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The business benefits of collaboration between insurers, patient groups


By Annette M. Boyle

By working with groups that represent chronic disease patients, insurers can save money on costly therapies while ensuring patients have access to the treatments they need, according to a recent Health Affairs blog post.

Striking the right balance matters. Some new specialty treatments for rare, chronic diseases come with steep prices. But they offer cures or quality-of-life improvements previously unavailable to subgroups of patients.

Health plans may try to limit the financial impact by shifting costs to patients or instituting restrictive formularies, which may lead to patients missing necessary treatments or having adverse reactions, according to the post by Marcia Boyle, president and founder of the Immune Deficiency Foundation (IDF).

But rare disease groups can help insurers stay on top of rapidly evolving research and guidelines to ensure their policies remain evidence-based so that efforts to manage costs do not unintentionally increase them, Boyle says.

Research has also shown that having health coverage helps those with chronic conditions manage their diseases, FierceHealthPayer has reported.

As an example, Boyle cites IDF's work with Health Care Service Corporation (HCSC) and its health plans. HCSC issued new guidelines in 2014 that required a group of patients with primary immunodeficiency to reconfirm their diagnoses and demonstrate a need for treatment with immunoglobulin.

IDF worked with HCSC and the individual health plans to explain the challenge the policy created for patients who depend on immunoglobulin and put HCSC in touch with national clinical experts on primary immunodeficiency diseases, according to Boyle.

As a result of the groups' collaboration, HCSC amended its policies to match the highest standards of care while enabling the organization to manage costs, an outcome that worked for all parties.

For more:
- read the post

Related Articles:
Payer-provider collaborations: The key to improved patient outcomes [Special Report]
Amid Obamacare turmoil, payers and providers must mend fences and collaborate
More health coverage could mean greater diagnosis, control of chronic conditions