Patient-centered medical home concept to benefit pharmaceutical industry

HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that the pharmaceutical industry stands to gain from the patient-centered medical home concept that continues to gain traction across the country. According to the recent New England Health Plan Analysis, medical home projects seek to maintain costs and improve health through better treatment compliance, including prescription drug regimens.

The medical home concept relies on a team-based approach where a primary-care physician provides coordinated care throughout a patient's lifetime, ultimately reducing hospitalizations and minimizing costs in the long run. Like pay-for-performance initiatives, the medical home payment model focuses more on outcomes than volume. On the provider side, physicians gain better monitoring tools, there is an increased focus on efficiency with physicians prescribing the most effective medications at the lowest cost, and care managers flagging duplicative tests and services. On the patient side, there are more discussions between the individual and the physician about his or her condition and treatment, with the expectation that a more informed, educated patient will be more compliant with treatment, including filling prescriptions and taking medications as prescribed.

"Pharmaceutical companies may stand to gain from the medical home movement, as patients become more educated and better monitored, and drug utilization and compliance increases," said Ric Gross, analyst with HealthLeaders-InterStudy. "However, the concept may prove to be a zero-sum game for pharma, where the most effective and least costly drugs gain share from those that are comparatively less effective or more costly."

Medical home projects highlighted in recent Health Plan Analysis reports include:

• Blue Cross & Blue Shield of Rhode Island has launched a medical home project and expects to have more than 100 primary-care physicians participating by the end of the year. The insurer also is part of a statewide, multi-payer chronic care medical home initiative.
• Blue Cross Blue Shield of Illinois has rolled out a patient-centered medical home pilot in the Chicago market that involves three large multi-specialty provider groups and 60,000 plan members, with a goal of at least doubling involvement in coming years.
• In Alabama, Blue Cross Blue Shield began a medical home pilot, the Alabama Health Improvement Initiative Medical Home Pilot, with about 70 physicians in family and internal medicine and pediatrics involved.

Health Plan Analysis identifies key health plan trends, allowing pharmaceutical companies to create comprehensive strategic plans and sales strategies at state and local levels. Updated quarterly, Health Plan Analysis provides a detailed look at plan design and financials, as well as information about mergers, legislation and other influencers driving healthcare in a particular region.