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What happened to the CARE in healthcare?
What's your organizational culture?
Today's article from Employee Benefit News (link at the bottom) lists the "25 Places...with the best company culture, according to employees."
I find it Interesting that there's not a single healthcare organization listed in the Top 25. Why do you think that is? When I review the top 25 list, there are definitely some jumbos on there that are multi-billion dollar organizations - so size and revenue is not the reason. There are various organizational structures and 'remote vs. in house' models. So that's not it either. It sometimes seems as if we forget about the CARE aspect of healthcare. That should be care for the patient/member, care for the provider, care for the clients AND (last but certainly not least) care for the ASSOCIATES.
In today's highly competitive healthcare business (and yes it IS a business) there tends to be a lot of negativity, a lot of finger pointing and even more ineffective leaders. Combined with the ever-increasing need to expand the business and the revenue targets, the negativity and lack of leadership can very easily morph into a toxic corporate environment. Many times this negativity even flows into our own company's internal departments and colleagues. We silo our teams to prevent in-fighting and power struggles. Hopefully, those silos and that protection will help the teams and the company become more successful, right? How's that working for you today? Unfortunately not very well in the healthcare sector.
It doesn't have to be this way. There are plenty of great organizations and great leaders who work together in such a way that prevents the building of a toxic work environment. Through numerous mergers and acquisitions over the past twenty five years, I have had the pleasure to work with some of those effective leaders and organizations. Unfortunately, I have also had the opportunity to work in some of the most toxic and cut throat organizations in the business. So I have seen it done RIGHT and I have seen it done WRONG. I can tell you with no uncertainty - an effective organizational alignment and a positive workplace culture wins every time. It's better for your business, your bottom line AND your employees.
Has your organization gone through a recent merger or realignment? Is there a feeling of uncertainty in the crowd. Is there a lack of leadership and growing dysfunction in the ranks? If so, then you need a game plan to show your team that the organization does CARE - about the revenue, the clients AND the associates.
At Managed Health Solutions Group, we have the experience and the leadership style that can help bring your teams together. We can help you assess your teams and structure to ensure that everyone is rowing the boat in the right direction. Let us help you put the CARE back in the healthcare that your organization provides. Contact us and let's discuss how we can help.
PBM Pricing Transparency - Fact, Fiction, or Fodder
December 6, 2023
On Tuesday, CVS announced new pricing models for both its CVS Pharmacy retail business and its CVS Caremark pharmacy benefit management business.
https://www.cvshealth.com/news/company-news/our-path-to-accelerating-long-term-growth.html
To many, this may see like a blockbuster approach. So let's dig into each of the programs:
CVS Pharmacy has launched a new Costvantage pricing program. This strategy in essence will allow the CVS pharmacy chain to charge a 'cost plus - admin fee' structure for customers who are interested. This will help to make the true cost more transparent to the customer and the member. This is big because CVS Pharmacy has continually led the nation in driving down reimbursement rates to maintain their strength in the market and respond to the 'need for savings' for their customers.
In similar fashion, CVS Caremark has develop TrueCost, a 'cost plus - admin fee model' that will be available to their PBM customers (health plans and employer groups) beginning in 2025.
Although this seems like a blockbuster announcement for the pharmacy world, it is NOT. These strategies have been in place for several years with many other (typically smaller) pharmacy organizations. These models have just begun to take off and are still growing strength in the market.
This announcement IS interesting - coming from one of the 'Big 3' PBMs - as those are the players that have generally pushed back on transparent models in favor of their continued drive to provider deeper rates and savings to their customers.
Is this all confusing to you? Not sure where to go for real and unbiased information? Managed Health Solutions Group can help you sort through the different industry models to determine which is best for your business.
Contact us today for your free consultation: Https://mhsolutionsgroup.com
Defining the Look of the New PBM Model
Overview
In their annual Customer Satisfaction Survey, our colleagues at Pharmaceutical Strategies Group (PSG) highlight a trend that may be either a flash in the pan OR may be the way of the future when designing your pharmacy benefit management program. Read their article here: https://www.psgconsults.com/blog/carving-out-pharmacy-benefit-solutions
Satisfaction with the legacy PBM model is decreasing
In their survey, the PSG data confirms what many of us have been seeing for a while now - Customers are simply losing faith in the 'big bundled PBM model'. There are several reasons for this:
- The big are getting bigger - More than 80% of the prescription volume in the US is administered through one of the 'Big 3' PBMs. I won't call them by name, but you know who they are. Although they do provide deep discounts to the customer in many cases, these organizations have become juggernauts who lack flexibility and capability to make decisions quickly. For the mid-market, self-funded client, it is frustrating to be treated 'like a number' without meaningful focus on your goals or a personalized experience.
- Transparency at a cost - WIth many of the large bureaucratic organizations, it's becoming harder for the customer to receive the data, information and answers needed to make important benefit decisions. In some cases, the PBMs simply refuse. While in others, the organizations are so large and 'siloed' that they cannot find the information internally. Customers are demanding more transparency into policies, contract terms and financial outcomes data.
- Lack of customization - By design, much of the value from the large PBMs comes from their economies of scale and 'take it or leave it' bundled packages. The lack of flexibility sometimes bridles the customer with lackluster products and services that are 'required' in order to achieve the maximum savings offered by the PBM.
New technology players
Over the past few years, we have seen a surge in new technology and improved capabilities. Many of these are coming from newer startup firms who are capitalizing on machine learning and other AI-based use cases. The days of the dreaded 'green screen' desktop are on the way out. In its place we are seeing the emergence of new platforms, new capabilities and improved connectivity options that are simple and easy for the customer to use. These new technology vendors often focus on just a few aspects of the pharmacy products and services thus making them a potentially new ancillary product that integrates easily with the other systems. In this type of scenario, the technology vendors can focus only on those tools that are cutting edge and within their scope of expertise.
To carve or not to carve
Whether you refer to a carve out, decentralized, disintegrated, outsourced or modular model, the decisions remain the same - whether to use a single vendor OR divvy out the tools and services to the technology partners that truly provide the best product or service.
Benefits of the bundled / single vendor model
- One stop shop, one (very large) contract and client service team
- Multiple 'levers' to help drive deeper discounts and savings
- Volumes of scale generally prove the large bundles to be cheaper at the end of the day
Benefits of a more modular / decentralized vendor model
- Allows the customer to choose the individual product or service that best meets their need
- Drives more accountability and 'keeps the vendor honest'
- Easier to change an ancillary vendor instead of having to go through an entire PBM migration
Choosing the best path forward
Choosing the best model for managing your plan is really a very personal and unique choice that is based on the goals of the customer, bandwidth for administration and technical savvy of your organization. Given the more recent announcements for large payers to move to a decentralized model, the jury is still out on whether the new model will (or will not) provide the projected cost savings. While we certainly expect each of the vendors to be the best in class, the administrative burden of managing a dozen separate contracts will certainly have an impact that must be taken into consideration.
Let us help
At Managed Health Solutions Group, we help customers design, develop or change the model of their pharmacy programs. With three decades of industry experience, our experts have seen it all. Let us help you or your customer determine the best path forward that will provide cost savings, ease of administration and improved clinical and financial value .
Contact us today for a free phone consultation to see if MHSG can help!