The Impact of Government Policy Directions on Medication Adherence


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Presentation By Greg Caressi, Frost & Sullivan.

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The Impact of Government Policy Directions on Medication Adherence

  1. 1. 6 th Annual Patient Adherence Congress Interactive Discussion HC Reform, Govt Policy Changes Connected Health Technology Scales Up 1:1 Contact Feedback Tools That Drive Adherence Predictive Diagnostic Tools Compliance Packaging Retail Pharmacy Interactions Behavioral Economics & Motivation Social Media, and Online Engagement Successful Patient Adherence Programs A Well-Rounded Day, A Variety of Insights, An Expert on Each Side of You* *…in a very cool place
  2. 2. The Impact of Government Policy Directions on Medication Adherence Greg Caressi Senior Vice President, Healthcare March 10, 2011
  3. 3. Key Take-Aways Event Title: Speaker/Facilitator: Session Title: 6 th Annual Patient Adherence Congress Greg Caressi The Impact of Government Policy Directions on Medication Adherence Top 3 Take-Aways for Participants Insight on how Healthcare Reform and policy shifts will drive medication adherence efforts New thinking on the changing interactions of stakeholders in the system New opportunities to engage with partners to increase adherence
  4. 4. Future of Healthcare What Will the Future Look Like? Healthcare increasingly data driven and customized Healthcare more like other service industries Greater collaboration and information sharing across value chain Greater transparency of prices/costs and outcomes Increased development of standards of care and incentives to adopt them Increasingly challenging market for new technologies. Demonstrating value will be essential. Focus on economics Longer time to market for new technologies Increasing two-way interaction with patients More “generics” – technologies providing same value at lower price, stripped down feature sets
  5. 5. Common Forces Impacting All Healthcare Stakeholders Patients Physicians Hospitals Pharma/Biotech Devices Health IT Payers Economic Constraints - The Great Recession, Credit Crunch, Unemployment, Rising Deficits Regulatory Changes - ARRA/HITECH, PPACA, HIPAA 5010, ICD-10, FDA Political & Social Change - Partisan Politics, Empowered Consumers Increased Use of IT - Internet, Mobile Devices, EHR/PHR, Social Media, Analytics Demographics/Epidemiology - More chronic illness, poor nutrition, obesity, aging population, poverty
  6. 6. Obama Administration Goals Accelerating Many Trends The Health Information Technology for Economic and Clinical Health Act (HITECH), part of the American Recovery and Reinvestment Act of 2009 (ARRA) included >$35 B in incentives to help healthcare organizations modernize operations through the use of health information technology HITECH specifically allocates $19.2 B in the form of direct payments to increase the use of EHRs by physicians and hospitals CBO estimates that HITECH incentives will boost physician EHR adoption rates to 90% by 2019 Two key pieces of legislation will dramatically accelerate the pace of change HITECH (February 2009) PPACA (March 2010) The dual passage of the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010, puts into place a series of changes in the way providers are compensated and expands access to health insurance to 32 million Americans who currently are without coverage Primarily, PPACA is health insurance legislation. Secondarily, it addresses reimbursement and physician payment for services More emphasis on diagnosis, monitoring, preventive care leading to increased collaboration with other providers
  7. 7. Shifting the Financial Gravity of the System $ $$$ $$$$ $$ Investment Continuum of Care “ At Risk” Undiagnosed Chronically Ill Managed Chronically Ill Unmanaged End of Life Healthy
  8. 8. Shifting the Health Focus of the System <ul><li>Early identification and prevention </li></ul><ul><li>Access to new forms of care delivery to improve patient knowledge, self-help and health </li></ul><ul><li>Connection to benefits design to increase coverage for those services which prevent disease and improve health over long term </li></ul><ul><li>Reducing administrative and clinical waste </li></ul>Prevention/Wellness Disease/Care Management Healthy/ “Worried Well” “ At Risk” Undiagnosed Chronically Ill Managed Chronically Ill Unmanaged End of Life Continuum of Care Size of Impacted Population Goal : Keep People Healthy Longer Goal: Manage or Mitigate Risk Goal: Diagnose and Reduce Treatment Delay Goal: Manage Goal: Move to More Interaction and Self-Mgmt Goal: Informed Decisions
  9. 9. Technology To Monitor and Achieve Better Outcomes Remote Patient Monitoring Hospital-based Systems Consumer Health Telehealth Connected Health
  10. 10. New Care Delivery Models – Patient Centered Medical Home <ul><li>Communication among the care teams is essential requiring an extensive use of health IT, including EHRs, e-Rx, clinical decision support, secure messaging and patient/provider Web portals </li></ul><ul><li>Physician practice designated as a patient's &quot;medical home&quot; to coordinate the continuum of care and improve quality and outcomes </li></ul><ul><li>The medical home model promotes a team based approach = increased collaboration and communication among stakeholders </li></ul><ul><li>Increased interaction among care team of the variety of meds being taken </li></ul><ul><li>Increased patient empowerment focuses on understanding of disease and medications </li></ul>Existing Medical Home pilots have focused on medication adherence as key to goals of patient empowerment and reducing hospital readmissions
  11. 11. New Care Delivery Models – Accountable Care Organizations <ul><li>ACO models: </li></ul><ul><li>require tracking of info and outcomes </li></ul><ul><li>focus on chronic disease management to improve outcomes </li></ul><ul><li>Increase patient engagement, activation and accountability </li></ul><ul><li>Utilize monitoring and analytics to achieve health outcomes </li></ul>Groups of providers or practices under the umbrella of one organizing entity with responsibility to improve health, care efficiency + experience and outcomes for a defined population Engage in joint decision-making to manage the full continuum of care The efficient operation of ACOs will be highly dependent on a solid information infrastructure, including health information exchange ACOs must meet certain criteria including quality measurements and share in the cost savings for Medicare and Medicaid programs
  12. 12. Summary of Impact of Policy and Market Trends Present Market Conditions Future Market Conditions Health IT cost subsidies by government and commercial payers; increased focus on prevention and reduced hospital admissions ACOs and Medical Home accelerating focus on medication adherence to reduce hospital admissions, achieve health outcomes, especially with chronic disease care Greater need to document process of care and document outcomes. Increased physician interaction and awareness of variety of meds one patient is taking Increased patient empowerment to understand and manage disease. Patient interacts directly with caregivers via remote monitoring and mobile apps (including re adherence) Move away from fee-for-service to bundled payments based on quality of care (volume to value). Med adherence has high ROI in achieving outcomes, reducing hospitalizations MEDIUM TERM SHORT TERM
  13. 13. Coming to Media Near You in 2011: Smoky the Bear says, “Only you can improve medication adherence” <ul><li>The Agency for Healthcare Research and Quality (AHRQ, part of HHS) asked the National Consumers League to lead a national public education campaign to improve medication adherence </li></ul><ul><ul><li>PSAs via TV, Radio, Print, Outdoor, Internet, plus social media </li></ul></ul><ul><ul><li>Recognition as a public health problem - “America’s other drug problem” </li></ul></ul><ul><ul><li>Elevate adherence to a national health priority </li></ul></ul><ul><ul><li>Educate consumers on the importance of taking medication as directed </li></ul></ul><ul><ul><li>Target those with chronic conditions </li></ul></ul><ul><ul><li>100+ stakeholders </li></ul></ul><ul><ul><li>Three-year campaign </li></ul></ul>Govt agencies, Health plans, HCPs, PBMs, Pharma, IT firms, Employers, Unions, Patient groups, Consumer groups, Quality & Safety groups, etc.