One in four respondents – including healthcare providers, hospital / healthcare system executives, payers, advocacy groups and academics – said the biggest problem was professional silos that prevent care integrated patient-centered. When asked what is the biggest problem in drug management in particular, most chose the lack of communication between prescribers and pharmacists – rather than the cost of drugs.
GTMRx Executive Director Katherine Capps says there are several reasons there is a lack of communication between these two parties. However, here are the most important reasons:
- Much of today’s communication is transaction-based and focused on a single drug between prescriber and pharmacist at the time of dispensing, not part of a continuous, person-centered, and value-designed process of care.
- Usually, the pharmacist is not part of the interprofessional patient care team.
- Most medical offices are either unwilling to contract or know how to leverage a pharmacist’s expertise in a patient care role. However, those who do would not work with complex patients (those with multiple chronic conditions, take multiple medications, see multiple prescribers) without the expertise of an ongoing pharmacist-led medication management program.
- Lack of interoperability: ideally, all members of the patient care team should have full access to all relevant health data the point of care. This is not happening yet for various reasons. Even if the pharmacist is part of the care team, he or she may not have access to a complete picture of a patient’s health (diagnostic results to target the correct therapies, medical history, all medications taken) . Likewise, a prescriber may not have access to a complete list of medications.
- HIPAA: Depending on the pharmacist’s relationship with a practice or healthcare system, HIPAA can be a barrier.
Capps noted that healthcare professionals are prevented from providing patient-centered services for a number of reasons. These reasons again include lack of interoperability, lack of time, and limited visits due to reimbursement.
Doctors spend about 15 to 16 minutes with each patient. That’s barely enough time to do a cursory examination, let alone talk about drugs, she said. One study found that about 5% of a 16-minute office visit involved the introduction and explanation of newly prescribed medications. Approximately 26 seconds were spent on the components recommended by the guidelines and 23 seconds on all other aspects of the medication.
Capps added tThe reason the tours are so short is the refund.
“As you know, we continue to pay for volume, not for value,” she said. “Payment systems are starting to evolve, but fundamentally they are based on fee-for-service (FFS) models. FFS models do not reward person-centered and team-oriented services designed to optimize medication use through a more comprehensive medication management process. . ”
However, the main discussion around the benefits of pharmacy centers around drug access and affordability, but the elephant in the room is proper use of all drugs, she added.
“We need to find a better way to optimize the use of drugs to avoid potentially fatal and unnecessary overuse, misuse and underuse,” Capps said. “Outside of discussions about the opioid crisis, the tragedy of drug misadventures is often not quantified or brought to the table. How can we manage the more than 10,000 drugs available on the market today without reorganizing the process of care towards a systematic, patient-centered and team approach? We believe, with the experts, that an evolution towards comprehensive medication management (CMM) is the way to get there. “
The survey also focused on the wide awareness and adoption of CMM, a systematic approach to drugs where physicians and pharmacists ensure they are individually evaluated to determine the suitability, efficacy and safety of each drug.
Although over 96% of those surveyed believe we need a more comprehensive and integrated way to manage medications, 44% said MWC is not well understood or not at all understood in their immediate network. And those interviewed know that CMM has the power to create achievable change; nearly 84% of respondents believe that widespread adoption of MWC could help stem the crisis of opioid addiction.
“The effects that widespread adoption of CMM could have are innumerable, but the need is particularly urgent for patients with multiple chronic conditions,” said Paul Grundy, president of the GTMRx Institute. “For patients who take multiple medications and see multiple physicians, CMM is arguably the best way forward as it improves medical outcomes by ensuring medications are used appropriately and effectively while reducing the total cost of medication. care. We have already seen proven success with MWC in large health systems like the Department of Veterans Affairs, but a complete and systematic overhaul will require buy-in from all angles possible.
Interviewees recognize that the road to revision may not be straightforward. Regarding the likely origin of the resistance, respondents largely agree: almost half cite resistance from medical carriers / PBMs to shift from managing drugs to providing a reimbursable care process as the biggest obstacle to wide adoption of MWC.
Conversely, the survey reveals that reflections on where to start – what should be the first step in changing the way we manage drugs – are almost evenly distributed: just over a third of respondents chose drugs. physicians working with pharmacists to help patients. achieved their clinical therapy goals, 31% chose access to point-of-care clinical information for all team members working with the patient, and 27% chose payment for CMM services.