By Katherine H. Capps, Co-Founder and Executive Director, GTMRx Institute
February 19, 2020
Optimizing medication use: Actionizing what works
Actionizing may not be a real word, but it’s what comes to mind as I reflect on what we heard from health care changemakers at our February 6 GTMRx Institute and Bipartisan Policy Center event in Washington, DC less than two weeks ago.
At the co-hosted event, “Get the Medications Right: Innovations in Team-Based Care,” we issued an important call to action to put the issue of sub-optimal medication use onto the national health agenda. Sub-optimal medication use happens when prescription drugs make you sicker, are wrong or are used incorrectly. And when it happens, it costs both lives and money—an estimated 275,000 lives lost and $528 billion every year.
Despite its significance, sub-optimal medication use—and the delivery system’s trial-and-error approach to managing medications that contributes to it—surprisingly hasn’t yet made it to the forefront of our collective conscious in the health care community or to Capitol Hill. Though GTMRx is committed to changing that!
Why this, why now?
Anand Parekh, MD, chief medical advisor at the Bipartisan Policy Center offered BPC’s perspective in his introductory remarks. “BPC has previously engaged in policy work on other aspects of medication therapy for example, our work leading to the 21st Century Cures Act, the increased access to new therapies for the American public and our most recent work on advancing ideas to improve the affordability of prescription drugs. However, this particular issue—the appropriateness of medications and whether the right patient gets the right medication at the right time— is one that we have come to realize deserves equal attention.”
Liz Fowler, executive vice president of programs for The Commonwealth Fund and former special assistant to President Barack Obama on health care and economic policy at the National Economic Council, put it this way in her keynote presentation, “Think about all the time we’re spending on drug pricing and looking at the amount that we’re spending on medications in this country, and right now, there’s a solution that’s under our nose that we’re not paying enough attention to.”
So why haven’t we been paying attention?
Another observation from Liz sheds some light here, “I thought that public policy had already weighed in on medication therapy management. I had worked on the Medicare Drug Bill in 2003, and medication therapy management was a required part of all Part D plans. And then the ACA extended the requirement to all Part D beneficiaries, including the long-term care setting. So I wasn’t sure how much more there was to do, but as I started digging into it and reading all the material and all the studies, it became apparent that there’s a lot more to do and further to go in this area.”
Why is it imperative that we take up the mantle on optimizing medication use when there are so many things about health care that need to be fixed – access and affordability, to name just two?
In his keynote, Greg Downing, DO, PhD, founder of Innovation Horizons and founding executive director for innovation in the Immediate Office of the Secretary of HHS, offered his perspective on our ability to deliver on the promise of personalized medicine. “Where we will be going in the next decade is really built upon the fundamental building blocks of biology, DNA, proteins and all the genomic data. That path to personalized medicine has not been an easy one, and there are important challenges and shortcomings with clinical implementation. The concept of individualization of medical decision-making is really fundamental to how people practice and work together, and this team-based approach is the right way to go.”
If you’re bought into the idea that we need system and practice transformation to optimize medication use, you have to be asking yourself, “where do we start?”
Susan Dentzer, MPH, senior policy fellow at Robert J. Margolis Center for Health Policy, Duke University, former editor of Health Affairs, facilitated a panel discussion with three leaders who represent a range of perspectives—the largest public health system in the country, an innovative integrated delivery system and a health plan. All are vastly different models with one important thing in common: they’ve adopted a team-based, person-centered approach to medication use that includes a medication expert on that team—comprehensive medication management.
Among what they’ve learned from their experiences:
“I can tell you in the spirit of health care being a team sport, we couldn’t serve the nation’s 9.2 million veterans who are enrolled in our system as well as we do without a fully robust team, including a pharmacist. Getting the medication right is important, and it is doable.”
—Carolyn Clancy, MD, Deputy Under Secretary for Health for Discovery, Education & Affiliate Networks, Veterans Health Administration
“An advanced reimbursement structure will probably make things a lot easier, but it’s also just getting folks to understand that they shouldn’t be looking at this part or that part, they need to look at the end game—in making people healthier, the total cost of care is going to be lower.”
—Jerry Greskovic, RPh, CACP, CDE, System Director, Ambulatory Pharmacy Programs, Enterprise Pharmacy, Geisinger.
“When people are on the right medicines, they reach their health goals. When they reach their health goals, the reason that we’re saving money is because they’re not ending up in the hospital. They feel good. They go to work. It’s a great story, and employers want their employees to be healthy. They want their employees to be able to go to work and do their work. And if they’re going to pay less in health care and have more productive employees, I mean how is that not a win?”
—Dan Rehrauer, PharmD, Senior Manager, Medication Therapy Management Program, HealthPartners (a Minnesota-based health plan)
What happens next?
Our morning at the Bipartisan Policy Center was just the beginning of a policy discussion kicked off in Washington, and we are committed to continue this discussion until real change happens.
To further our effectiveness, it is essential that through the GTMRx Institute we actionize the body of evidence and highlight best practices that have been in place throughout the country—be it systems of care, health plans or at the physician practice level—showcasing astounding results from implementation of a systematic, team-based, person-centered approach to medication use that assures access to a medication expert.
February 6 was our call to action to raise awareness among policymakers as they consider not only access and affordability but also the importance of appropriate use of medications as an essential component of optimizing outcomes and reducing total cost of care.
To again quote Liz Fowler, “By ensuring appropriate and personalized use of medications, including new gene therapies and personalized medicine, we have the potential to address a lot of the issues that we’ve been trying to address for many years in Washington.”
Next starts now
As a walk away from the morning public event, the GTMRx Institute also held an Executive Roundtable on February 6. Over 50 health policy influencers joined us for a candid discussion of how we should move forward to “actionize.” And in the coming months, we will put forth the GTMRx Institute Blueprint for Change, an important byproduct from that day, that will offer a path forward. This work is well underway, and in my next blog, I’ll share a sneak preview of top–level details and insights gained during our afternoon Executive Roundtable.
In the meantime, I invite you to take a listen to the recording of our February 6 event at the Bipartisan Policy Center. While I have only scratched the surface with this blog sharing insights of our morning keynote presenters and panelists, I urge you to listen to learn more directly from them as these insights are valuable to anyone who is ready to help get the medications right.