On October 1, MedBen Chairman and CEO Kurt Harden spoke on the topic “A Third-Party Payer’s Approach to Providing Quality Care While Minimizing Cost” at the 2024 Ventegra Client Conference. Ventegra serves as MedBen Rx’s pharmacy benefits partner.
“As a third-party payer, MedBen is not in the business of determining care… rather, we determine payment for care,” Harden observed. “That said, the best quality care is the appropriate care as early in the process as possible, such as early detection and treatment of cancer, heart disease, and diabetes. Or by using precision medicine to match a patient suffering from a mental health condition with the right medication.”
Although the conference was focused on pharmacy, Harden spoke primarily about methods of managing health care spend. “While MedBen clients view clinical claim reviews, cost containment plan language, and prevention-based wellness programs as commonplace, they are not as widespread as might be expected,” he explained.
Throughout his presentation, Harden highlighted some of the ways that MedBen uses its role as a third-party administrator to maximize care while minimizing cost, such as reducing chronic care occurrences through proactive wellness, addressing high medical costs by implementing alternative reimbursement strategies, and using forensic claims review instead of auto-adjudication to ensure proper payment for the right care.
As for solutions to keep prescription drug spending in check, Harden spotlighted the potential for pharmacogenomics to improve efficacy and lessen adverse events. “Genetic variations can cause different results in individuals taking the same medications – some patients may see benefits with no toxicity, while others just get the side effects but no benefits whatsoever. Pharmacogenomic testing uses a patient’s DNA to produce better outcomes and minimize trial-and-error,” he said.