Accessible Media Transcripts

What Sets Navitus Apart

21:59 runtime version

00:00 [Audio Description Voice Over]: Dr. Mark Huth, President and CEO of Group Health Cooperative, joins us for an insightful Q&A session. What drives Group Health Cooperative?
00:10 [Dr Huth]: The thing that keeps me here at Group Health is the fact that we’re really focused on providing exceptional care and service at an affordable price, and that really is the thing that drives us. And it’s the thing that brings me into work everyday. And I really think this is a fantastic model for driving high quality healthcare that patients are able to access and they’re able to afford.

00:33 [Audio Description Voice Over]: What’s the impact when member experience and outcome are prioritized?
00:37 [Dr Huth]: I think that this is actually one of the solutions to the crisis we have in healthcare here in the United States. I think by focusing on patients, and by delivering care in the place that they need it at the time that they need it and at a price that they can afford, I think that’s really the key to having good outcomes for patients. So it’s really exciting to be part of this model and really see the way that we put the patient at the center of all that we do.

01:00 [Audio Description Voice Over]: What was your previous experience with PBMs like?
1:04 [Dr Huth]: Early on, other PBMs that we worked with were really a headache for
us. There was no transparency.  We knew that money that should have been going to network pharmacies or should have been coming back to us was being gobbled up and skimmed off the top, and there was really no vision or no transparency as far as what they were doing.    
The other thing was we have a very talented Pharmacy Administration team that really works hard to review evidence and make the best recommendations for formulary and how we tier our medications. Their input was basically ignored by previous PBMs. It was “our way or the highway,” there’s no flexibility “we don’t really want to know your opinions on things” “this is what you need to do,” and so to say that our relationship with previous PBMs was strained is an understatement. It was a constant headache and a constant frustration
to us.
 
02:00 [Audio Description Voice Over]: How would you describe the unique impact a PBM has on individuals across a partner organization?
02:08 [Dr Huth]: I’ve had the opportunity to interact with Navitus in a number of different roles here. First, as Chief of Staff, then chief medical officer, and then as president and CEO. And the things that have really stuck out for me is how different Navitus is from other PBMs. There’s great transparency, so we see a very open model. We know exactly where the costs are, what money is going where. And we don’t have the same concerns that we had with other PBMs. We have a very, very high level of comfort with what Navitus is doing. The other thing that really sticks out is it’s a very collaborative relationship. Navitus comes to us with their best recommendations based on evidence and based on best practices and outcomes that they’re seeing, and they sit down with our team and they really want to know what we see as well, and so it becomes a very open dialogue about what opportunities are out there and what are the best choices that we can make for our patients.
Navitus also understands that our patient population may be different than another patient population, and so there’s a flexibility for us to make decisions based on what is best for our market. That is completely unprecedented when you look at the relationship we’ve had with other PBMs in the past.
 
03:37 [Audio Description Voice Over]: Are certain groups or roles more heavily impacted by a PBM, and what are the implications?
03:42 [Dr Huth]:  Yeah, the partnership benefits a lot of people here. so it could start with our Pharmacy Administration team. The people who work here at Group Health Cooperative feel very much that they are listened to and appreciated and that their opinions are heard and taken into account, but it extends to everybody. So our Care Management Department, our utilization management department, and the providers who do the prescribing — they feel this open line of communication as well. So when providers have questions as well, we can work both with our internal Pharmacy team and then also with Navitus to make sure that the best decisions are made for our patients. So, in that way Navitus touches a lot of levels of our organization and a lot of departments in a very, very positive and productive way.
 
