Bleeding disorders frequently rank among the highest-cost conditions, largely because of treatment costs. While patients are exposed to some of the treatment costs through their deductibles, coinsurance and copays, the health plan bears the majority of the costs.
For health plans, managing those members with the highest-cost claims is a top priority. They will implement a variety of strategies aimed at lowering the total cost of care; however, some of these strategies can result in an increased cost burden to the health plan and patients alike. One of the most notable strategies of late are copay accumulator adjustment programs, which essentially change the rules on how manufacturer copay assistance is counted and applied.
Another common strategy involves restricting access to only one specialty pharmacy and thereby excluding hemophilia treatment centers (HTCs). This arrangement can interfere with communication among the physician, the pharmacy provider and the patient, disrupting the continuity of care and resulting in increased costs, not cost savings.
Hemophilia Treatment Centers Play a Vital Role
In an effort to address these issues, the National Hemophilia Foundation (NHF) formed a partnership between HTC healthcare providers and health plans called the Comprehensive Care Sustainability Collaborative (CCSC). CCSC is composed of medical professionals and health plan leaders who share a common goal: to promote high-quality, cost-effective management of bleeding disorders, which in turn supports HTC sustainability.
Bringing health plans and providers together enables CCSC to provide an in-depth overview of the integrated, coordinated services delivered by HTCs, highlighting their intrinsic value, with a goal of promoting HTC inclusion in both the medical and pharmacy networks.
The Many Benefits of Comprehensive HTC Care
For the bleeding disorders community, access issues and disruptions in care are typically the result of plan policies that lack disease-specific knowledge because of the rarity of these conditions.
Many health plans, large and small, have been unaware that HTCs even exist, let alone that they deliver coordinated, individualized care through a team of subspecialized experts (such as doctors, nurses, social workers, physical therapists, dentists and pharmacists) who are on call 24/7/365, and that patients served by HTCs have a reduced rate of emergency department utilization and an increased rate of prophylaxis and self‐infusion compared with those receiving care outside of the HTC network.
Patients who receive care at an HTC have better outcomes, including fewer complications and reduced hospitalizations and emergency department visits.
Clear Lines of Communication
The relationships forged between health plans and providers through CCSC participation has opened the door for patients wishing to use HTC pharmacies, thus helping to support the HTC infrastructure.
Overall, CCSC has served as a platform to advocate for HTC inclusion in all health plan and pharmacy networks. It also serves as a platform to partner with health plans in finding ways to best manage the total cost of care without attempting to implement one-size-fits-all strategies, such as copay accumulator adjustment programs, step therapy policies and other programs that can be harmful to patients and increase, rather than decrease, costs for the health plans.
“What CCSC has done is to open up the conversation with these employers to show that allowing HTCs in-network will save them considerable money, not only on the pharmacy side but in overall patient management and outcomes versus an exclusive specialty pharmacy,” says Rebecca Burns, executive director of the Bleeding & Clotting Disorders Institute in Peoria, Illinois.
For more information on CCSC and how it benefits patients as they navigate the challenges of living with a bleeding disorder, visit CCSCHemo.com.