypoindexter.com .
Blog Insights

With Chronic Kidney Disease and Dialysis, it is time to disrupt the business-as-usual paradigm of waiting until a member “triggers” for medical management intervention because they use the emergency department excessively, take high cost medications, have a hospital admission or have high dollar claims.

Early intervention is the key to slowing or stopping chronic kidney disease (CKD), improving the quality of lives for those at risk and containing health plan costs. Avoiding dialysis for just one member represents a health plan savings of $350,000 to $700,00 per year, which more than pays for the CKD program by itself.

Click here to read more.

In this blog we wanted to share an updated eBook that outlines some of what the Advanced Plan for Health is hearing from our TPA, health plan and employer clients related to what employers are really looking for as they’re shopping for benefits.

Here’s an excerpt:

Providing your employer clients with the right mix of services and support boosts your chances of standing out and winning and retaining their business. Fortunately, most self-insured employers want the same thing: healthy employees, positive employee healthcare experiences and reduced costs. Sounds simple enough, but how can you be sure that you are offering the best solutions in today’s strained and ever-changing healthcare environment so that you can continue to differentiate yourself and show value?

Click here to download the eBook or email marketing@mypoindexter.com and we’d be happy to send you a copy.
APH, On the Road
Upcoming Tradeshows and Conferences
September 23-25 l Austin, Texas

The Advanced Plan for Health will have our exhibit booth setup (booth #218 ), and ready for demos. We will also be participating in the conference as delegates.

The SIIA National Conference & Expo is the world’s largest event focused exclusively on the self-insurance / alternative risk transfer marketplace and typically attracts more than 1,700 attendees from around the U.S. and from a growing number of countries around the world.
The APH team would welcome the opportunity to meet you in person at any of our scheduled tradeshows and conferences. Contact us here , email us at marketing@mypoindexter.com or call (888) 600-7566 to arrange a time to meet with us.