Snow: In the Health Care Showdown, Don’t Fix the Blame, Fix the Flaws

Posted February 23, 2010 at 11:17am

Many critics have already dismissed this week’s health care summit as little more than a political sideshow, confident that when our elected leaders gather for the bipartisan health care summit, they will choose to focus only on fixing the blame for the current financially and clinically compromised health care system.

[IMGCAP(1)]Instead of fixing blame, I would prefer that we seize the opportunity to fix the flaws. This is possible by forging public and private collaboration and leveraging technology and innovation to raise clinical quality and lower costs, which in turn liberates the resources to extend access to uninsured populations.

It’s estimated that every year in America, we waste about $350 billion — about 15 percent of everything we spend on health care — largely related to the poor management of patients with chronic and complex conditions. That’s enough to cover the uninsured, without a single penny of additional health care dollars.

Patients with chronic and complex disease comprise about 50 percent of the population. However, they account for 96 percent of all drug costs and more than 75 percent of all health care spending. With a near insatiable demand for health care services, but finite resources, we can’t afford to ignore this problem.

Wiring the health care system, and embracing the evidence-based, protocol-driven practice of medicine are pivotal first steps in better managing health care for patients — particularly those with chronic and complex diseases. This is the foundation of real health care reform. That’s a bold statement, but proof is available by examining today’s practice of pharmacy.

Medco operates the world’s most advanced pharmacy and is forging the future of pharmacy care. Our pharmacists receive enhanced training so that they can specialize in counseling patients with the types of chronic clinical challenges that drive health care spending — conditions such as heart disease and diabetes. This specialization makes Medco pharmacists among the most effective at closing gaps in care — and we deliver this capability to our clients and members and, by extension, to the entire health care system.

For instance, in our specialized practice for diabetes care, a recent study reflected that our patients are 40 percent more likely to adhere to their prescribed medications compared to patients using traditional pharmacies.

That’s important because dealing with the tragic complications from uncontrolled diabetes — such as heart disease, blindness and amputations — is much more expensive than ensuring patients adhere to their treatment and keep their chronic condition stable. Our studies reveal that when patients adhere to their prescribed therapy, the overall cost of health care may decrease by as much as 50 percent.

Medco’s advanced pharmacy also lowers the cost of medicine. For example, our clients who experienced a mail-order pharmacy penetration rate of more than 40 percent saw their drug costs, on average, actually decline year-over-year. Medco’s programs encouraging the use of generic medicines saved our clients and members nearly $2.7 billion in 2008 alone.

These are among the advantages available to the private and public employers, health plans, labor unions and government agencies of all sizes that use Medco as their pharmacy benefit manager — organizations that cover approximately 65 million Americans, including beneficiaries served through the Medicare Part D prescription drug program.

Our wired pharmacy today enables us to share patient-safety information with retail pharmacies. It allows us to provide a heads-up to physicians when patients aren’t following their recommended course of treatment. It also empowers patients with resources that allow them to take an active role in their care and become more informed consumers of health services.

Extending the wired system beyond pharmacy is the required step to better integrate a patient’s overall care program. It does so by providing real-time access to a patient’s medical treatment and will allow all caregivers — physicians, pharmacists, hospitals, medical homes and other providers — to ensure that the current treatment protocols for a patient’s condition are being adhered to. This delivers better health care at a lower cost.

Wiring health care not only delivers benefits today, but also serves as a wellspring for clinical innovation and operational efficiency far into the future.

With strong policy leadership and the promulgation of thoughtful regulation, the private sector will be enabled to operate and innovate, thereby unlocking significant opportunities for savings. Wiring the system, addressing Medicare, focusing on tort reform, and delivering on prevention and wellness initiatives hold the potential to trim as much as $1 trillion a year from the nation’s cost of care. That would bring per-capita average health care costs in line with virtually all the other developed nations of the world and free needed capital for future innovations in health care and other cutting-edge industries that can lead to significant job creation.

Advanced pharmacy today is wired and serving as proof that evidence-based, protocol-driven medicine enhances the quality of care for patients and reduces costs for payors. It’s the enabler for smarter medicine. There’s no reason why the rest of our health care system shouldn’t be wired, measured and accountable for delivering better outcomes.

The evidence to act is compelling. The time to act on this evidence is now.

David B. Snow Jr. is chairman and CEO of Medco Health Solutions Inc.