Medicaid as a Driver of Care Innovation

06.13.17

More than 74 million Americans receive health care coverage from Medicaid, and 35 percent of those beneficiaries have two or more chronic conditions. Regardless of how Congress decides to provide resources for the Medicaid program, at the end of the health care reform debate, what remains constant is the need to deliver more value to patients and taxpayers by improving quality and lowering costs.

CVS Health Chief Policy and External Affairs Officer and General Counsel Tom Moriarty offered his perspective and ideas for meaningful solutions at today’s POLITICO Pro Health Care Briefing on Medicaid as a Driver of Care Innovation in the States. The event brought together health care thought leaders to discuss delivery innovations that are helping Medicaid deliver greater value for patients and taxpayers.

Better Health Outcomes and Lower Costs through Pharmacy Care

Moriarty underscored the important role of pharmacists in delivering value, explaining that “through personalized counseling and clinically effective interventions, pharmacists are a trusted voice in helping patients with chronic conditions like diabetes and cardiovascular disease manage their medications.”

CVS Health programs such as Pharmacy Advisor® and Transform Diabetes™, are shown to reduce costs, improve chronic disease management, and promote medication adherence. As an example, Moriarty cited a Health Affairs study that showed one-on-one counseling between a patient and a pharmacist improves medication adherence and results in cost savings of $3 for every $1 invested.1

Despite the clear case for pharmacy management programs, Moriarty explained that pharmacy benefits are not always included in managed care programs, and Medicaid Quality Programs do not always include adherence and medication management measures.

Addressing Costs and Delivering Affordable High-Quality Care

Finding opportunities to reduce costs is critical, since rising health care costs affect everyone, both as patients and taxpayers. One opportunity to drive savings and better outcomes involves increasing access to high-quality, low-cost care sites.

“Alternative sites, such as urgent care centers, retail clinics and in-home care can help meet primary and preventive care needs while preventing unnecessary and costly visits to emergency departments,” Moriarty remarked.

For example, CVS Health’s retail health clinic, MinuteClinic, is an enrolled Medicaid provider in 31 states and D.C. and offers convenient, high-quality care at more than 1,100 locations throughout the country. Research shows that patients who use CVS MinuteClinic make fewer emergency room visits and have a lower total cost of care.

Regarding drug prices, Moriarty noted, “effective pharmacy management can help states control rising drug costs while providing better care coordination at the member level to achieve better health outcomes.”

Moriarty highlighted successes from Ohio’s Medicaid program, where CVS Caremark worked with the state’s managed care plans to use PBM tools to drive costs down and deliver quality care. As a result, Ohio’s Medicaid program spent less on prescription drugs compared to other states and earned higher average quality scores than national and state averages.

More Work Remains to Maximize Value

While the multiple strategies being employed help deliver value, there is opportunity to incentivize even better outcomes within Medicaid.

“Utilizing a consistent set of quality measures combined with meaningful incentives will help to ensure better health outcomes and savings for the Medicaid program,” Moriarty remarked, pointing to the Medicare Star Ratings program as an example.

In addition, Moriarty highlighted the potential for federal collaboration with the states to align quality measures and incentives for managed Medicaid to spark innovation from the public and private sectors.

Underscoring the important role of pharmacy management, Moriarty explained that “including pharmacy programs and incentivizing medication adherence ultimately delivers better value to patients and taxpayers through better health outcomes and lower costs.”

Read the full text of Tom Moriarty’s remarks at the POLITICO Pro Health Care Briefing.

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1 Brennan, T. A., Dollear, T. J., Hu, M., Matlin, O. S., Shrank, W. H., Choudhry, N. K., & Grambley, W. (2012). An Integrated Pharmacy-Based Program Improved Medication Prescription And Adherence Rates In Diabetes Patients. Health Affairs, 31(1), 120-129. doi:10.1377/hlthaff.2011.0931