04:33 [Audio Description Voice Over]: Were other PBMs effective in meeting those needs and building strong, empowering partnerships across the organization?
04:39 [Dr Huth]:  I would say past PBM relationships were not at all responsive to the needs that we had as an organization, or the needs that our providers and our patients had. In fact, there was a lack of flexibility or a lack of understanding, so when we had an issue that we needed their help on, we would call [and] often not be able to get anyone on the phone. Or if we could get someone on the phone we would explain a situation, there would be a promise that there would be somefollow up, and then we would never hear from them again. Email after email went unanswered. Phone call after a phone call went unanswered. And  it was a huge headache because we really felt that we were not important at all and the issues that we were having really didn’t even get on anyone’s radar screen. Our experience with Navitus has been 180 degrees in the other direction. Phone calls are answered right away. Questions are fielded, answers come back to us, [and] there’s a very collaborative spirit of “we really want to help you work through this,” so it’s been just tremendously rewarding to have a relationship with Navitus where our questions are really important, the issues that we face are really important, and they’re working side by side with us to come to the best solution.
 
06:01 [Audio Description Voice Over]: What role should a PBM play and what should that partnership achieve?
6:06 [Dr Huth]: The pharmaceutical industry is so amazingly complex, and there are so many different factors and so many moving parts, it’s hard to stay on top of them. So I think a PBM really needs to be advocating and working on their end of the business to find the best alternatives
for medications and the best decisions as far as our pharmacy network. And then working collaboratively with us to help design a formulary and the kind of programs that we have in place that really influence and help prescribers get to the right medicine for a patient in the right setting.
So, I see it very much as a collaborative partnership. We’re very close to the actual individual patient encounter and the individual prescribing decision, and the PBM is looking I think more at the business of the pharmaceutical industry and how we get the medications to the patients who need them at the best price possible and using the best formulary decisions and best prescribing decisions possible so that we really drive value for the patient. Which is really what we want to do. We want the best medications made available to patients in an affordable way.
 
07:28 [Audio Description Voice Over]: What’s your experience with Navitus been like these past 10 years?
07:32 [Dr Huth]:  Well, it’s been night and day. We went from a PBM experience that was a constant frustration to a PBM experience with Navitus, where we felt like we had a true partner that was working hand in hand with us to deliver the best value to our patients. So, our experience with Navitus has just been fantastic. It’s been very collaborative [and] very open. We have felt a great responsiveness to our needs and we felt that we have someone else working with us to deliver the best value to our patients.
 08:10 [Audio Description Voice Over]: What sets Navitus apart from other PBMs?
08:12 [Dr Huth]:  We’re in the business of delivering the highest quality Health Care to our patients at the most affordable cost, and that’s really the thing that drives us. What sets Navitus apart from all other PBMs that we’ve experienced, is they are very much aligned in that mission with us. In fact, when we talk to Navitus at any level of the organization, from their president and CEO down to the account representatives, they all say the same things that we do. We’re all speaking the same language and we have the same goal of providing the best level of care and service to patients, so that’s really been a remarkable difference in our relationship with Navitus. We feel that we have a partner that is doing the same work and has the same mission as we do.
 
09:03 [Audio Description Voice Over]: How important is it to have a PBM partner who aligns with your goals and shares your commitment to quality of care?
09:19 [Dr Huth]:  I often think that business relationships are often like marriages. So, when you come together, it works best when you both have the same goals in mind and you have the same approach and the same ideals. And that very much has been our experience with Navitus. We’re both working for the same thing.  And if we’re both working for the same thing, then conversations become much much easier. It’s like we don’t have to convince our PBM to work for value or doing the best for our patients because that’s what drives Navitus in the first place, and when you have that alignment between organizations, it’s like that good marriage where you’re both working for the same thing, you both want the same outcomes and so then the work becomes that much easier.

