A major satisfaction of writing this blog comes from the occasional comments of some people engaged in actually advancing health care. For example, last week's posting discussed the possibility that pharma can rise from its current funk by addressing the needs of accountable care organizations. The two comments below added substantial depth and perspective to that discussion.
The first was from Tom, who works with a major IT supplier to hospital systems. His remarks deserve quoting at length.
I'd make two points here. First, pharma missed the boat and, second, pharma missed the boat so badly that they'll find it very difficult to recover.
The outcomes models you discussed are called value-based purchasing. Payer-provider programs linked to outcomes use performance protocols as a major component of provider compensation. Hospitals are developing performance protocols and they are starting to appear in chronic care sites. As far as I'm aware, no drug company has ever made the effort to get involved in this process.
Performance protocols involve "workflows" that specify how a physician, nurse, caregiver and others should behave in any given circumstance, such as a patient presenting with symptoms A, B and C. These workflows are highly detailed and most are associated with electronic health records. In fact some companies are developing advanced workflow processes that tell a physician the likelihood of potential outcomes, given the specific set of circumstances a patient exhibits. They also advise the physician on what to expect next in terms of the patient's responses. There's even one new analytic tool called the "probability assessment calculator," where a patient's lab results, vital signs and all previous treatment data are analyzed to produce a list of probabilities that a patient will develop various problems over the next thirty days. When a probability is higher than some threshold, a visual alarm appears on the patient's record.
All of this is being done without drug company involvement. For example, health IT companies are looking at behavior modification as part of the health-and-wellness component of accountable care. These are not fig leaf marketing ploys intended to sell more product. They are objective programs with no ties to any specific product. They can even become part of another vendor's system.
By the time the drug industry wants to get involved, I'd be surprised if there was much left for them to do. Even all the genomic process information around patient responses and lab results are coming from outside the drug industry."
Another reader who works with a wellness management company was a bit more sanguine about pharma's prospects for addressing current realities, but not a lot.
The companies that use claims data to develop "emerging risk indexing" find their results dovetail nicely with wellness programs that try to change behavior before disease takes hold.
We're developing a service that enables providers to do population management in their practices. The service would use a tech-enabled coordinator to help the provider group meet its performance goals while also recommending which chronic disease management, treatment decision support, and wellness programs a particular patient needs. In pilot programs, participation rates tend to be high because the doctor recommends these services at the point of care. That contrasts with what payers and some providers do now, which often involves just calling patients who have been identified by analytical models that use claims data. You can imagine how badly some of those phone conversations go.
I think there are some opportunities for pharmas to partner with service suppliers already working in this area, but their chauvinism and the fact they won't get off a pills-vials-ampoules business model creates a conceptual barrier for them.
So it's fair to say that the needs of large organizations within this country's developing health care system will create opportunities for pharma. The question is whether pharma will recognize those opportunities or at least partner with service companies to make the effort.
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