From Tom's Desk


Accuracy is Your Edge

Smaller Medicare Advantage insurers need an edge. Bonus programs like star ratings tend to reward those insurance plans who already have the resources to work around the healthcare delivery organizations they contract with.  How can one compete with the big boys for covered lives?

The answer is simple: customer service.

Specifically information accuracy.

Experience teaches, and CMS quality studies confirm, that the larger the insurer, the less accurate the provider information when requested by the consumer. It appears there’s a greater return on investment in pestering patients about their colon cancer screening than there is in making sure customer service reps have access to the latest information. 

Panels fall out of date, providers drop out, often the provider’s own office managers are unsure which insurances they themselves are taking.  Inaccurate provider information is the factor that most dissatisfies 
beneficiaries. The problem is rampant and frustration levels high.  It represents an excellent opportunity for the motivated organization.

These frustrated customers have the chance to choose insurers every Novermber—many will not hesitate to switch.

If you want to stand out in a tight, highly competitive Medicare Advantage insurance market without an outrageous financial investment, make sure the information available on your help line is of the highest possible quality.

The return will be enormous, on every level.

You Should Know...

Most Expensive Medications--What To Do

Hepatits C drug Harvoni topped the list of the 10 most expensive drugs prescribed under Medicare part D in 2015, in a report released this past week. Insulins, COPD inhalers and neuropathic meds round out the list.  Only one out of the top ten, Nexium(™), has a generic alternative—an alternative that was first available late in the year measured.

There is not a lot of flexibility on this list. There is no alternative to Harvoni, the COPD meds have just a little wiggle room (see below,) and the constant evolution of brand name insulins along with a lack of generic alternatives leave little room for cost control.

This makes it all the more essential to put restrictions on the access drug reps have to your clinicians and to counter their influence with a counter-marketing program with your own Pharm Ds--so you can make an impact where you have the opportunity.

Cost control is the art of the possible. Just because you can't really impact the most expensive drugs doesn’t mean you shouldn’t try to impact all the rest. There's plenty of low hanging fruit below the top ten—and the critical thinking skills nurtured by a counter-marketing program can make a real impact in your clinician’s decision making down the line.

High-Value Insight

Nebulize Your Way to Success

As noted above COPD meds, specifically inhaled corticosteroids and anti-cholinergic agents figure prominently in the list of the ten most costly drugs prescribed in 2015.  That cost is not only being bourne by the plans, and your pool—but increasingly, also by the patients themselves.  The result?  Decreasing compliance, worsening control and increased cost. But since there are really no generic alternatives, what’s a value-minded clinician to do?


Nebulize those meds.


In many circumstances, nebulizer administration of corticosteroids and anticholinergics are significantly more cost-effective than their power inhaler counterparts.  Many patients used to be resistant to using these forms of meds, preferring not to be “tied down” to a nebulizer machine.  However, once the case has been made to them about the critical importance of combination therapy in their COPD, patients take a look at the price difference and are increasingly thrilled that there’s an alternative so much less expensive than brand name inhalers.


In addition, the technology behind the hand held nebulizer has progressed to the point that they can be had for a reasonable out-of-pocket cost.


I’m waiting expectantly for the first organization to buy those hand-held nebs in bulk from Amazon and give them to their patients for free to remove the psychic pain the patients feel about being “tied” to their nebulizer machines.

You could pay for a lifetime of handhelds for the cost of one avoided admission.

Q&A with Dr. Tom

Nutraceuticals to the Rescue?  Yeah.  Really.

Lyrica(™) was one of the most expensive medications prescribed under Medicare D in the most recently released report of drug costs.  Any suggestions on how to moderate that expense?


Try something else first.


Lyrica(™) indeed figured prominently on the top ten list discussed above. Indicated for seizure prevention and treatment of post-herpetic neuropathy, the primary driver behind its expense is it’s use in diabetic and other neuropathies.


Unlike the other meds on the list, however, there are some steps you can use to limit its use and it's costs—without additional costly tests.


Consider using an over-the-counter preparation such as Metanx (™) for a three month trial in the treatment of diabetic neuropathy.  The preparation costs about $60 a month out of pocket—competitive with tier 2 and 3 drug copays and completely paid by the patient rather than your pool.

It also works--very well.


I first stumbled upon the preparation during routine CME to maintain my diabetic center of excellence designation through a nationally recognized medical center. When the chief of neurology from this high powered institution explicitly recommended a nutraceutical such as Metanx for treatment of a disease it was like one of those moments in a courtroom drama when the audience gasps in amazement at a dramatic reveal. 


After acknowledging our response with a chuckle, he went on to show pathology slides of regenerating nerves and comparative conduction studies to give objective support to the subjective pain data. He was firm that you need at least a three month trial and that if there is any improvement in symptoms over that three months, it is then likely that the improvement will continue over time.


My NP and I immediately put Mentanx in our treatment plans and it flat out worked—to the point where I was targeted by the drug reps for my declining prescribing volume of other medications.


I have absolutely no financial connection to Mentanx. I don’t sell it, own stock in it outside of my index fund, or even go out to dinner on their dime.


It just works.

I suggest your investigate and consider using it as an alternative to more expensive treatments--and save your pool some money.


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