Pharma and the patient-centered medical home
Andrew Tolve explores how the patient-centered medical home (PCMH) can deliver better care to patients and improve adherenceBy Jun 2, 2012 on
Specialization is a blessing and a curse for today’s patients. On the positive side, no matter their ailment, patients can seek out an expert rather than a generalist and receive that expert’s diagnosis, advice, and recommended treatment.
On the flip side, communication between specialists is notoriously poor, and the broader system has thus become rife with redundancies, unnecessary costs, and gaps in information. Even within the domain of individual practices, the current system has been dominated by individual roles rather than teams working together for the betterment of the patient.
Against this backdrop, a new model has emerged for delivering better care to patients. Called the “patient-centered medical home” (PCMH), the model envisions doctors offices as interconnected networks all threaded around the nucleus of the patient.
Doctors and nurses know their patients and are positioned to provide and coordinate the appropriate medical care. In turn, patients interact with more office members—nurses, nutritionists, and different kinds of practitioners—at their home office, and they’re kept more in the loop after a visit thanks to emails and regular phone contact, much of which is made possible by leveraging electronic health records.
“In many respects, it’s a back to the future paradigm,” says Andy Reynolds, assistant vice president, marketing and communications at the National Committee for Quality Assurance (NCQA). “That is, it’s an idealistic return to the idea of really strong patient-doctor relationships, which is the sort of environment that patients want and clinicians got into medicine for.”
In the past four years, PCMHs have gained in popularity in the United States. In 2008, the non-profit NCQA, which is the most widely adopted national model for PCMHs, launched its first recognition program. Today, that program has more than 23,000 certified clinicians and sites.
Meanwhile, health plans, private payers, the federal government, and yes, pharma, have come to play an important sponsorship role. “At the end of the day, without pharma’s support a lot of this wouldn’t be happening,” says Paige Robinson, NCQA’s manager of external relations for recognition programs.
Three main points have attracted pharma to the PCMH model.
First, pharma has been talking about wanting to deliver better outcomes to patients for some time, and PCMH seems to set the groundwork to deliver on that promise. Studies have shown that PCMHs lead to reduced use of hospitalization and emergency room visits for patients and oftentimes reduced cost of care. The state of North Carolina has found that the more Medicaid beneficiaries enroll in medical homes, the more the state’s medical savings go up—to $204 million in 2008, $295 million in 2009, and $382 million in 2010.
“Ultimately, this is an opportunity for pharma to paint a more active picture of their roles in the overall improvement of the healthcare system,” says Jennifer Dziekan, NCQA’s director of corporate and foundation relations.
“If pharma is seen as quality champions putting money out there to help practice transformation, it gives the industry a better image and helps them push the drugs that they’re marketing,” seconds Robinson.
Of course, systems that deliver better outcomes typically go hand in hand with systems that do a good job of keeping patients on treatment. A second motivation for pharma to support the PCMH model, therefore, is to improve patient adherence. Indeed, several studies have shown spikes in adherence from those patients enrolled in PCMHs. As the industry is well aware, improved compliance is a very good thing for pharma bottom lines.
Finally, as the industry faces increased regulations that limit access to physicians, embracing PCMHs and sponsoring initiatives that drive better care is a way for pharma to maintain touch points with key customers. There are restrictions on how pharma can interact with the PCMH model. In NCQA’s case, no pharma funding can influence quality measure development, but that doesn’t limit industry from being able to get involved in other ways with recognition programs.
“This is one way they’ve found to still keep a presence in the marketplace and improve their image in the process,” says Dziekan.
Those pharma companies eager to get involved in the PCMH space have chosen to direct their energies in several different capacities. The first has been to pledge sponsorship dollars to PCMH organizing bodies, which channel that money into support for different recognition programs. NCQA’s corporate sponsors list reads like a who’s who of big pharma: Boehringer Ingelheim, Merck, and McNeil Pediatrics are platinum sponsors; Pfizer is a gold sponsor; Eli Lilly and Novo Nordisk are silver sponsors; and more fall under the bronze sponsorship level.
Beyond pledging sponsorship dollars, companies are getting directly involved in the development and distribution of resources and materials to teach physicians. Physicians generally want to limit exposure to drug details as much as possible. The opposite seems to be the case when it comes to pharma quality reps supplying valuable information about obtaining PCMH status.
“There’s a big need for resources, support, and education,” says Robinson. “Since pharma has massive amounts of foot soldiers all over the country, they can go one-on-one to touch base with physicians and walk them through the recognition process.”
Accordingly, pharma companies have been active in creating toolkits and brochures for their quality teams to distribute. Merck recently created a video that walks physicians through the NCQA standards and gives them peer advice. Merck plans to roll the video out into the field, and NCQA has peer-reviewed it and posted it to its website.
“Peer-reviewed best practices really do help folks get through PCMH,” says Dziekan. “That’s one important way that pharma can help, by bringing in best practices for folks that may not be able to access them or go to conferences regularly.”
Opportunities and needs
As PCMHs become standard, pharma companies will need to further consider how to optimize their relationships with them. One frontier is for pharma companies to provide funding directly for practice training. This may prove particularly valuable for medical societies or independent practice associations that need support when it comes to educating physicians on the steps toward PCMH transformation.
Electronic and online support is a second opportunity. Small practices need a lot of help when it comes to online proficiencies, securing online education programs, and uploading information to get certification.
As pharma continues to act on these opportunities, internal education will be an important component. On the one hand, PCMHs don’t change pharma’s fundamental sales model, as PCMHs are still built around prescribing physicians that will receive details and prescribe drugs accordingly.
However, sales reps will need to be aware of the role that their quality counterparts are taking with practices. “It’s not their primary job, but they need to be introduced into the world of quality, which is usually quite foreign, so that messages are aligned between the two,” says Dziekan.
For more on patient adherence, check out SFE USA on June 12-14 in Somerset, NJ.
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