Recognize your consumer segments who need value
Consumers with high-deductible health plans, Medicaid consumers and those without insurance all have varying needs for value lines. They also have varying health needs and preferences that should be considered when creating these value lines.16 Providers that understand the consumer segments they want to serve can design an operating model for the future—perhaps as “integrators” serving a payer mix and consumer base that are both diverse, or as “health managers” targeting the frail elderly, complex chronic, chronic and mental health consumer segments.17
Consider partnerships to deliver lower-cost, high-quality care
Scottsdale, Arizona-based Redirect Health is working with employers nationwide to make it easy and affordable to provide healthcare to even low-wage employees.18 For example, the company offers employees unlimited primary care visits paid for by their employer. Redirect Health is in talks with hospitals about collaborating to reduce unnecessary and expensive utilization by uninsured and Medicaid patients.19 Such partnerships would let Redirect Health manage those patients’ ongoing care and avoid unnecessary, pricey emergency room visits that often go unpaid or under-reimbursed, so that hospitals can concentrate on where they are needed most.
Go beyond the prescription coupon
Pharma has yet to fully embrace the idea of value lines other than generic drugs and patient financial assistance programs. It could build on existing patient support programs to tackle social and lifestyle barriers to patient adherence. Pharma also could do more with outcomes-based payments, with which the price paid for a drug is linked to its economic or clinical performance.20 These companies also could develop value lines in the direct-to-consumer market with digital therapeutics such as Natural Cycles, a contraception app approved by the FDA in August 2018.21 The app costs $80 a year and doesn’t require a doctor visit or prescription.22