In an effort to control the rising costs of healthcare, a payment and delivery model called Managed Care Organizations (MCO) came into prominence in the 1990s. This system attempted to control costs by limiting access to care by using physicians as gatekeepers, requiring patients to get authorized referrals for many procedures, with success being measured through financial outcomes. When MCOs authorized a healthcare service, there was often no mechanism in place to measure the quality of that care after it was delivered. Essentially, MCOs were funding systems managed by insurers, rather than healthcare professionals, and frequently frustrated physicians and patients alike.
The recent rise of Accountable Care Organizations (ACOs) has led to a new direction in healthcare – a synergistic approach to medicine with a physician-managed, patient-centric approach. The Centers for Medicare and Medicaid (CMS) defines ACOs as “groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to their Medicare patients. When an ACO succeeds both in both delivering high-quality care and spending health care dollars more wisely, it will share in the savings it achieves for the Medicare program.”
ACOs have distinct philosophical and financial differences from MCOs—simply stated, Managed Care Organizations manage care. Accountable Care Organizations are accountable for the care they deliver.
|Managed Care Organization||Accountable Care Organization|
|Administered by insurers||Administered by physicians|
|Cost containment||Health management|
|No measurement||Measure health endpoints through multiple data points|
|Success defined by financial outcomes||Success defined by healthy outcomes and patient satisfaction delivered in a cost-effective way|
While primarily focused on Medicare patients, the recent successes seen in ACOs have encouraged some private sector pilot programs. As of March 2013, there have been 449 ACOs and ACO-like entities (sponsored by hospital systems, physician groups, insurers, and community organizations) identified, and an estimated 14 percent of the U.S. population being served by an ACO. It’s noteworthy that some hospital networks have walked away from the ACO designation for various reasons.
ACOs are changing the healthcare landscape, so it’s important to understand which physicians and pharmacists are participating in an ACO and how their information needs are evolving. How do these changes impact the way pharmaceutical brands reach and deliver information to physicians?
Because an ACO is accountable for 100% of the care and expenses of the patient population under their care, physicians are interested in more than specific clinical information on one brand at a time. They are looking for broader health economics information that can provide value to the organization – proactively seeking information that shows long-term outcomes that cut down on costly ER visits and hospitalizations. These practitioners are taking a portfolio approach, creating organizational formularies that help keep costs down, but may restrict individual physicians within their network from prescribing as freely as they did before joining the ACO. Therefore, targeting decision-makers for marketing messages will be essential.
It is important to ensure the brand message be tailored to this audience, providing information focused on patient outcomes and cost, as ACO and MCO professionals have to weigh not just specific brand efficacy and safety, but the cost of care in the long-run. In additional to cost and outcomes data, decision makers also look at the additional benefits a particular product provides patients. Does a diabetes product provide an app that monitors a patient’s glucose level? Does one product offer significantly higher co-pay discounts vs. competition? All this goes into formulary decisions, which can have significant impacts on brands.
It is valuable for brands to dedicate a specific section of their owned media to ACO and MCO professionals. If proprietary health economics resources are housed on a specific website, utilizing both print and digital media can effectively drive the correct audience to these resources. CMI’s ByDoctor research has indicated that managed care professionals are open to registering at a brand’s website in order to gain access to robust solutions that enable value-based decisions. Banner ads with relevant messaging and calls-to-action on relevant sites (i.e. MHE, AJMC, etc.) will help bring qualified physicians to interact with content that improves the overall patient experience or reduces cost, such as apps to assist with adherence challenges, with the intention of considering including the brand in their formulary.
While traditional media is important to promote awareness and connect professionals with brand content, in many ways the messaging needing to be articulated is too complex to communicate via traditional media. Brands will succeed by reaching out to these professionals with richer and more complex discussions about the cost/benefit of their brands. Online learning modules, e-details, email and customized direct mail can communicate far more complex messages to these professionals. Paid search is a very effective and cost efficient means of capturing hand raisers, and can target through keywords and text ads carefully designed to resonate with this audience.
By using sophisticated targeting, and communicating key product benefits, competitive cost analysis, long-term product benefits and patient financial support, brands can have greater impact on ACO and MCO decision makers.