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A Blue Cross Blue Shield venture sparks concern

Five Blue Cross Blue Shield (BCBS) insurers plan to leverage patient data on drug efficacy to lower healthcare costs. A June 23 Healthcare Dive story digs into the controversial tactic.

A new business dedicated to reducing the high cost of prescription drugs and curbing needless drug spending? Sure, we’re all for it. Setting up that business so that the health insurance investors can cherry-pick data to use only if it suits them? We’re less enthusiastic. In another health insurance-driven attempt to “address costs,” five Blue Cross Blue Shield (BCBS) insurance plans based across the country are setting out to pinpoint the costs and benefits of prescription drugs by investing in a new company, called Evio Pharmacy Solutions.

Evio will analyze claims trends from more than 20 million people covered by the five BCBS plans in order to identify how well various drugs work and how much they’re costing. Ultimately, the venture’s goal is to move the dial toward value-based payment and form outcome-based contracts with drug makers, where payments are driven by drugs’ effectiveness.

The sheer volume of data Evio has at hand certainly has the potential to produce a great deal of useful insights in aligning a given drug’s cost with its real-world performance. Our concern is whether these insights will be used to benefit BCBS members—or will insurers be motivated to restrict patients’ pharmacy choices to lower-cost drugs, even though they may also be lower-performing?

This suspicion is reinforced by Evio’s own CEO’s not-so-subtle caveat about the findings, stating that the BCBS plans who are pumping what they call “significant” funds into Evio aren’t committed to actually implementing the insights Evio provides them. So, the question that springs to our mind is: After investing what we can only imagine is a substantial amount of money in Evio, why wouldn’t the BCBS plans want to put Evio’s insights into practice? Our guess is that they’re leaving themselves an escape hatch, in case Evio’s findings aren’t fiscally in their favor. For example—just off the cuff—what if an expensive cancer drug got great results 100% of the time, while a cheaper cancer drug got good results 75% of the time?

Elizabeth Mitchell, CEO of the Purchaser Business Group on Health, which represents major employers like Microsoft and Boeing (which collectively spend $100 billion a year on healthcare), isn’t convinced by Evio’s intentions either. She questions where this new company will be focusing its priorities. “In our experience,” she says, “it is rarely with the customer.”

It sounds like Mitchell shares our wariness about this new endeavor. While we agree that rising healthcare costs are an issue that demands attention, we have to ask whether this is a genuine step toward keeping them down for anyone but Evio’s BCBS investors.

Original Article:

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