Population health management increasingly is being viewed as an essential strategy across the health care system. For many pharmaceutical manufacturers, it’s a box they’ve already checked off. They currently interact with specific groups of patients through direct marketing and involvement in clinical trials. Sales are tracked across geographic regions and population groups. So, what else needs to be done? The answer is: plenty.
Why population health?
Population health is one of those “I’ll know it when I see it” propositions. There is no standard definition. That said, the evolving health care system is more consumer facing and its success is predicated, in part, on improved management of the health of patient populations. Every stakeholder group is involved.
The federal government and private insurers are moving away from volume to value with new care models, such as accountable care organizations and patient-centered medical homes. These models are looking for ways to reduce costs and improve outcomes, as well as improve patient safety and satisfaction. The arrangements take various forms, such as agreements that include terms to reduce or eliminate therapy costs where patients do not achieve clinical outcomes promised. Addressing population health is a payment metric for Medicare and other payers. The shift toward outcomes-based payment requires significant investment in infrastructure and programs to manage the health of patient populations.
Population health also includes the health status and outcomes of the larger communities to which the physician and patient belong. Providers must consider a wide range of factors that influence their patients’ health and outcomes, such as the social and physical environments in which their patients live and work. Addressing these factors affects how well physicians meet their savings and quality targets for reimbursement purposes. At the same time, patients are beginning to take charge of their health and wellness, as well as advocating for increased involvement in their own care and care decisions. Patient satisfaction and involvement also are metrics of many value-based care arrangements.
Technology vendors are playing a key role in population health. Electronic health records (EHRs) are being expanded and augmented to meet the new criteria involved with population health, including the ability to analyze patient populations and to capture and share necessary patient data. For physicians, the EHR is their hub for population health initiatives. EHR systems are adding capabilities to address the challenges population health places on practices. EHR efforts are competing with add-on population health software designed to be comprehensive population health systems.
Digital technologies — including wearables, mobiles and various applications — are a growing business, helping to connect payers, providers and patients to better manage health and wellness. They also are key to helping patients access and manage their health data.
How does this impact pharmaceutical manufacturers?
Pharmaceutical companies have taken note of these developments but few have taken them to heart. They should take a closer look for several reasons.
The first is that medications lie at the heart of most population health strategies. In fact, a recent survey found that three-quarters of health care organizations are targeting management of the health of a specific group of patients — those with chronic medical conditions. This is not surprising. Medications are the principal form of therapy to control the vast majority of chronic diseases. According to recent statistics, chronic diseases are responsible for 7 of 10 deaths each year, while treating people with chronic diseases accounts for 86% of our nation’s health care costs.
Secondly, as a result of how new payment models work, fresh approaches will be needed to demonstrate clinical and economic values of a particular drug. As a result, pharmaceutical manufacturers must go beyond the traditional yardsticks of the cost and clinical efficacy of the drug itself. Increasingly, patient satisfaction, adherence and hospitalization rates are now part of the equation for physician payment and cost-sharing arrangements under the new value-based models. Pharmaceutical manufacturers must respond to these new metrics and accordingly prove the value of their products. They also must provide relevant data and analytics — efforts that will require more near-term attention and investment.
Third, payers and providers are well down the road to population health implementation. According to a recent KPMG survey, 44% of payers and providers surveyed said they have a population health platform that is being “utilized efficiently and effectively.” Another 24% said they will have a population health program in place within the next three years. This means pharmaceutical manufacturers will have to hustle to provide the new kinds of information that payers need or risk losing market share. This is going to be challenging since data requirements can vary across payers and technology platforms.
Finally, pharmaceutical companies also will need to develop new ways to communicate with broader groups of patients and providers, as well as more effectively monitor outcomes. That may be easier said than done. A recent survey found that 88% of patients would be willing or somewhat willing to share personal health data with their doctors; in contrast, only 53% would do so with drug companies. In addition, there is a 30% dropout rate for clinical trials, which experts attribute largely to poor patient engagement and communications. Such barriers must be overcome so that pharmaceutical companies stay competitive while health care transitions to value-based arrangements.
What can pharmaceutical manufacturers do? Obviously, they will need to reorient their processes and outlooks to be successful in addressing population health. Such efforts can start with identifying at-risk populations and creating intervention tools that improve outcomes.For example, pharmaceutical companies can work with practices to:
Identify patients at risk who would likely benefit from a particular drug. A fundamental goal of population health management is to bring patients into the system who are either (a) at risk of a chronic disease, (b) untreated for a diagnosed condition or (c) have lapses in care needed to control the disease. Proactive, early interventions help avoid high-cost health care events down the road. Pharmaceutical companies have a lot of data about patients who are more likely to benefit from and adhere to a particular drug. This can improve the reliability and precision of predictive analytics algorithms used to identify patients needing outreach and treatment.
For patients flagged for intervention, provide clinicians with meaningful recommendations and drug information that is specific to a patient’s situation. To be meaningful — and accepted by clinicians as part of their practice — the message must account for comorbidities, active treatment, recent hospitalizations and a patient’s past self-management history (e.g., adherence to prescribed regimens). For drugs that require prior authorization (PA), presenting the PA requirements and initiating the process at the point of prescribing using electronic PAs increases the value of this decision support service.
Develop tools for care teams to monitor patients’ medication adherence and intervene when needed.Ensuring patients take their medications as prescribed is essential to achieving health outcome targets in a population health management program. Applications now available in many EHRs and data warehouses to support these programs are designed to improve medication adherence rates. The core electronic prescribing application available in all certified EHRs has led to a greater likelihood of an initial prescription being dispensed to the patient. Decision support applications to detect gaps in care and patient noncompliance with care plans can be extended to detect medication nonadherence. This component of decision support includes algorithms to calculate the medication possession ratio (MPR), detect patients falling below a minimum MPR threshold (suggesting possible adherence problems) and trigger an alert to the patient’s care team. The pharmaceutical company can enhance the effectiveness of these applications by providing drug-specific guidance to the care team on possible actions when a patient is found to be having adherence challenges.
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