Real World Health Care Blog

Tag Archives: meds

Not Your Mother’s Big Pharma

In a September 29 article in Adweek, Joan Voight demonstrates how the Affordable Care Act (ACA) is expected to create new opportunities for pharmaceutical stakeholders to play a more active, personalized role in managing patient care through interactive web-based tools. Three aspects of the ACA will change the way treatment decisions are made and reinvent how patients and Big Pharma interact.

Paul DeMiglio

Paul DeMiglio

Fill the Primary Care Gap
Although providers will be overwhelmed by an expected uptick in newly insured patients, pharmaceutical companies can help reduce the strain while strengthening relationships with consumers in the process. MerckEngage — an online educational and marketing program that has attracted 8.2 million visits since its launch in 2010 — is one example of just how this can play out. Among some of the resources the website gives members access to include:

  • Free personal health tracking
  • Daily planners
  • Food and exercise tips
  • E-mail messages
  • Content updates

Doctors who sign up will receive alerts to track their patients’ activity, and starting this year the program also features mobile versions for patients and providers alike.

Provide Solutions to Adherence Challenges
A key goal of the ACA — to prevent sick patients from developing more serious conditions and needing more care — emphasizes the importance of increasing medication adherence. This need presents a valuable opportunity for pharma to personalize treatment and communicate in ways that resonate effectively with target audiences.

AstraZeneca is collaborating with Exco InTouch to help patients and doctors track and manage chronic conditions through mobile and web-based tools:

“The first app addresses chronic obstructive pulmonary disease. Patients enrolled in the program collect, transmit and review their own clinical data, while their doctors use real-time information to personalize each patient’s care, adjust meds and possibly prevent hospitalization. The patients’ identifiable data is only seen by patients themselves and their healthcare providers, says AstraZeneca,” the report notes.

Develop Innovative Bundles
Implementation of ACA will also change the way prescriptions are made, with insurance companies and accountable care organizations (ACOs) choosing what to prescribe instead of individual doctors. This can serve as an opportunity for pharma to build support among ACOs by creating and branding a package of services for patients and providers that spans behavior modification, education, tracking and dispensing of drugs.

Eli Lilly’s online diabetes program that helps patients and families manage the disease, Lilly Diabetes, was critical to paving the way for this marketing approach, according to the article:

“In Lilly’s case the tools include a meal planner, a self-care diary, a carbohydrate tabulator and even an emergency guide in case of hurricanes or earthquakes.”

Now we want to hear from you. Do you agree with the article? What are the long-term implications of pharmaceutical companies having access to more data about consumers in this new era of digital outreach? What might be the potential advantages and disadvantages?

Striking the Right Balance for Better Patient Outcomes

A recent article in Health Affairs reports that ChenMed – which serves low-to-moderate income elderly patients primarily through the Medicare Advantage program – is achieving better health outcomes for Medicare-eligible seniors, including those living with five or more major and chronic health conditions.  Dozens of Chen and JenCare Neighborhood Medical Centers are helping tens of thousands of seniors live better, longer: 

chris_chen

Dr. Christopher Chen, ChenMed CEO

  • Total hospital days per 1,000 patients at ChenMed in 2011 were 1,058 for the Miami area in comparison with 1,712 total US hospital days per 1,000 patients in the same year (Centers for Medicare and Medicaid Services Office of the Actuary).
  • Just one year prior, according to Dartmouth Atlas of Health Care, the Miami Hospital Referral Region was above the 90th percentile in inpatient hospital days.

Why is ChenMed so successful?

Dr. Christopher Chen, CEO of the organization, says its patient care model integrates cutting-edge medical expertise in a way that empowers physicians to ensure patients receive personalized attention and optimal care.

“People always ask, ‘What is your secret?’ There really is no secret,” he says. “It comes down to having the right incentives, the right physician and staff culture, and the right philosophy of care. My goal at the end of the day is to be cost-effective through improvement of outcomes by changing the philosophy of care. We care about results.”

The group practice’s popularity also attests to its effective one-stop-shop approach to patient-centered care through multi-specialty services. Smaller physician panel sizes of 350-450 patients spur intensive health coaching and preventive care, and prescriptions are given to patients during their visits at all Chenand JenCare Neighborhood Medical Centers.

This aspect of ChenMed’s model makes the biggest difference in boosting medication adherence, followed by strong one-on-one doctor-patient relationships that help to change habits for the better. Receiving meds within 3-5 minutes of ordering drugs not only means patients don’t have to wait for the treatment they need, but that they receive their medications while having face-to-face interactions with their primary care doctors.

“In our model we aren’t looking for high-income patients,” Dr. Chen says. “People ask, ‘Are you saying that patients like you because you give more attention to them and provide more access to doctors than those who pay for concierge service?’ I would say yes.”

