If you are concerned about health care costs, you’re not alone. A recent poll found that 58% of Americans are worried about unexpected medical bills and close to half of all Americans are worried about prescription drug costs1. Some 29% of Americans report not taking their medicine as prescribed, because they could not afford to pay for it2.
There aren’t any simple answers. But having medical and pharmacy benefits fully integrated is a critical step in the right direction.
What Are Integrated Benefits?
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Integrated benefits mean a member’s health coverage and pharmacy coverage are provided by the same health plan. When medical and pharmacy benefits are integrated, a clinical team sees the “whole picture” of a member’s health.
Why a Holistic Approach is Safer
An example can help show the importance of integration in medicine. Take diabetes, which affects over 10% of the population in the U.S., and 29% of people over 65. When a person with diabetes who has integrated benefits shows up at an emergency room, the health plan’s care manager is able to access medical and pharmacy data in real time. Did the patient miss a recent medical appointment, or fail to pick up their prescription? Are there any gaps in care? A collaborative team approach can help the patient comply with their prescriptions or get extra support from a nutritionist or social worker.
Without integrated benefits, a patient’s care is likely to be fragmented. There is a medical chart and prescription data, but no clinical team can see the whole picture, in real time.
Lower Costs, Better Health Outcomes3
Integrating medical and pharmacy benefits leads to real savings for the employer and the individual member. In our experience, overall medical costs are 4-6% lower when pharmacy and medical benefits are integrated.
When clinical teams have a full picture of each member’s health story, including physician visits and medication regimens, many types of Emergency Room visits can be avoided, saving money, time and worry for patients. Integrated benefits result in 17% fewer instances of all unnecessary ER visits for our members, at an average cost of $1,695 per visit.
The Strength of a Team with a Single Point of Contact
Integrated benefits are easier to manage, with one point of contact for any questions or concerns. Members carry one card, with one phone number. If a member needs to call for assistance, the professional responding to their call has access to both medical and pharmacy data.
At Excellus BCBS, our clinical team has 48 full-time pharmacists and 17 medical directors who review claims, consult with care managers to make sure patients are adhering to their care plans and prescription regimens, monitor for drug interactions, and verify that the most appropriate medical or pharmacy drug benefit is being applied.
To learn more about the great outcomes achieved through integration and the comprehensive management programs that come with every integrated plan, download our brochure or visit ExcellusForBusiness.com.
Excellus BlueCross BlueShield is a nonprofit independent licensee of the Blue Cross Blue Shield Association.
- “KFF Health Tracking Poll – March 2022: Economic Concerns and Health Policy, The ACA, and Views of Long-term Care Facilities” Kaiser Family Foundation, March 2022
- “KFF Health Tracking Poll – February 2019: Prescription Drugs,” Kaiser Family Foundation, March 2019
- Comparison of Book of Business integrated medical and pharmacy employer groups vs. medical-only employer groups