(Medical Director, Strategic Health Initiatives, GlaxoSmithKline)
She was wonderful I could have sat and listened to her for hours.
Chronic Conditions
the US health system is geared and aligned financially
-to focus on one problem at a time
-usually in a short office visit
-with no payment or system for coordination of care
-between my various doctors
-or education about my conditions
-for understanding all of medications, vitamins, supplements or perhaps my latest herbal remedies
How About Changing the Healthcare System
What if-the US health system is geared and aligned financially
-to focus on the person (patient centric) instead of just one problem at a time
-usually in a longer office visit by my primary care doctor
-with payments and systems for coordination of care
-between my various doctors
-to educate me about my conditions
-to educate me on all of my medications, vitamins, supplements and herbal remedies so I can make informed decisions to keep healthy
The Payment System for Primary Care must be fundamentally changed!
–Coordination of care activities, disease management, and enhanced access (such as e-mail correspondence with patients) must be reimbursed
- IT systems and practice infrastructure must change-advanced EMR’s, registries, interoperability of reports, e-prescribing, etc. must be in place to coordinate and deliver high quality care
Medication Therapy Management
In any given week, four out of five U.S. adults will use prescription medicines, over-the-counter drugs, or dietary supplements. Nearly one-third of adults will take five or more different medications.”
“Pharmaceuticals are the most common medical intervention, and their potential for both help and harm is enormous. Ensuring that the American people get the most benefit from advances in pharmacology is a critical component of improving the national health care system.”
Medication Therapy Management MUST be:
Patient-centered
•Consistent and systematic processes that:
–Assess all of the patient’s drug-related needs
–Identifies drug therapy problems
–Establishes therapeutic goals
–Designs a medication therapy care plan
–Conducts follow-up visits to evaluate progress
–Communicates information to the patient’s physician or provider
This was tried in Minnesota:
285 MTM patients and 252 comparison group –all BCBS Minnesota health members
An average 6.4 medical conditions and 7.9 drug therapies per MTM patient
Results
–Goals of therapy improved from baseline 76% to 90% after MTM
–2.2 drug therapy problems per patient identified and resolved –78% resolved without MD
–HEDIS Hypertension criteria achieved in 71% of MTM patients versus 59% comparison group
–HEDIS Cholesterol criteria achieved in 52% of MTM patients versus 30% comparison group
Total health care cost reduced by 31.5%post MTM from $11,965 to $8,197(drug costs slightly increased with 12% increase in Rx claims)
