One of the keys to managed care is to reflect on past experiences, understand lessons learned and consider their implications for the future, said Bobby Currie, director of drug evaluation at Manulife, during a session at Benefits Canada’s 2024 Face to Face Drug Plan Management Forum.
While traditional tools like caps, deductibles and co-insurance that employers opt into may provide short-term cost relief, she said, managed care strategies must move beyond these cost-containment tools and focus on encouraging treatment options that optimize health outcomes and address appropriate utilization.
“Managed care is about not just moving costs around, but actually trying to incorporate value and sustainability into the decisions that we’re making to optimize health outcomes and reduce costs.”
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Leveraging clinical trials and health economic assessments can help drug plan managers refine decision-making processes, said Currie, noting they also need to balance the speed and due diligence of their drug reviews. It’s critical to ensure drugs meet value and safety criteria without causing unnecessary delays for high-value treatments, she added.
She explained the next frontier of managed care lies in outcome measurement, which uses real-world evidence to validate drug and program effectiveness and fine-tune solutions. By integrating these findings, drug plans can demonstrate value and help ensure each dollar spent contributes meaningfully to member health and overall plan sustainability.
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“Managed care professionals need to be looking at how we can evolve to better meet the moment. Good management and adapting quickly when we see new trends makes a difference if we can strike the right balance between access and affordability in the long run.”
Currie recommended plan sponsors look for and rely on drug plan management partners that align with their principles and values, prioritize value over cost and measure outcomes rigorously. The result will be a balanced, effective and sustainable approach to managing drug plans, she noted, that shifts from traditional cost-control mechanisms to a managed care philosophy that underscores a commitment to delivering value-driven outcomes.
Read more coverage of the 2024 Face to Face Drug Plan Management Forum.