cardiology industry is undergoing rapid change as control over cardiology
practices shifts from independent practices to ownership by hospitals.
According to a September 2012 report by the American College of Cardiology, the
percentage of cardiology practices owned by hospitals has tripled in five
years, from 8% to 24%, while the percentage of cardiologists employed by
hospitals increased from 11% to 35%. MCOs similarly have begun to buy physician
groups but to a much lesser extent. The result from MCOs’ standpoint is higher
costs because services rendered at hospital-owned outpatient facilities have
higher fee-for-service payments. In addition, this trend may influence which
formulary is followed by cardiologists and likely will affect patient shares of
specific brands used to treat acute coronary syndrome (ACS) and atrial
fibrillation (AF). Similarly, MCOs are increasingly adopting narrow networks—subnetworks
that offers beneficiaries lower premiums or cost-shares—a move that would
likely give MCOs greater control over prescribing.
report explores how the fundamental reshaping of the cardiology ownership model
as well as other major trends under way are affecting brand prescribing in
high-profile cardiology indications. Specific therapies examined in this report
include the following:
- Boehringer-Ingelheim’s Pradaxa.
- Bristol-Myers Squibb/Pfizer’s Eliquis.
- Johnson & Johnson’s Xarelto.
- Eisai’s warfarin.
- Sanofi-Aventis’s Multaq.
- Eli Lilly’s Effient.
- AstraZeneca’s Brillinta.
In this report, we analyze survey findings from 102
non-interventional cardiologists as well as 40 MCO pharmacy or medical directors.
By understanding recent trends in ownership structure of cardiology practices,
drug marketers can anticipate the long-term impact of provider consolidation on
prescribing and develop effective responsive strategies.
Questions Answered in This Report:
percentage of surveyed non-interventional cardiologists is currently employed
by a physician-owned group, a hospital, insurer, or other entity? How will that
change in the next year? What is driving that change? For what percentage of
their patients do these physicians prescribe to the patient’s insurance
formulary versus a hospital formulary or other? How will that change in the
specific therapies used to treat ACS or AF have physicians seen increased or
decreased use because they changed from an independent group to hospital
ownership? What do they anticipate will be the change over the next year? Have
they found the hospital formulary to be more or less restrictive than the ones
they encountered as an independent physician? How has ownership by a hospital
affected their prescribing of newer ACS or AF therapies? How are these
therapies’ uses encouraged as part of the practices’ new ownership? Do they
view this change as positive or negative?
MCOs seen consolidation among their cardiology network? What has been the
impact on prescribing, drug trends, and overall cost trends for cardiology?
What are they doing in response? Have MCOs purchased or plan to purchase any
cardiology practices themselves? What is driving this desire to own physician
practices? What has been the impact on their prescribing and drug cost trends
versus non-MCO-owned practices? What brands have seen increased or reduced
prescribing within surveyed MCOs’ plans? How does this trend influence their
operate a narrow network? If so, why and when did they adopt them? How narrow
is this network? What inducements are there for a beneficiary to join such a
plan (lower premiums or lower copays)? What has been the impact of these
networks on prescribing and the overall drug cost trend? Are cardiologists
participating in a narrow network? If so, why did they join? If not, why not? What
has been the impact on their prescribing of specific brands or therapies? Do
they view narrow networks as a positive or a negative?
102 non-interventional cardiologists (47 in hospital-owned practices and 55 in
independent practices), 40 MCOs (19 pharmacy and 21medical directors).
Disease focus: ACS
and AF, acute and post-hospital.