Health Care Reform...Disruptive Changes?

One of the Megatrends identified in my Editor’s Note in December 2011 was health care reform. This seems like an obvious Megatrend since Congress has already passed the Patient Protection and Affordable Care Act. How it might affect pharmacy and health care is still not known until the Supreme Court rules and Congress reacts. What is certain is that there will be changes in the US health care system.

What is uncertain is exactly what those changes will be, unless we invent them. Why will change occur? When no one has anything left to gain from the existing system, a “tipping point” is reached. As Ed O’Neil, director, Center for the Health Professions at the University of California, San Francisco, said: “The system that we have is no longer sustainable for those who pay, those who consume, and even those who provide.”

Because no group will have the motivation to try to hold onto any facet of the existing system, I believe that the changes that will occur over the next few years will be disruptive rather than incremental. This means that pharmacy leaders and pharmacy practitioners have a unique opportunity to do things differently. “What should be done?” is the million dollar question!

I’ve asked myself this question regularly. Although not easy to answer, doing the hard work necessary to answer this question may be the only way to survive in a disruptive environment. The question I would try to answer is, “What is the most important activity that you and/or your pharmacists should do for your clients?” This might be answered differently— depending on your setting, resources, or skill sets—but knowing what you want your pharmacists to do is critical to your ability to invent your future.

You might look at what others are suggesting. I have been in agreement with the Joint Commission of Pharmacy Practitioner Organization Vision 2015: “Pharmacists will be the health care professional responsible for providing patient care that ensures optimal medication therapy outcomes.” This role suggests several activities that I believe are not being done well by any health care professional currently.

I don’t believe anybody is really monitoring drug therapy outcomes, nor is anyone really assuming accountability for those results. There is an opportunity here for the pharmacist to work collaboratively with the prescriber to better monitor drug therapy outcomes. I make this statement because I keep hearing stories of how someone stops taking their medicine and seems to get better rather than worse. In talking to my own physician recently about whether I should continue on my cardiovascular therapy, he mentioned one of his elderly patients, who was complaining of muscle weakness and forgetfulness, common signs of old age.

He suggested that she first try stopping several of her medications, including a “statin”—and the patient’s memory and muscle weakness improved. He said that there are many patients in nursing homes who are overmedicated. It is not always easy to make the decision to stop a medicine, as I am learning in my own case, but I think this scenario demonstrates why someone needs to be regularly monitoring drug therapy outcomes.

Yes, some physicians believe they are the ones who perform this role—and they are the only ones who should do it. But in reality, physicians are not doing it, nor are they well positioned to accomplish it. Today’s pharmacy graduate is trained for this role, and since pharmacists often see the patient more frequently, they are better positioned to do it. If you want to reinvent the pharmacist’s future role, I suggest you at least consider this role.

A component of this role is assuring drug adherence by patients. Evidence suggests that getting patients to comply with their prescriptions could cut health care costs. So, I might start with this effort first. Some suggest that health plans will incorporate pharmacistsupervised medication management as an essential benefit. If that were to occur, your pharmacy would be well positioned to offer this service. Your patients will appreciate it, and your profession will be the beneficiary too. PT

Mr. Eckel is a professor at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He serves as executive director of the North Carolina Association of Pharmacists.