New Paper Published in Health Affairs Supports Effectiveness of ActiveHealth Management’s Value-Based Insurance Design Program

ActiveHealth Management (ActiveHealth^®), a subsidiary of Aetna (NYSE: AET), today announced the publication of a paper in the February issue of Health Affairs. The paper demonstrates that properly structured value-based insurance design (VBID) programs can be effective at increasing adherence to drug regimens for specific chronic medical conditions without increasing overall costs. The analysis also suggests that, by targeting outreach to members who need it most, additional cost savings can be achieved, not only in averting serious health events but through fewer disability days, less absenteeism and greater worker productivity.

The ActiveHealth program, currently available to employers and health plans, can couple a VBID incentive with a disease management program. When individuals with chronic conditions engage in disease management nurse coaching, they are eligible for reduced co-payments on their medications. The program is designed to remove financial barriers to medication compliance and encourage individuals to participate in nurse coaching.

"As employers face increased pressure to keep their health care costs in check, increasing copayments are often considered as a way to lower employers’ costs. However, the increased financial barrier to employees may lead to negative and more costly health events for the employee and employer. Programs that combine disease management and VBID are proving effective at helping employers slow the rate of growth in health care spending, while offering employees valuable benefits that help them stay well and productive at work,” said Stephen Rosenberg, M.D., senior vice president for Outcomes Research at ActiveHealth, and an author of the paper.

Highlights of the Health Affairs paper

Methods

• In January 2005, a large employer reduced copayments for five classes of drugs used to treat serious chronic conditions: ACE Inhibitors and beta blockers used to treat high blood pressure and other heart disease risk factors, diabetes medications, statins which help lower cholesterol and inhaled corticosteroids, used to help manage asthma.
• The employer reduced copayments for generic medications from $5 to $0, preferred brand name drugs from $25 to $12.50 and non-preferred brand name drugs from $45 to $22.50.
• All patients who were already taking these medications were eligible for enrollment in the VBID program and the reduction in copayments. Copay relief was also available to people who were not currently taking the medications but were identified as patients who would benefit from its use, once their doctors agreed and provided prescriptions.

Results

• The VBID program increased adherence to medications by three percentage points, resulting in an average increase in pharmacy costs to the employer of $7.75 per employee, per month.
• But, as a result of this program, the employer reduced its costs for other (non-drug) health care services like hospital admissions by the same amount, so that there was no overall increase.
• The analysis shows that better compliance with medications can avert serious or catastrophic health events, leading to reduced costs and potentially healthier and more productive employees.

Programs Built on Patented Technology

ActiveHealth’s patented technology, the CareEngine^® System, powers Active Disease Management^SM and ActiveHealth’s VBID program, which is known as Active Benefit Design^SM. The CareEngine creates a personal health profile for each individual using claims and other data, and compares the profile to the evidence-based literature. As part of this process, the CareEngine identifies the individuals whose clinical profile indicates they could most benefit from disease management nurse coaching, as well as the individuals who would most benefit from a medication included in the incentive program. Program medications were selected based on the large body of evidence-based medical literature documenting their cost effectiveness in the treatment of common chronic conditions.

The paper was written by Michael E. Chernew, professor in the Department of Health Care Policy at Harvard Medical School, Iver A. Juster, senior vice president for Informatics at ActiveHealth, Mayur Shah, formerly employed at ActiveHealth, Arnold Wegh, senior informatics analyst at ActiveHealth, Stephen Rosenberg, senior vice president for Outcomes Research at ActiveHealth, Michael C. Sokol, corporate medical director for Merck and Company, Kristine Yu-Isenberg, associate director in Regional Outcomes Research at Ortho-McNeil Janssen Scientific Affairs and A. Mark Fendrick, professor in the Division of General Medicine at the University of Michigan.

The current paper complements an earlier study¹ published in Health Affairs by researchers from ActiveHealth, Harvard Medical School and the University of Michigan. That study showed that lowering co-pays for certain classes of drugs improves medication compliance. The study demonstrated that ActiveHealth’s VBID incentive can be effective in increasing compliance with important medications and can complement ActiveHealth’s disease management program.

About ActiveHealth Management

ActiveHealth Management is a leading provider of health management services, including disease management, clinical decision support and personal health records. The company's solutions, all based on its patented CareEngine^® System, help individuals receive quality care and help organizations like health plans, employers and government payors reduce medical costs. More than 19 million people nationwide benefit from ActiveHealth programs. Founded in 1998 and headquartered in New York City, ActiveHealth is an independent subsidiary of Aetna (NYSE: AET). For more information, please visit http://www.activehealth.net.

About Aetna

Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.3 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.

¹Chernew, Michael E., Shah, Mayur R., Wegh, Arnold, Rosenberg, Stephen N., Juster, Iver A., Rosen, Allison B., Sokol, Michael C., Yu-Isenberg, Kristina, Fendrick, A. Mark, "Impact Of Decreasing Copayments On Medication Adherence Within A Disease Management Environment”, Health Affairs March/April 2007; 26:195-203