Mitigate Escalating Plan Costs with Personalized Clinical Support

Posted by Navitus Health Solutions on Jun 24, 2021 7:45:00 AM

The prescription journey for members can be tough. Help them overcome challenges with personalized clinical support. Find out how in today's blog!

CEC Social

Chronic diseases are the leading driver of health care costs.1 Prescribed medications are essential for helping patients effectively manage these conditions, yet many patients do not adhere to their prescription therapies. In turn, this can lead to poor health outcomes and escalating costs for both the plan and the member. Each year, 125,000 individuals with chronic illnesses die.2 And the cost of nonadherence results in up to $289 billion annually to the health care system.2

Members may find navigating their prescription journey difficult. When a benefit change transition is confusing, or when the cost of filling prescriptions is challenging to the member, the likelihood of disruption is high.

Navitus’ three-pronged solution, the Clinical Engagement Center (CEC), works with the plan, prescriber and member to address challenges along the prescription journey. It successfully lowers plan costs, helps improve health outcomes and minimizes member disruption.

How Does It Work?

The CEC combines the synergies of three core programs: Medication Therapy Management (MTM), Academic Detailing and Personalized Member Transitions.

Moving the Needle in Medication Adherence With MTM
The statistics around medication nonadherence are concerning:
  • 20% of prescriptions are never filled2
  • 50% of prescriptions filled are taken incorrectly2
  • 22% of patients take a lower dosage than prescribed2

Members need to be engaged in their health care to stay adherent. Our fully customizable MTM services provide the additional support members need. During a personalized, 1:1 clinical consultation, a staff clinician conducts a thorough, comprehensive medication review (CMR). The clinician examines all medications and supplements that a member is taking and identifies any medication issues, gaps in care and screens for safety concerns. The clinician then develops an action plan and written summary, sharing it with the member and the prescriber. When coordination of care is required, the clinician will handle it and provide evidence-based recommendations to the prescriber. Plan sponsors receive real-time reporting of improved member/prescriber communications. This program is CMS-compliant.

For every dollar invested in MTM, plan sponsors typically receive $4-6 in savings!

LOWERING HIGH-COST MEDICATION PRESCRIBING WITH ACADEMIC DETAILING

Physicians are one of the most important members of a patient’s health care team. With the many changes in drug therapies and the sheer number of patients a physician treats, they can find it challenging to stay on top of the most cost-effective, and efficacious medications. That’s where Academic Detailing comes into play. After analyzing prescribing patterns and identifying high-cost medication patients, clinicians contact physicians educating them about equally-effective, lower-cost, formulary alternatives. All recommendations are evidence-based. Influencing better prescriber patterns can increase savings opportunities.

Plan sponsors can achieve an estimated savings of $308 per member each year. Members also save on lower out-of-pocket costs.

ALLEVIATING MEMBER DISRUPTION WITH PERSONALIZED TRANSITION SERVICES

Receiving member complaints is not something a plan sponsor wants after switching benefit plans. Members may become frustrated if they experience any disruption during a benefits transition. Through our high-touch Personal Transition Services, we can drive smoother benefit transitions and create more positive member experiences. After identifying members taking maintenance medications that are not on the formulary, we send out a clinical transition letter. Our clinicians will follow up with the member to discuss formulary alternatives and contact prescribers to obtain new prescriptions to help prevent gaps in care. Plan sponsors benefit from minimal member disruption during transitions, lower plan costs and satisfied members.

The CEC program's three-pronged approach addresses challenges along the member’s prescription journey, improving health outcomes while reducing costs for the member and the plan.

To learn more about how our Clinical Engagement Center program can help improve medication adherence, lower member and plan costs and ease the process of benefit transitions, email sales@navitus.com today!


  1. Why You Need to Take Your Medications as Prescribed or Instructed. FDA. https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed#:~:text=The%20High%20Cost%20of%20Not,per%20year%20in%20this%20country. Published February 16, 2016. Accessed October 6, 2020.
  2. Brody J. The Cost of Not Taking Your Medicine. The New York Times. https://www.nytimes.com/2017/04/17/well/the-cost-of-not-taking-your-medicine.html#:~:text=This%20lack%20of%20adherence%2C%20the,and%20%24289%20billion%20a%20year.  Published April 17, 2017. Accessed October 6, 2020.

Topics: Insider, Member

Subscribe Here!