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By Katherine H. Capps, Co-Founder and Executive Director, GTMRx Institute

March 4, 2020

The Path to Optimized Medication Use: What the Changemakers Say

How do you follow up a landmark event with the Bipartisan Policy Center to issue a national call to action to get the medications right?

For the GTMRx Institute, you bring together an elite group of health policy influencers, fuel them with coffee and food and invite a seasoned health policy veteran to lead a robust dialogue on how to make change happen.

And what a discussion it was! Susan Dentzer, MPH, senior policy fellow at Robert J. Margolis Center for Health Policy, Duke University and former editor of Health Affairs expertly facilitated a marathon roundtable discussion with GTMRx Institute board members, workgroup leaders and over a dozen senior leaders representing the primary stakeholders who are not just shaping health care delivery and payment policy, they are driving the system-wide transformation that is happening in physician practices, health systems, health plans, government agencies and other settings across the ecosystem. They were invited to participate because they understand first-hand the levers we’ll need to pull in order to change the paradigm from our current trial-and-error approach to medication use to one that ensures appropriate and personalized use of medications and gene therapies.

This discussion took place immediately following the event we co-hosted with the Bipartisan Policy Center on February 6, “Get the Medications Right: Innovations in Team-Based Care.” ICYMI, I shared highlights of the event in my February 19 blog. You also can watch a recording of the event here.

The agenda for this executive roundtable was designed to inform the development of the GTMRx Institute Blueprint for Change, which will offer a path forward to achieve our goal of optimized medication use. As we prepare the Blueprint for release later this year, here are some of the insights and guidance shared during our discussion on four key elements of system change.

On practice delivery, integrated care and system transformation…

“MACRA and MIPS in 2019 was the game changer. It has nothing to do with the ACA, and many physicians don’t understand that, and it’s all about outcomes. And what I would suggest to this group is to think about the information asymmetry that most providers are experiencing out there. We may be able to maximize what is already in place and get rid of some of this information asymmetry that most of us are working in and find out how that would benefit the people delivering care to improve the outcomes of the patients, which is the ultimate goal.”

“I look at how much resource goes towards engaging patients to check boxes, and it’s an amazing amount of resources for very, very little value in many cases. So, what if all of those resources are going into improving diabetes, improving vascular health, improving all of the things that we know that we can do? I think we need to put a lot of focus on the things that we know that we do and getting them inserted into the programs that already exist.”

On payment and policy reform…

“Right now, we have a lot of ambiguity in payment structures and ambiguity in regulatory language. The scope of practice must be replaced with concrete definitions and a guidance to show everyone here’s how you do it, here’s the way. We must conceptualize value-based payment models that will incentivize integrating a medication expert into the care team together with all of the other supporting activities needed to optimize medication use.”

“Shared risk and shared decision-making will be an important way that members of the care team engage around optimizing medication use.”

On health IT and AI…

“Everybody talks about fragmented data in health care. The reality is that we do have a lot of clinical information on there, we simply can’t aggregate it all together and get it to the right people at the right time. That is a real challenge that we have, and because comprehensive medication management (CMM) is a team-based approach, it’s really incumbent upon us to come up with ways to incorporate that information together and deliver it.”

“We’ve heard a lot about practice fidelity. It is essential. And if we have a system that’s more integrated and more purpose built, specifically to handle or to manage CMM and some of the other activities that build in the workflow specifically, we can do a lot more on value measurement and also consistency.”

On precision medicine and pharmacogenomics…

“We really need to make sure that we have an elevated level of awareness with regards to these precision medicine technologies so that we are supporting providers at the point of care. It’s an immense amount of information, and we need to ask how we can support providers so that they can assimilate all of this into their practice. Information technology specifically looking at precision medicine is critical. We need to have solutions where we can bring that data into the electronic medical record in a discrete format.”

“Looking at patients, we need to make sure that we have some general genomic literacy amongst patients so they are able to understand these technologies and what they may mean to their clinical care.”

And finally, on managing change…

Change management was a current running through every part of the discussion. Participants around the table shared lessons learned and how we can apply successful strategies to the challenge in front of us.

“The biggest problem in all of this is culture or change management. You typically look at these things in four quadrants. The first group of people are the diehard supporters. They’re not waiting for the rest of us, they are off and running. They help set the benchmark, get the message out and advocate, showing everybody else what they’ve done. The second group is really willing to go with you, but they want to make sure the first group doesn’t die, so they need to hear your story over and over again to give them confidence. They’ll be okay when they step out. The third group will eventually go with you, but you have to kind of nurture them—spend a lot of attention with them. You have to convince them of the business cases and the ROI. Get everything they need to hear based on wherever they’re sitting, so they will move. That’s the group you spend the most time with, not group one and two, but group three. Group four is never, ever, ever going, so go without them.”

I’m grateful that our discussion was filled with people who fall into the first group of “changemakers” in their respective areas of health care. They graciously shared their time, knowledge and learnings with us – input that we will be bringing forward in the GTMRx Blueprint for Change and our ongoing work to execute the blueprint together with stakeholders across health care.

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