Reflections from the Inaugural Medication Optimization Summit
By: Amber Ray
Chapel Hill – Often discussed but rarely understood. This is how many view the concept of “value” in healthcare. This is in part due to the complexity of improving health outcomes while simultaneously lowering overall costs, but also due to the lack of tactical knowledge in how to make value-based programs successful. Even more challenging to grasp is how medications factor into this cost/quality value equation. Medications are an investment, but the best ways to establish working value-based health care models that help reap the full benefits of this investment are not clearly understood.
Highlighting what it takes to implement medication optimization programs in a value-based world is what the inaugural Medication Optimization Collaboration Summit aimed to address. On Wednesday, January 16, over 100 healthcare payers, providers, and patients joined together for the 2019 Medication Optimization Collaboration Summit in Chapel Hill, NC.
The summit was kicked off with a video featuring caregiver, Brenda Shipley, who boldly and bravely conveyed what the reality of medication management is to patients and their caregivers today. Brenda described a world that is so confusing and frustrating for patients and caregivers that it makes them deeply confused, afraid, and angry.
Susan Dentzer, summit moderator, set the day’s agenda and purpose, highlighting the importance of focusing on driving value and optimizing the benefits of medication regimens to lower total costs of care and improve health. Dentzer emphasized the importance of defining “value”, engaging patients, and building collaborations; themes that were carried throughout the two panels she moderated.
The summit then turned to a riveting keynote presentation by Patrick Conway, CEO and President of Blue Cross and Blue Shield of North Carolina (BCBSNC), who described the BCBSNC’s rapid and comprehensive transition to value-based care. The day before the summit, BCBSNC and five of the state’s largest healthcare systems announced “Blue Premier”, an accountable care organization (ACO) that will hold each stakeholder jointly accountable for quality, patient experience, and total cost of care. Following, the summit took a deeper dive into medication optimization through case studies of real-world working models, where attendees heard of real success and how those successes were accomplished. The summit concluded as participants developed individualized medication optimization program roadmaps to assist in collaboration model planning, development, and implementation.
Below is a summary of the key summit highlights!
Abandoning the Path of Least Resistance
One of the most talked-about themes during the summit was patient engagement – involving patients and doing what is best for them, rather than taking the path of least resistance. Often the voice of the patient is left out, particularly in decision making and quality program development. But, as those in healthcare continue to emphasize value and quality, stakeholders should be building quality systems that pursue outcomes that truly matter to patients. Otherwise, “we will be chasing things that patients don’t care about,” said Eleanor Perfetto of the National Health Council. This means that patients should be involved in program, protocol, and service design, as well as program evaluation. This sentiment was echoed by many payers, providers, and patient advocates at the summit.
From the payer perspective, we live in an age where healthcare has to mold to consumerism, noted Arif Khan, CEO of CareFirst. “Consumerism is a trend and healthcare has to mold to that ideology, or it will fail,” Khan said. This makes understanding what patients want from their plans all the more important. Similarly, for employers seeking better health outcomes for predictable costs, the first step involves engaging patients to better understand what their expectations are, to better design products that they will value and use. In this respect, a cultural change is needed – movement from supply driven to demand driven – where patient constituents play a much greater role. “Patients should feel emboldened to advocate for what they want”, noted Gary Salamido, CEO and Acting President of NC Chamber of Commerce. And for him, “value” involves designing medication optimization programs with these ideas front and center.
“The Future has Arrived, it’s Just Unevenly Distributed”
The importance of sharing best practices became a common thread throughout the conference as various stakeholders described the successful implementation of medication optimization programs. Pharmacy costs are growing at an alarming rate, so the need to balance this growth with better outcomes was addressed several times. Arif Khan described the successful medical home program at CareFirst, which links pharmacists with care coordinators and established quality as a central focus of providers. This model aims to address the fact that drug spend represents a large portion of total healthcare costs for the organization. Ultimately, although pharmacy costs have increased due to better adherence, the total cost of care has decreased due to reductions in emergency room visits and hospitalizations. The success of this model has made embedded pharmacists a service that providers are eagerly asking for.
Kevin Ronneberg, VP of Health Partners, indicated that his organization has seen immense benefit from implementing pharmacist-driven medication optimization programs specifically, reflected in financial models, clinical outcomes, and the patient experience. Through case studies, those at the summit learned about other medication optimization programs that have provided benefits, like the significant reduction of adverse drug events, improvements in the number of controlled diabetics, reductions in hospital readmissions, and significant return-on-investments through reductions in total cost of care.
“We’ve studied it, we know the data is out there, we just need to let people know so they can understand what might work for them,” said Liz Helms, CEO of California Chronic Care Coalition. “The future has arrived, it’s just unevenly distributed,” she noted as she underscored the need for informative collaborations summits like this one.
Priorities Matter
Successful collaborative models require local action with mutually developed objectives. However, as it stands, incentives to do so are often misaligned because of the differing priorities of collaborators. Understanding the priorities of not only patients, but also of the organizations trying to deliver the best care is essential.
Khan noted that identifying these priorities early – even during provider contracting – will help prevent the asymmetry of information and level-set expectations, especially regarding the real-time use of data and outcomes, a priority for many healthcare payers.
Along similar lines, understanding the priorities of physicians and gaining physician buy-in is essential to coalition building. So, establishing trust between members of the team will require collaboratively determining what models work best within current workflows. “Medication optimization might mean very different things to different people,” said Ronneberg, thus, it’s important to be very clear about what you are talking about and to always have a feedback loop to ensure programmatic goals are being met.
Those at the summit emphasized that medication management is key to improving value; however, they are getting outcomes too late. With many focused on the need to aggressively measure quality due to the establishment of value-based payment models, learning what is working and what is not requires strong communication and collaboration between providers, payers, and patients, noted Maraya Thorland, Interim COO of UNC Health Alliance.
Ultimately, however, Steven Nuckolls, CEO of Coastal Carolina HealthCare, encouraged organizations to “do the right thing.” Although people don’t stay with their plans forever, people need to think beyond what is going to benefit the next cycle – what is the right thing to do in the longer term to drive healthcare value.
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About CMO
The Center for Medication Optimization at the UNC Eshelman School of Pharmacy brings diverse healthcare stakeholders together to create impactful real-world research, generate evidence, disseminate best practices, and advance education in order to integrate medication optimization into value-based care delivery and payment models. These collaborative efforts are directed toward raising awareness and helping implement rigorous evaluations, solutions, best practices and policies to improve patient health outcomes and healthcare delivery.