Payers, Pharma, Startups

5 Blues plans launch pharmacy solutions startup Evio

Five Blue Cross Blue Shield plans provided funding to establish Evio, which aims to improve clinical outcomes and cut drug costs. It will initially only offer services to the founding health plans, including data analytics to determine drug performance and enhancing outcomes-based contracting.

Five Blue Cross Blue Shield plans have joined forces to establish Evio, a new independent pharmacy solutions startup.

The for-profit startup aims to rein in drug costs and improve clinical outcomes.

The founding insurers, who invested the same undisclosed sum, are Blue Cross Blue Shield of Massachusetts, Blue Cross Blue Shield of Michigan, Blue Shield of California, Highmark Inc., and Independence Blue Cross, which together provide coverage to more than 20 million members across the country.

Initially, Evio will offer services to each of the five investor health plans to complement the medication services they already offer, said Hank Schlissberg, Evio’s president and CEO, in an email.

These services include developing new and enhancing existing partnerships in the pharmacy and health IT arenas and leveraging data to ensure every patient gets the right medication when they need it.

“With access to blinded data, Evio will have the…evidence to show how a drug is actually performing for patients in the real world, across the drug’s indications, different patient types and combinations of other comorbidities,” Schlissberg said.

Further, Evio will support the move toward value-based care and focus on enhancing outcomes-based contracting in the pharmacy space, especially with respect to high-cost drugs.

“We talk every day about achieving the quadruple aim of healthcare — affordability, outcomes, patient experience and clinician fulfillment — through medications [and] it’s time to make good on those promises and begin to innovate so we can truly transform the pharmacy system,” Schlissberg said.

The startup will establish clear metrics to measure success, and eventually, it will start working with other health plans. Profits will be reinvested in new solutions.

Rising drug costs are among the most intractable problems in healthcare today. Total drug spending is expected to grow from about $500 billion in 2018 to $863 billion in 2028, according to recent estimates from the Centers of Medicare & Medicaid Services. Bringing down the cost of prescription drugs is also one of the few truly bipartisan issues in healthcare on a policy level.

But it remains to be seen whether Evio’s strategies will be successful in tackling those rising costs.

Take outcomes-based contracting, for example. The popularity of the model, where drugmakers and payers tie reimbursement to specific patient outcomes, has grown over the years, with 59% of payers saying they had such a contract in a 2019 Avalere survey. But there are several hurdles standing in the way of implementing these contracts, like expensive technology, outmoded infrastructure and regulations. Further, research says it is unclear if the contracting model is effective at reducing costs or improving quality.

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