In financial year (FY) 2018/19, National Health Service
England (NHSE) spent almost £8 billion on drugs prescribed by general
practitioners to their patients. This level of expenditure has decreased by
nearly 2.7% from FY 2017/18.
The reduction in prescription drug expenditure is driven
by a combination of lower average costs and lower levels of activity. The per
person per month (PPPM) costs for central nervous system, endocrine and
respiratory conditions have decreased, largely driven by a reduction in the
average cost per item. Cardiovascular system drugs, however, have experienced a
PPPM increase driven by a 3.2% increase in cost per item.
In this paper, Milliman’s Joanne Buckle and Tanya Hayward investigate the drivers of the PPPM trend at a drug class and regional level using actuarial principles.
The availability of real-world data (RWD) and the recognition of its value are on the rise, both in the UK and overseas. RWD is described as data relating to patient health status or the delivery of healthcare collected during the course of clinical care and captured in a variety of data sources, such as administrative claims, electronic health records and product and disease registries.
Real-world evidence (RWE) is generated through the analysis and/or synthesis of RWD and can identify the effects of healthcare interventions, such as benefits, risk or resource use, that are not routinely collected during randomised control trials (RCTs). RWE may enable research that is not possible to model using RCTs but that may be possible through RWE and pragmatic trials.
When considering the use of RWD, a number of questions
should be kept in mind from the outset and initial decision-making phase on
whether or not to use RWD right through to the analysis and producing results.
This paper by Milliman’s Joanne Buckle and Tanya Hayward outlines some of these key considerations associated with using RWD to widen the evidence base in economic evaluations. These considerations are discussed with a focus on the English National Health Service (NHS) but apply more generally to any healthcare system considering the use of RWD.
Actuarial skills are immensely relevant in regional National Health Service (NHS) environments and can be used to inform the design of risk-based accountable care system (ACS) contracts. An article in The Actuary by Milliman’s Joanne Buckle and Tanya Hayward highlights their recent experience helping to develop an ACS within a subsegment of the NHS encompassing a small number of clinical commissioning groups and local councils.
In healthcare, return on investment (ROI) can be used to measure the effectiveness of various disease management programmes. ROI provides a framework to help determine whether additional funds should be allocated to a particular activity or alternatively whether these funds should be withdrawn and allocated elsewhere. The rapid uptake of genetic testing within the National Health Service (NHS) and current debate around genetics make evaluating tailored interventions increasingly more relevant to ensure an efficient use of NHS spend. Milliman’s Joanne Buckle and Didier Serre provide perspective in this paper.
Capitation arrangements are traditionally used as an alternative to fee-for-service reimbursement to facilitate a transfer of risk from the funder to providers of healthcare services. The objective of introducing risk sharing between funders and providers is to encourage the delivery of efficient and patient-centred care by incentivising the integration of services and minimising unwarranted variation in care. This paper by Milliman’s Joanne Buckle and Tanya Hayward explores how the principles of a traditional capitation arrangement may apply in a regional National Health Service system where the stakeholder roles differ and the implementation of various key capitation principles is not possible.
The United Kingdom’s National Health Service (NHS) and the United States’ Medicaid program both provide publicly funded medical services to a broad population. The general goal of both is to find a balance of quality and efficiency that promotes access to appropriate and financially sustainable medical care. This article written by Milliman consultant Jennifer Gerstorff and Northampton General Hospital’s Chris Pallot explains the history of both programs. The authors also compare and contrast how the programs are funded, how providers are contracted, and how innovations are changing each system.