The h-e-B value-based health management program: impact on asthma medication adherence and healthcare cost

Am Health Drug Benefits. 2010 Nov;3(6):394-402.


Background: Recent publications have shown that copayment reductions increase medication adherence above the effects of existing disease management programs, demonstrating an additive effect of combining a value-based insurance design with a disease management program. This effect, however, has yet to be demonstrated for medications used for the treatment of asthma.

Objective: To evaluate the impact of a value-based health management asthma program-which included providing patient education and lowering copayments for select asthma controller medications-on medication adherence and healthcare utilization and costs.

Study design: The study involved a quasi-experimental intervention versus control group design of insured patients diagnosed with asthma.

Method: After applying the inclusion/exclusion criteria for study participation, we obtained informed consent from the intervention group; those eligible to participate who did not return the forms served as the control group. The final sample size included 764 patients with asthma-298 in the intervention group and 466 in the control group. The intervention consisted of a reduction in copayment for select asthma controller medications from an average of $20 to $30 down to $5, as well as 3 mailings of educational materials for asthma management. Medical and pharmacy claims data for the study population were used to evaluate all study parameters and outcomes. Medication possession ratio was used to measure adherence to asthma controller medications. Statistical models were used to study differences in the 2 study groups during the 12-month follow-up period for adherence and cost outcomes.

Results: Participation in the value-based health management asthma program increased patients' 12-month medication adherence by 10 absolute percentage points in the intervention group (53.9% for intervention vs 43.9% for control group, P <.001) and significantly decreased average monthly medical costs ($170 intervention vs $229 control, P = .004). This increase in adherence resulted in greater monthly pharmacy costs ($181 intervention vs $124 control, P <.001). However, the increase in pharmacy costs was offset by lower medical costs, leading to a nonsignificant increase in average monthly total healthcare costs ($362 intervention vs $337 control, P = .276).

Conclusion: Adoption of a value-based health management program that combines patient education with lowered copayments has a positive impact on medication adherence, resulting in a reduction in associated medical costs and no significant increase in total costs.