ChenMed continuously employs top specialists from a variety of fields to conveniently provide fully integrated medical services to patients.  It effectively combines services like acupuncture into its portfolio of care, and improves outcomes and patient experience with customized end-to-end technologies enhancing its daily operations. For example, all the medical assistants and staff are equipped with iPads and can offer physician support tailored to each patient. This fuels collaboration, enabling doctors to work side by side with patients and providing a significant convenience to all parties as a result.

Primary care physicians at Chen and JenCare Neighborhood Medical Centers also meet three times a week, engaging in thoughtful ongoing discussions that generate numerous enhancements to care and delivery for better outcomes.

“We discuss whether a hospitalization could be improved through better outpatient care. We ask, ‘What can we do to improve patient outcomes while the patient is in the hospital?’ We innovate to improve outcomes and can achieve great things for patients because of our small panel sizes. These meetings have saved many lives and continue to do so,” explains Dr. Chen.

When interviewing prospective doctors to work at ChenMed, they are asked whether they like spending time with patients and whether they love the complexity of medicine. If they say no to either of those questions, then this group is probably not the best place for them, Dr. Chen says, underscoring that:

“We want you to practice medicine the way you thought you would when you graduated from medical school. It’s not about how many patients you see, how many procedures you do, or how much you bill. You should want to be a doctor to make people feel better.” 

ChenMed, through its Primary Management Resources subsidiary, also provides behind-the-scenes consulting services to enhance medical practice operations nationwide.  Physicians interested in end-to-end solutions that streamline operations while enhancing patient health outcomes and the patient experience should contact ChenMed at (305) 628-6117 or go to ChenMed.com.

New Drug Delivery Options that Help the Medicine Go Down

David Sheon

David Sheon

The water cooler talk for us at RWHC is frequently about improving treatment adherence (a patient’s ability and willingness to take his or her medicine consistently, as directed).  OK, so we don’t have the most exciting water cooler discussions.  But this happens to be important – for all of us because when patients stay on treatment, they get better faster.  This is almost universally true, regardless of the therapeutic category.

In some cases, improving adherence not only saves the life of the patient, but it can benefit an entire community.  In HIV, for example, taking antiretrovirals not only helps the patient to manage his or her viral load (the amount of HIV circulating in the blood), but it also lowers that patient’s ability to transmit the virus to someone else.

Sometimes, adherence can be improved by using a different delivery system.  This is the first post in a series on how drug delivery helps adherence.

Remember the first time you took a breath strip that dissolved on your tongue? The technology was invented in the 1970s, but only since July 2012 have pharmaceutical companies been able to win marketing approval to put a drug on the strip.  Two products have been cleared by the FDA.

Zuplenz (ondansetron) oral soluble film is an anti-nausea and vomiting product used by cancer patients who experience nausea and vomiting as a result of receiving chemotherapy and/or radiation as well as for the prevention of postoperative nausea and vomiting.

“We know from market research that patients who are nauseated don’t necessarily like swallowing pills or using suppositories and that sometimes taking pills with water contributes to their nausea,” said John V. Aiken, M. Ed., Vice President, Corporate Operations, Marketing, and Training, Praelia Pharmaceuticals, Inc.  “Since launching the product in December 2012, a number of doctors are telling us that their patients prefer the dissolving strip.”

The second drug now available on an oral dissolving strip is Suboxone (Buprenorphine and Naloxone), from Reckitt Benckiser Pharmaceuticals Inc.  For more information on this product, click here.

If the dosing is standardized and absorption is as good as more typical drug delivery methods, we see only an upside in terms of patient adherence to oral dissolving strips.  Please tell us what you think.  Also, if you know of a new drug delivery option that you’d like to see us cover, let us know!

Walgreens Unveils Solutions to Boost Medication Adherence

How can health professionals enable their patients to take medications more consistently as prescribed?

Personalized counseling from pharmacists and prescription refill reminders are two effective ways now shown to fuel better drug adherence, according to research from Walgreens presented March 15 at the World Congress Summit in Philadelphia.

Walgreens’ community pharmacy programs – in addition to successful intervention models – are equipping patients with powerful tools to self-manage their health.

One finding, for example, revealed that individuals receiving in-person counseling from their pharmacist saw 7.2 percent higher adherence than those with more conventional pharmacy care. Meanwhile, one of Walgreens’ pilot programs demonstrated that patients who receive prescription refill reminders (also called automated refill reminders or ARR) are more likely to consistently take medications for chronic conditions.

“In order to improve medication adherence among patients, providers need to understand the key challenges and contributors to non-adherence, and how to address them,” said Jim Cohn, Walgreen Co. spokesperson. “The research findings demonstrate how programs at the community pharmacy level designed to target common barriers to adherence, such as the challenge of learning a new medication therapy or simple forgetfulness, can significantly improve patient health and outcomes.  Ultimately, these types of pharmacy initiatives can help providers do their part to ensure more people get, stay and live well.”

