Pharmacy Benefits Uncut

Read time: 4 min

​Read this newsletter online​

A growing number of employers are realizing they’re going to need a comprehensive overhaul of their pharmacy benefits plan to ensure their drug spend is sustainable. This revamp will likely require not only amending your PBM contract but also how you provide clinical services to help your plan members manage their medications. But even the biggest, boldest pharmacy benefits overhaul isn’t going to be successful if you don’t have buy-in from your plan members.

That’s why it’s imperative for you to implement a plan member engagement strategy. Plan member engagement is two-way communication focused on building a caring, trusting relationship between you and your plan members. It's designed to promote healthy behaviours and make plan members full partners in all aspects of their medication-related decisions. It can focus on a wide range of issues from getting members’ input on changes to their pharmacy benefits plan to clinical initiatives such as medication deprescribing for members taking multiple drugs. To successfully implement an engagement strategy you need to also understand what plan member engagement is not: it’s not simply using text messaging, email, or a web chat portal to share information or send a message. Nor is it a ham-fisted approach to forcing members to take certain actions or overwhelming them with unwanted contact. True engagement requires you to interact with your members in a thoughtful, constructive way so that both parties benefit from the relationship.

Today, I want to share a systematic framework for engaging with your plan members to make them full partners in managing their medications. It’s called the 5-4-3-2-1 method.

Here's how it works:

5 - Identify five key areas in which you want to engage with your plan members

‍4 – Offer four communication channels

‍3 – Establish three success measures for each area of engagement

‍2 – Provide two mechanisms for plan member feedback

‍1 - Create one comprehensive strategy to build strong relationships with your plan members

Let's dive in, and I’ll show you exactly how to implement it.

5 Key Areas

It’s important to prioritize the issues on which you want to engage with your plan. Identifying five areas of engagement should enable you to interact with a broad swath of your plan membership and address issues relevant to a majority of them.

Here are two examples of areas on which you could engage with your members:

If you're moving towards a value-based drug formulary to eliminate out-of-pocket costs for your plan members, you might be interested in understanding how they view the trade-offs between policies designed to keep drug costs lower and the savings they’ll achieve with no out-of-pocket costs.

Or it could involve a “high-touch”, personalized clinical service in which a pharmacist contacts a plan member who has started a new medication for a chronic condition such as diabetes or rheumatoid arthritis to discuss any issues or concerns the member might have and offer any additional support they require to assure success with therapy.

4 Communication Channels

Needless to say, your plan members will have different preferences for how you communicate with them. Some may be most comfortable with an old-fashioned phone call while others may prefer a text/SMS message or a live chat.

Gather information on how your members would like to be contacted and be sure to use their preferred communication channel. Your engagement strategy will have the greatest chance of success when you meet your plan members where they’re most comfortable.

Providing four modes of communication should enable you to account for the preferences of the majority of your plan members.

3 Success Measures

If you want to continually improve your member engagement experience, you’ll need to measure the success of your engagement initiatives. For each initiative, select three measures that will help you determine its success.

If we consider the above example of a “high-touch” clinical service for plan members starting a medication for a chronic disease, success could be measured by the number of eligible members who participate, their ratings of the value of the service to them, and adherence to their new medications.

Ideally, data you gather on success measures will be used as a continuous quality improvement mechanism for your engagement initiatives.

Choose your three success measures and be sure to put in place the tools to gather data on them.

2 Mechanisms for Member Feedback

In addition to measuring the success of your individual member engagement initiatives, you need member feedback on your overall engagement strategy. Do they appreciate the efforts you’re making to involve them in their healthcare decisions? Do they feel the points of contact are too many or too few? Do the communication channels align with their preferences?

Give your plan members two ways to provide you with this feedback. For example, you could use a web survey as well as once yearly in-person town-hall style meetings.

Just like gathering data on success measures of individual engagement initiatives, feedback on your overall engagement strategy is important to ensuring you’re meeting your plan members needs and improving your strategy as required.

1 Comprehensive Strategy

Finally, pull together everything from above and develop a singlecomprehensive engagement strategy to make your plan members full partners in all of their healthcare decisions. Your 5-4-3-2 are the critical elements forming the basis of this strategy. And if you can successfully implement it, your pharmacy benefits plan will be able to provide member-focused solutions, realize savings, and reduce health inequities.

That’s all for this week.

See you in two weeks,

Nina

If you know someone who would find this newsletter useful please share it. Was this newsletter forwarded to you? Sign up here.

Pharmacy Benefits Uncut is produced by Healthcare Decision Making, a consultancy that helps small and medium sized employers optimize their pharmacy benefits plan. We offer a comprehensive range of services focused on three areas: PBM procurement, ongoing management of your pharmacy benefits plan, and self-policing and oversight of your pharmacy spend. To learn more about how Healthcare Decision Making can help you, email Nina Lathia at nina.lathia@healthcaredecisionmaking.com