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BioPharma: Guidelines and Best Practices

HIT Perspectives Biopharma Insights – April 2014

Guidelines and Best Practices: Ripe for an Assist from Managed Markets Teams

By Brian Bamberger, Life Sciences Practice Lead

It seems that quality is king these days when it comes to improving patient care and outcomes while reducing costs. Payers and providers are expected to view use of clinical quality guidelines and best practices as central to their quality and value-based reimbursement efforts.

This is easier said than done. Adoption continues to be low, despite the proliferation of guidelines and best practices and widespread dissemination of research on their positive impacts. This represents a huge opportunity for managed markets teams to help accounts wade through the noise and disseminate credible information to providers so they can make more informed decisions, standardize care and improve quality.

The need is there. According to the Agency for Healthcare Quality and Research (AHRQ), there is a disturbing gap in quality – namely, the difference between present treatment success rates and those thought to be achievable through the use of best practices and clinical guidelines. This gap has been documented for some time. For example, a 2003 Institute of Medicine report identifies 20 diseases and clinical conditions that may be significantly improved or effectively managed by using best practice treatment guidelines.

As a result, patients suffer needlessly – and sometimes even die – from medical conditions that could be treated successfully if guidelines and best practices were followed. Meanwhile, public and private payers (and taxpayers) are stuck with the unnecessary bills. In addition, providers such as accountable care organizations and integrated delivery networks are being judged on their quality metrics and outcomes, which figure heavily in their reimbursement.

While this is a frustrating situation, managed markets teams can help bridge the gap because their pharmaceutical companies are sitting on a wealth of data and expertise on guidelines, both of which can be brought to bear. They also are uniquely positioned to overcome provider-centered barriers to adoption of evidence-based care. For example:

  • There is a trust factor. Research has shown that providers are skeptical of guidelines and often believe that implementing the recommended practices would not represent a change for the better, consequently serving as a barrier to adoption. By building on their relationships with their accounts, managed markets teams can bring their own credibility to the conversation when disseminating guidelines and information from their company.
  • Providers and their staff often lack time to keep up with the latest guidelines and assimilate the ever-expanding deluge of clinical studies and emerging treatment advances. Convenience is surprisingly important to adoption – the preferred option should involve the least mental and physical effort and be available ‘just in time.’
  • Guidelines change all the time. Managed markets teams can be their accounts’ eyes and ears by bringing relevant information to their attention and helping to interpret results and applicability. They then can translate the needed changes into a series of easy steps to the electronic health record (EHR).
  • Not all settings are created equal. An advanced specialty office may be highly effective in researching a topic but unworkable in the primary care practices. Managed markets teams can help providers and payers determine if and when research can be translated to their particular practice setting.

In short, managed markets teams can be an invaluable resource in identifying best practices, best EHR operational usage and best standards of care. Let Point-of-Care Partners help you identify those opportunities for your accounts and translate them into action.