Walgreens isn’t alone in recommending evidence-based approaches to enhance adherence outcomes. The Medication Adherence Project’s (MAP) 2010 Training Package also offers strategies for both providers and pharmacists that stress individualized patient engagement, with solutions that include writing 90-day instead of 30-day prescriptions, prescribing generics, communicating directly with providers, and more.

Securing increased medication adherence will not only go far in helping patients live longer and healthier, but will deliver considerable savings for the health care system too.

How do we know? Underscoring the benefits of adherence, MAP cites “lower disease-related medical costs” for diabetes and hypercholesterolemia in addition to related “reductions in health care costs.”

The New England Health Institute (NEHI) also provides compelling evidence in its October 2012 Issue Brief that reducing medication non-adherence, which contributes to hospital readmissions, helps lower hospitalizations and saves on associated expenses, noting: “One study found that one-third of adverse drug events resulting in a hospital admission were related to non-adherence. The aggregate cost of hospital admissions related to medication adherence has been estimated to be roughly $100 billion per year and estimates of the share of hospital admissions related to non-adherence are as high as 10 percent.”

Successful strategies generating increased medication adherence are clearly worth pursuing and replicating, both to strengthen the quality of health services and to lower the cost of care.

Now we want to hear from you. As a medical professional, what approaches do you incorporate to encourage patients to properly take their meds? If you’re a patient, what has worked for you?

Three Pillars of Health Care Success: Cost Savings, Prevention/Patient-Centered Care, and Access to Care

Welcome to www.RealWorldHealthCare.org, a blog dedicated to showing what’s working to  improve health care in the U.S.

Why are we talking about improving access to good medical care? Rising costs could bankrupt us, and most people need to do a better job of preventing illness. But digging deeper, you may be surprised to learn that almost 10 percent of the U.S. population (that’s 29 million Americans) can’t afford the health insurance copayments, coinsurances and deductibles required to cover out-of-pocket costs for necessary treatments of certain chronic and life-altering medical conditions. The situation is so dire that about 60 percent of the personal bankruptcies filed in the U.S. are due to medical expenses.

As we see every day in the news, patients are facing more obstacles in accessing affordable, quality care. As across-the-board cuts to health care programs are now taking effect with implementation of the sequester – along with projected layoffs to health providers across fields – available funds to cover the rising cost of care will be strained even further. Staying abreast of the latest proven solutions to the increasingly complex challenges of our health care system is more important than ever, for patients and providers alike.

We want our blog to be the go-to source for demonstrating what’s working in our health care system by focusing on three important pillars of health care success:  Cost Savings, Prevention/Patient-Centered Care, and Access to Care.

Cost Savings: No patient – adult or child – should go without health care because he or she cannot afford it. The first step to finding solutions to the increasing cost of care is enabling health care systems and health care professionals to share their practical knowledge with one another as well as the patients who often have to choose between paying their medical bills and putting food on the table. From paying for prescription drug copayments and deductibles to affording health insurance premiums, our Cost Savings posts will explore proven strategies to help patients and families reduce the financial strain associated with the rising price of care.

Prevention/Patient-Centered Care: What’s the first thing you think of when given the words “health care?” Most people think “trip to the doctor,” or “medication.” Our attention has to shift more aggressively to find ways to help people stay healthy. Seeing a dietitian could be vital for millions of Americans hoping to live healthier and longer. Annual lab work can find vitamin deficiencies. Sometimes very simple things, like removing carpeting from the home, can contribute to better cardiovascular health, resulting in increased life expectancy. It takes a village to care for a patient. Partnerships among practitioners, payers, patients and their families are crucial for ensuring that health care decisions are made in a way that respects patients’ needs and that patients have the knowledge and support they need to make reasoned decisions and participate in their own care. In our Prevention/Patient-Centered Care blog posts, we’ll focus on the many strategies available for staying healthy and recognize ways that patients are taking an active role in decision-making about treatment options.

Access to Care: We are so fortunate to live in a world where scientists are developing novel, breakthrough therapies. But those therapies can’t result in positive health outcomes if the patients who so desperately need them can’t access them. The evidence is clear: Proper medication compliance and adherence – consistently the right medication, at the right dosage, for the right patient – is essential to mitigating chronic disease. Continued and properly managed care and staying on treatment will be the focus of our Access to Care blog posts.

We’ll be sharing real-life examples of positive health outcomes in this space, and we encourage you to join in the dialogue. How would you tackle the problem of unaffordable health care? How can business and philanthropy work together to reduce the financial burden on patients? Have you or someone you know received help paying for needed therapies? Let us know in the comments section.

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