09:58 [Audio Description Voice Over]: What difference does an aligned partnership make for member experience and your organization when the focus is on supporting your goals rather than chasing rebates?
10:10 [Dr Huth]: The decision to move from Humira to a bio similar is a great example of the flexibility and the collaboration that we have with Navitus. We and our internal pharmacy team did a lot of study on this and did a lot of research to determine whether biosimilars could provide the same benefit to patients as Humira, and when we came to the realization that yes it was the appropriate move to make we decided we wanted to move very very quickly. We actually wanted to move to biosimilar before Navitus recommended it by about six months, but this is an example of the flexibility and the collaboration. When we had conversations with Navitus about the fact that we wanted to move sooner to a biosimilar there was great support for that, and there was great understanding. That’s a very different experience than we’ve had with other PBMs. Other PBMs would say, “this is our formulary” that “we are not going to allow you to change it at all” and “we don’t really care what you’re looking at”. In this case, Navitus heard our rationale for moving quickly to a biosimilar from the brand name Humira, and they supported it and said “we understand exactly what you’re seeing and we’re going to allow you the flexibility to make that decision for your formulary” even six months before we are going to take it off the formulary that we offer to our clients. That kind of flexibility is just part and parcel of the very
collaborative, very productive relationship we have with Navitus as our PBM.
 
11:51 [Audio Description Voice Over]: How would your experience have differed if you had worked with a traditional PBM focused on rebates instead of Navitus?
11:57 [Dr Huth]: Other PBMs really are very inflexible, and in my experience, any modification or any custom changes to formularies– especially as they affect rebates and income for the PBM — really were not allowed. So, there was no flexibility for us to make decisions based on what we felt was best for patients in our particular market. That was one of the very frustrating things in our experience with other PBMs. That we saw opportunities to deliver better value and better care to our patients and yet we didn’t have the flexibility to make those choices. That is radically different with Navitus. Navitus is a  very strong collaborator, is a very, very strong partner that understands that not every market is exactly the same. And not every prescribing situation is the same. With our relationship, we have that flexibility and that understanding and that collaborative partner that really helps us do the best we can for our patients.
 
13:06 [Audio Description Voice Over]: GHC has received almost $71 million in rebates from Navitus. How does that impact GHC and your members?
13:13 [Dr Huth]:  Rebate dollars that we receive through work that we do with Navitus, it really has a very material impact on our bottom line. We operate as a non-for-profit, so we use those rebates to lower the cost that we pass on to our patients. And that’s really the critical difference. This doesn’t become a profit margin for us or something that we use to pad our coffers or to increase the profit we put on the bottom line — rebates and many other things that we experience with Navitus that help keep those costs low, that results directly in lower premiums and lower out-of-pocket costs for our patients. And that’s a critical thing because we want to take down every barrier that we can that keeps patients from accessing the care that they need and that they deserve.
 
 
14:11 [Audio Description Voice Over]: How has Navitus supported and facilitated the member lives at GHC, particularly in Commercial and Exchange?
14:20 [Dr Huth]:  When you look at medical costs in general, pharmaceutical costs are a major driver of the cost trend that we see. And that cost trend translates into the amount of premium that patients need to pay, the amount of out-of-pockets that they have, or what they’re deductible maybe that they have to meet every year. So, the higher the cost, the more that people have to pay out of pocket, the less that they bring home in their salary because the more they have to contribute to their premiums as an employee and then also the more that they have to come up with when they go in to see their provider or end up in the emergency room or the hospital. So, these costs actually become a huge barrier for patients, and they actually end up driving higher cost down the road. Our work with Navitus to keep our pharmaceutical spend as low as possible really allows us to provide the lowest cost possible to our patients. That’s good for our organization because that means that we’re very competitive in our markets and we are able to offer a product that is very, very appealing and very affordable. But it also allows our patients to be able to access the care that they deserve, and that’s really what it’s all about.
 
