Interview: Jim Robbins, ApotheCard
Jim Robbins, President of ApotheCard, says that traditional managed care has used three dials to meet their financial goals: how many people are enrolled in my health plan, what does it cost me to deliver care (to manage costs they beat up on doctors, clinics, labs, hospitals, pharmaceutical companies to negotiate good discounts), and conform behavior of physicians and patients towards a preferred network of physicians, hospitals and a preferred drug list.
A consumer directed model changes this, because the consumer has complete choice over which doctor or hospital they use, because they are spending their own money up to the deductible.
A lot of cost is allocated to controlling behavior in the Pharmaceutical Benefit Management (PBM) industry to try to get doctors and patients to use the preferred drug. Maybe the manufacturer gives the PBM a rebate when the patient takes that preferred drug, even if the physician thinks another brand is better. In a consumer directed model, the consumer isn’t pushed to make certain choices.
The PBMs sometimes make choices that reduce their cost, but not necessarily the patients cost to fill a prescription. They push patients in the direction of making choices that are in the best interest of the health plan or PBM.
Discussion
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