Guest Commentary: Health Care Crossroads—Where Do We Go from Here?

Dr. Cook is a senior manager ofApplied Outcomes and Analysis,Health Management Innovations,at GlaxoSmithKline.

Most of us recognize thatwhen it comes to healthcare, our country is chartingan unsustainable course and mustchange direction. Nearly half of ushave at least one chronic disease, suchas asthma, diabetes, or heart disease,and $3 of $4 spent on health care goestoward treating chronic diseases. Yet,these diseases and their devastatingcomplications are often avoidable. Ifwe can prevent and effectively managediseases to avoid costly complications,we would be a healthier nation thatsaves money on health care. Seems likean obvious solution, right?

Unfortunately, as we know all toowell, the common response is to focuson the components of care—cutting reimbursement,price controls, and limitingaccess to treatment—instead ofdirectly addressing the primary driverof health care costs: chronic diseases.To have a sustainable impact on costand the quality of care, however, wemust look beyond cost-containmentsilos to the total costs of health care—hospital, medical, and pharmacy—andmeasure the effects of our efforts onthe health outcomes of our patients.Our focus must be on prevention,comprehensive care management, andinvestment in medical research andinnovative systems that bring bettertreatments to patients.

Increasingly, these issues are beingaddressed through coordinated patient-centeredcare initiatives. For outpatientcommunity pharmacists, this meansgreater responsibility for ensuring thatpatients achieve their clinical goals.Hospital and long-term care pharmacistshave taken on this role with greatsuccess. Community pharmacists canhelp to improve both patient healthand economic outcomes by targetingprevention and control of chronic diseases,by addressing barriers, reducingdrug therapy problems, and encouragingmedication adherence.

Although these skills have beenunderutilized, our profession mustnow meet the systemic challenges ofworking with physicians, employers,insurers—and especially patients—toadd our unique expertise and value inproviding optimal pharmaceutical outcomesto the mix. We have seen manysuccessful variations of this model,including the Asheville Project andthe Diabetes Ten City Challenge; theNorth Carolina Medical Home Model;the Lancaster, Pennsylvania, CountyBusiness Group on Health's Bridgeproject; and the Minnesota MedicationManagement Systems model.

My employer, GlaxoSmithKline, understandsthat we all must changeour approach to chronic diseases tolessen the impact on patients andour pocketbooks. We accept that, asa responsible employer, we must bepart of the solution. Like other largeemployers, we face rising costs due tochronic diseases, and we see that notenough of our employees are adheringto their medication regimen. Wealso know that medications representone of the most effective and affordableways to manage chronic diseasesand help prevent complications thatrequire costly inpatient care.

GlaxoSmithKline is committed tocreating a culture of health by supportingour most valuable assets, ouremployees, in maintaining their health.By removing the barriers to care inbenefit design and supporting diseaseawareness, screening, education, andmedication adherence, our goal is toenable each employee to succeed inhis or her care.

With the promise of change in theenvironment, we face a crossroads.Which direction change takes willdepend on how we respond. Will ourprofession choose to address the challengein how we practice, have ourvoices heard as part of the solution,and accept the new responsibilities toimprove the health of our patients?