A recent study by Aetna’s analytics team found that members with an integrated pharmacy and medical benefit plan had significantly lower inpatient and emergency room use and higher engagement rates for case management programs.
The study found members with six of the highest-cost chronic conditions – diabetes, rheumatoid arthritis, HIV, hypertension, coronary artery disease and chronic heart failure – saw a 2 to 17 percent decrease in medical costs when medical and pharmacy benefits are integrated.
These members had fewer inpatient admissions and days and emergency room visits – resulting in lower costs.
Aetna’s integrated view provides a better understanding of a member’s health, which helps to provide high-quality care and more holistic treatment.
As an integrated benefits provider, Aetna can more effectively identify at-risk individuals who can benefit from our care management programs. The number of members who participated in care management programs was up 116 percent during the study period.
The study examined plan sponsors that had integrated pharmacy and medical benefits, and those with medical-only coverage. The study group contained Aetna’s larger plan sponsors who had Aetna medical benefits for at least four years between January 2012 and December 2015.
From a plan-sponsor level, the study found integrated pharmacy and medical benefits resulted in 34 percent lower medical cost growth than those who only had medical benefits.
Employers that opt for medical-only benefits would need to receive at least a 22 percent reduction in pharmacy costs to offset the corresponding increase in medical costs that occurs when pharmacy is “carved-out” from medical.