Practice Transformation
Americans give health care cost and equity low scores
A plurality of Americans gives the U.S. health care system overall a poor or failing grade, and most rank affordability and equity the same way, according to the West Health-Gallup 2022 Healthcare in America Report. Care quality scored somewhat better. In all, 21% of U.S. adults grade the health care system with an “A” or a “B,” 34% with a “C,” and 44% with a “D” or an “F.” Grades of D or F are even higher for cost (75%) and equity (56%) of care. Meanwhile, 47% of Americans grade the quality of care in the US as excellent (A) or good (B). (Gallup announcement; West Health-Gallup 2022 Healthcare in America Report)
$13.8B opioid settlement could transform SUD treatment
Last week CVS, Walgreens and Walmart agreed to pay about $13.8 billion to resolve thousands of state and local lawsuits accusing the pharmacy chains of mishandling opioid pain drugs. In anticipation, the Alliance for Addiction Payment Reform (AAPR) made the case to use settlement funds for longer term sustainable solutions. For instance, clinical pharmacists will be part of the team the AAPR’s proposed Addiction Recovery Medical Home. In addition, American College of Clinical Pharmacy experts have authored an AAPR issue brief on CMM in managing substance use disorder. (Reuters; issue brief)
Evidence & Innovation
Keeping up with the research overwhelms doctors
The ever-increasing rate of medical innovation is driving physician interest in new data, but most (68%) often feel overwhelmed by the amount of information they have to keep up with, according to a report from Doximity. Perhaps not surprisingly, the survey found a preference for accessing information online, and they want it to be brief. Across all specialties when learning about new treatments, 66% of physicians reported an interest in learning about insurance coverage, and 95% wanted to review clinical guidelines. (Fierce Healthcare; Doximity report)
Early burnout?
Nearly a third of young physicians say they would not choose a career in medicine again, according to Medscape’s 2022 Young Physician Compensation Report. When asked to identify the most challenging part of their job, young physicians cited dealing with difficult patients (22%), long work hours (19%) and having so many rules and regulations (18%). Over 70% of young physicians said they spent more than 10 hours a week on such activities. The portion of young physicians who reported spending 20 or more hours on bureaucratic activities (38%) has spiked since 2016 (18%). (Advisory Board Daily Briefing; Young Physician Compensation Report)
Policy Solutions
CMS makes big changes to Medicare ACOs
Last week, CMS released the final 2023 Medicare Physician Fee Schedule. Among the notable changes: CMS will offer advanced shared savings to low-revenue ACOs and allow more flexibility for those that take on performance-based risk. CMS also finalized adjustments to ACO benchmarks to incentivize long-term participation. Regulators anticipate the changes will lead to $650 million in higher shared savings payments, Modern Healthcare reports. The changes “bring a win to patients and will absolutely help providers deliver accountable care to more patients,” National Association of ACOs President and CEO Clif Gaus said in a prepared statement. (Modern Healthcare; CMS announcement)
PBMs, insurers impose exclusions contrary to ACA
An investigation of five of the nation’s largest health insurers and four of the largest PBMs found that they impose coverage exclusions and other restrictions on birth control products, contrary to an ACA requirement. Under the ACA, health plans must cover FDA-approved contraceptive products without cost-sharing. But a staff report from the Democrats on the House Oversight and Reform Committee found insurers and PBMs required patients to pay some of the cost or otherwise limited coverage of more than 30 birth control products. (The Hill)
In Case You Missed It!
ICYMI: Advocating for Patient-Centered CMM Policy in the Government and Private-Sectors
Thursday, November 3, 2022 | Virtual and In-Person GTMRx Advocacy Meeting
Thanks to all who attended GTMRx’s Advocating for Patient-Centered CMM Policy in the Government and Private-Sectors event on Thursday, November 3, 2022 from 12:00 – 4:30 pm ET. You can find the event landing page with the attendees, read-aheads, and agenda here.
The goal of the meeting was to collaboratively develop a successful long-term advocacy campaign designed to implement sustainable payment and policy models that will support team-based, person-centered services to optimize medication use. We believe that this is best accomplished by advancing access to, and payment for comprehensive medication management, CMM. This meeting was to build upon our strategic recommendations for implementing CMM into the care team with sustainable payment and practice structures, which you can find here.
October 2022 Policy Update: ERIC & GTMRx’s PBM Transparency Advocacy Campaign
After a short September of work in Congress, House and Senate members are once again back at home, campaigning in advance of the November election. They’ll be gone throughout October, although congressional staff will remain here in Washington, DC most of the time. They’re working to prepare for November and December, wherein Congress will address some must-pass legislation and potentially work to clear the decks before the new Congress convenes in January 2023.
ERIC and GTMRx are still working hard behind the scenes to advance legislation to improve care for patients.
GTMRx Blog | Overcoming turnover, transitions and a troubled system: Making CMM work in long-term care
Getting the medications right can be a challenge for any patient. When it comes to seniors, however, teams face even more hurdles. Older patients are more likely to be sicker, frailer and on multiple medications, requiring knowledge, expertise and patience. But the greatest challenges for this population may be operational, not clinical.
GTMRx in Health Affairs | Underappreciated CMM is the missing ingredient to value-based models
Comprehensive medication management is the missing ingredient in value-based models, but despite evidence supporting its effectiveness and value, it remains underappreciated and underused, a group of GTMRx leaders write in Health Affairs Forefront. They highlight the evidence for CMM, including how it supports all five elements of the Quintuple Aim—including the newest aim, equity. Their a call to action: Align on the standardized definition of CMM “to promote well-defined CMM practice standards for consistent implementation, and to promote properly resourced CMM services in value-based contracting.” (Health Affairs Forefront)
New Report Available! Optimizing Medication Use for Accountable Care Success
A value-based care resource derived from an event sponsored by the GTMRx Institute & the Institute for Advancing Health Value
This report covers:
- Comprehensive medication management (CMM) in ACOs/ enhancing value
- The reported effects of CMM and pharmacy integration
- The key elements of success for effective medication therapy management programs
- Key issues impacting CMM success in ACOs, such as:
- Population health
- Social determinants of health
- Using data to transform care
- Change management/philosophy of practice
- Network expansion and clinical integration
- Accountability and relationship management
Read the report here.
Join us to be part of meaningful change
Irma, like many others, struggles as a result of our current trial-and-error approach to medication. That is why we advocate for a new, comprehensive approach to medication use and prescribing. As a non-profit 501(c)(3) and 501(c)(4) organization, the GTMRx Institute and Foundation relies on funding from our supporting members. We ask that you consider becoming a Supporting Signing Member so we can continue to provide relevant, timely resources to get the medications right!
If you’re interested in supporting the Institute or Foundation at a higher level, please contact us. Your dollars will bring about meaningful change for people like Irma.
AmazonSmile is an easy way for 0.5% of your qualified purchases go to the GTMRx Foundation at no cost to you. And signing up is simple—go to smile.amazon.com and select “Get the Medications Right Foundation” as your charity of choice. If you prefer to directly donate instead, you can do so here.
Adding the foundation on AmazonSmile will help us continue to provide no cost educational webinars, issue briefs, weekly news briefs and promote the need for transformation of our current system of medication use through social media campaigns.
