Highmark group customers lower costs, improve health outcomes with integrated medical and pharmacy benefits, HealthScape study finds

PITTSBURGH (April 13, 2021) — Highmark group customers who combine medical and pharmacy benefits can significantly lower medical costs while also improving health outcomes and member engagement, according to an independent study conducted by HealthScape Advisors. Highmark group customers with integrated medical and pharmacy benefits saved an average of $150-$230 per-member, per-year compared to group customers who carved-out pharmacy benefits, with savings driven by shorter episodes of care, enhanced chronic care management and increased member engagement.

HealthScape Advisors conducted a three-year analysis (2017-19) of cost and health outcomes data for Highmark group customers with integrated medical and pharmacy benefits compared to group customers with carved-out pharmacy benefits, adjusting for member demographics and health risk score.

In addition to potentially lower medical costs, group customers with integrated medical and pharmacy benefits (meaning they use Highmark for both of these services) reduced the average length of inpatient hospital stays by 3.9 percent compared to groups with carved-out pharmacy benefits (meaning they use another vendor for their pharmacy needs), and had members who were 14 percent more likely on average to engage in care management engagement programs (including those for complex case management, integrated care, and wellness).

“This study demonstrates the value of an integrated medical and pharmacy benefits strategy for group customers,” says Jeff Bernhard, senior vice president of commercial markets for Highmark Inc. “With a unified model, employers and individual members both enjoy a seamless experience that provides optimized care because clinicians have access to real-time medical and pharmacy data that offers a comprehensive view of a member’s health status. A unified model also simplifies the prior authorization process, and provides single point of contact for all benefit needs.”

The HealthScape Advisors study also stratified Highmark group customers by the health risk score of their members. The higher the risk score, the higher the average medical savings experienced by group customers with integrated medical and pharmacy benefits compared to those who carved-out pharmacy benefits. Group customers with an elevated risk score lowered per-member, per-year medical costs by an average of 11 percent to compared to group customers who carved-out pharmacy benefits. Group customers with a lower risk score enjoyed medical costs savings of five percent on average with integrated benefits.

“With integrated medical and pharmacy benefits, members with complex health needs receive the kind of coordinated care required to manage and improve their health,” says Sarah Marche, senior vice president of pharmacy services for Highmark Inc. “Members have access to the most clinically and cost-effective medications, benefit designs that can lower out-of-pocket costs, and the support of Highmark pharmacists, case managers and health coaches who leverage medical and pharmacy data to provide customized care. Integrated benefits are a win for employers and individual members alike.”