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Emerging Trends Identification and Risk Management |
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Healthcare is a dynamic business.
Dynamic - Drugs change,
policies change, experimental treatments are developed,
economic pressures change, etc. and the changes impact your
plan and members. If a legislative change cuts payments
for one group, costs are going to increase for another group.
The introduction and marketing of a new drug will change
demand in the entire drug category. Associates & Wilson
stays ahead of the curve. We are on top of all the latest
healthcare trends and developments and we analyze the impact.
Our associates know where to look and what to do when they
spot new movement.
Business – Just
like any other business, healthcare is a business with the
goal of making money. Those that don’t are history.
Providers of products and services and healthcare players
have business plans, marketing strategies, sales people,
etc. The same rules that apply to purchasing other products
or services should apply to purchasing healthcare, but often
do not. The health plan generally specifies what’s
covered (i.e. treating an illness or injury; standard’s
based; effective for the member’s condition, etc.)
but other purchasing parameters and evaluation metrics are
required. Associates & Wilson has a deep understanding
of how the drug industry works – how they introduce
new products, keep old products profitable, extend patents
by introducing new uses for a product, etc. We understand
how PBMs and other healthcare players make money too. Our
years of experience help us make accurate predictions and
develop strategies to keep you on course.
“Sparks” is one of the services
we provide to help you avoid potential pitfalls. On a routine
basis, we “spark” ideas by presenting data from
our myriad of sources and track emerging experience/utilization
on identified drugs to monitor marketplace dynamics. Often
our work comes first and changes in FDA regulation or industry
policy follow our lead. Our proactive approach means you
avoid the problem entirely and don’t waste time and
money to clean it up after the fact. Here’s an example
of how our attention to trends benefited the client and
changed the marketplace.
Associates & Wilson realized that
our client’s members were making an alarming number
of claims for Neurontin, a drug approved for people with
epilepsy. A far higher percentage of the members were taking
Neurontin than were epileptic. This off-label use not only
forced employers to pay for unnecessary medications, but
placed members at medical risk from serious side effects.
We investigated and discovered that doctors were prescribing
Neurontin for a vast array of off-label uses at the urging
of pharmaceutical company representatives. The off-label
uses were not supported by scientific evidence. Soon after
we began to crack down on Neurontin prescriptions, others
began to follow our lead. Pfizer, Neurontin’s manufacturer,
had to pay $430 million for false advertising charges. Associates
& Wilson raised the issues and those with a resolve
to protect their pocketbooks and the quality of patient
care reaped rewards.
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