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View Diary: Cigna, Merck in "Performance-based Contract"--a good thing? (14 comments)

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  •  HEDIS Data (2+ / 0-)
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    dsteffen, rfall

    This is actually really intersting news, because the whole idea of incentives to ensure medication compliance on the part of patients is pretty cutting edge. No matter what drug you look at, even medications for chronic conditions like diabetes, you see a dramatic drop-off in medication use by patients over time. This can be for financial reasons, because of side effects, because patients believe they are getting better and don't need the drugs or, if you're my father, because you hear one bad report about a drug on the TV and just decide to stop taking it w/out checking with your doctor (Yes, I wanted to crawl through the phone and strangle the man when he told me). If Merck is able to provide these incentives, and Cigna passes them on to consumers, it could prove a classic win-win for everyone. The fact that the incentives are not contigent on any specific drug is even better.

    However, rfall is right to be concerned about how the data used to measure compliance are gathered and reported, though. If the agreement includes the use of HEDIS data - the Healthcare Effectiveness Data and Information System - which is a third-party data gathering and auditing operation, then that concern should be allieviated.

    "I'm sleeping with Don. It's really working out" - Elizabeth Moss as Peggy Olson, Mad Men

    by CPT Doom on Fri Apr 24, 2009 at 01:58:09 PM PDT

    •  Problem (0+ / 0-)

      if, as is the case with CIGNA, their customers are all people who work at good paying jobs, are not elderly and can afford health insurance, putting them in a category of people most likely to comply with a treatment regimen.  Makes you wonder what kind of pressure employers might bring to bear on employees taking these drugs - the higher cost will no doubt be passed on to them.

      OTOH, the government funded plans and providers - currently where the elderly, unemployed and poor people are clustered, and compliance with treatment is much more difficult to accomplish, doesn't get to negotiate prices with prescription drug companies.   And if they did so under a plan like this one, they would lose, simply because they're stuck with all the patients the private insurance company doesn't want.

      No, plans like these punish providers  who can least afford it - thos who have much more difficult patient populations to manage and offer them no means of improving treatment compliance.

      A conservative is a man with two perfectly good legs who, however, has never learned how to walk forward. FDR

      by Betty Pinson on Fri Apr 24, 2009 at 03:50:22 PM PDT

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