15:40 [Audio Description Voice Over]: How do the program offerings at Navitus complement GHC’s in-house experience?
15:47 [Dr Huth]: With Navitus and the various programs that they offer, what’s really remarkable about the relationship is we can sit down with them and decide collaboratively which things do we do better in house, or does it make sense for us to continue doing in house, and which things can we rely on Navitus for. With past PBMs, it was very cookie cutter, one size fits-all.  “We ‘re going to do these things and you are not involved in them,” so it was very inflexible and it often did not allow us to really play to our strengths. With our pharmacy administration team that works here internally, we have a lot of bench strength and we have a lot of experience, and our relationship with Navitus has been very different from past PRMs in that we can sit down and have a discussion about what things does it make sense for GHC to do internally and what things does it make sense for us to rely on Navitus and their bench strength and their influence and their expertise. So that’s another place where that collaboration between the two organizations has been really fundamentally different and extremely positive for us.
 
17:09 [Audio Description Voice Over]: Access Guidance has saved over $3.3 million in just the first six months of this year. What led to the decision to add this program and what impact has it had?
17:20 [Dr Huth]: Access Guidance has been really a positive experience for us and it’s another example of where Navitus came forward with a program that could assist us and could help us keep our costs down, and also provide the best medications for the best outcomes for our patients.  So you know, it’s a really great thing that we have a PBM that continually looks for opportunities to serve us and our population at a higher level, and so it’s been a great program for us. And it’s actually one that we’re looking to expand with Navitus in the future.
 
 
17: 58 [Audio Description Voice Over]: As healthcare costs rise, what has GHC done to manage overall costs and keep member premiums and out-of-pocket expenses lower?
18:08 [Dr Huth]: The fact that our pharmacy trend is well below the national average in the time that we’ve been with Navitus really speaks to everything we’ve been talking about. It speaks to the collaborative relationship. It speaks to the shared vision of providing the best medications and best outcomes for patients at the lowest possible cost. That can’t be seen in other any other way as powerfully as it’s seen in what our pharmacy trend has been, and the fact that we’ve been well below the industry average since switching to Navitus, I think really underscores the power of the relationship and the power of the work that’s going on. We talked a lot about rebates, and Navitus works very, very hard to help us get rebates, but that’s not all of the story. Navitus helps us work to get the lowest possible unit cost for every medication that we
prescribe — sometimes that involves rebates, but other times it does not. And it’s more of a question of “what are we going to have on the formulary and at what tier” and “how do we support the prescribers and the patients so that they get the best medication at the lowest possible cost”. That’s a radically different relationship we have with Navitus than we’ve had with other PBMs in the past.
 
19:28 [Audio Description Voice Over]: What advice would you give health plan executives shopping for a PBM partner? What should they prioritize?
19:35 [Dr Huth]: I would say for anybody who’s looking at switching their PBM, the thing to know is that Navitus is radically different from other PBMs that you may have experienced. Our  experience with Navitus compared to other PBMs before, it really speaks to that. And other Navitus customers say exactly the same. This open model, the pass-through pricing, and the collaboration at all levels of the pharmaceutical industry and all levels of the relationship that we have with PBMs — it is radically different and so positive with Navitus, and that’s really been a remarkable difference that we have noticed over our entire relationship with Navitus. I think for anyone who is considering Navitus as their PBM, the thing that I would say is the things that they’re telling you are correct. Navitus does return your phone calls. They do respond to emails. They work very collaboratively with you and they do have an open model, so that you know exactly what you’re paying. you know exactly where the money is going. And you have a partner that is going to work with you to keep costs as low as possible while also providing the best possible outcomes for patients.
 
 
20:59 [Audio Description Voice Over]: What’s kept you and your organization with Navitus for over a decade?
21:03  [Dr Huth]: The fact that Navitus is able to fulfill its promises to us as far as being a great partner, being responsive to our needs, being understanding of the needs of our market, and the fact that we have this experience with Navitus time and time and time again makes them a very, very cherished and very, very important partner to us. Other PBMs are just not able to provide the things that Navitus can provide. Navitus is very unique in the industry because of that, so the reason we stay with Navitus is they fulfill their promise to us time and time and time again, and with Navitus, we have a partner that really allows us to achieve the goals that we have as an organization — especially as a nonprofit health plan that is really focusing on doing the very best for its patients.