Catalyst for Payment Reform

Cutting Costs: CHG Healthcare Carves Out Specialty Pharmacy

Cutting Costs: CHG Healthcare Carves Out Specialty Pharmacy

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CHG Healthcare and VIVIO Health Inc tackle the perfect storm of challenges when it comes to specialty pharmacy: out-of-control costs, lack of clinical evidence, and limited use of outcomes data.

Back in 2016, benefits staff at CHG Healthcare found a $174K charge in the monthly claims spend report. It wasn’t a mistake; it was the actual price for a specialty drug being used to treat a rare medical condition. Forecasting further costs without evidence of effectiveness, CHG Healthcare partnered with VIVIO Health Inc. to implement a specialty drug carve-out plan that covers both pharmacy and medical benefit drugs. Since 2017, CHG Healthcare has saved a net $4.4M through the program even with zero out-of-pocket costs for plan participants paying for specialty medications. Hear directly from Anne Hopkins, Director of Benefits and Wellness at CHG Healthcare, and Pramod John, CEO & Founder of VIVIO Health Inc., on how a focus on outcomes and individualized care can lead to savings.

This event is part of CPR’s Fall 2020 Webinar Series: Timely Topics with Innovative Purchasers.

Originally recorded on November 12, 2020.

For more insights on this topic, check out this event from our 2019 Policy Webinar Series: State Laws Addressing Pharmacy Prices, featuring Katie Gudiksen, Senior Health Policy Researcher at UC Hastings, discussing state laws addressing pharmacy prices and the utilization of these laws in driving higher-value in health care. In addition, find out how CHG Healthcare innovates in other ways by reading CPR’s case study Enhanced Access with Telehealth: CHG Healthcare, to learn about the telemedicine services program that CHG Healthcare implemented to address the health care needs of their traveling clinicians and corporate staff.

Please note that these and other CPR resources are always free to those who purchase health care on behalf of a population. If this description matches your role, be sure to create or log into your account for free access.

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