Focus on Prevention Pays Off

“An ounce of prevention is worth a pound of cure” — Benjamin Franklin

This truism lies at the heart of much of what managed care pharmacy does. AMCP members and their organizations have long championed the use of preventive-care services to achieve better health outcomes and lower overall health care costs. To wit, it’s better to ensure a heart patient takes his medicines regularly than to treat him in the emergency room with a heart attack.

This concept is nicely confirmed in a new study by Avalere Health: “Medicare Advantage Achieves Cost-Effective Care and Better Outcomes for Beneficiaries with Chronic Conditions Relative to Fee-for-Service [FFS] Medicare.” 

Medicare Advantage has a higher proportion of patients with clinical and social risk factors shown to affect health outcomes and costs than FFS Medicare, Avalere notes.

Compared to the FFS Medicare program, Medicare Advantage provides more preventive services and uses interventions designed to better manage chronic conditions, the study finds. This approach may avert preventable complications and result in lower overall costs, it adds. 

This is especially true among the most clinically complex and dual eligible/low-income beneficiaries. 

Despite Medicare Advantage beneficiaries having more social and clinical risk factors, they had similar costs to those in FFS Medicare overall, according to the study. This indicates that Medicare Advantage’s focus on coordination of care may lead to more efficient treatment patterns and care delivery, it adds.

Avalere’s findings show that Medicare Advantage beneficiaries with chronic conditions experience better outcomes, have fewer adverse events at similar or lower costs, and have a better quality of life. 

For AMCP and its members, these findings are a ringing endorsement of what we aim to do every day. 

Specifically, one of the top practices in managed care pharmacy is disease management, which aims to reduce health care costs and improve quality of life for individuals with chronic conditions by preventing or minimizing the effects of the disease through integrated care. It is one way that managed care pharmacy not only helps address rising costs, but helps improve patient outcomes and satisfaction. 

I invite you to learn more about managed care pharmacy concepts and practices in our Managed Care Pharmacy 101 section. To read the Avalere Health study, click here.