One of the most under-appreciated and underutilized ways to reduce medical costs in the U.S. is health care prevention. Yet, instead we often promote draconian policies such as the Independent Payment Advisory Board, the body charged with indiscriminately cutting Medicare when it reaches a certain spending level, to manage rising health care costs. Such policies call for cost management without any consideration given to patient outcomes or the value of an intervention to society.
The reason policymakers take this type of action is twofold. One, these types of policies are simple to implement and two, they reach their intended results quickly by reducing budgets whether it be hospital costs or drug expenditures. On the other hand, promotion of prevention measures and policies that support such behavior are complicated and difficult to implement. And although the data shows that these measures lead to better patient outcomes, including improving quality of life and productivity, policies that support such behavior haven’t to date been given the budgetary or programmatic focus they deserve.
Two examples of preventative interventions that have not only shown to reduce costs but also improve outcomes are ensuring patients are properly vaccinated and improving medication adherence.
Vaccines are by far one of the most cost-beneficial interventions in health care. In the U.S., we have done a great job ensuring our children are protected from various communicable diseases. Vaccination rates for most serious ailments are in the 90th percentile for children. However, the same cannot be said when it comes to adults, as their vaccination rates are abysmal. For example, only 50 percent of adults obtain a flu vaccine annually and, even more alarming, only 20 percent of high-risk patients (e.g., patients suffering from lung disease) receive a pneumococcal vaccine. Such poor compliance by adults in getting their recommended vaccinations has led to almost no change in the last three decades in the number of individuals dying from pneumonia or influenza. In addition, millions of dollars are lost due to the negative impact on worker productivity. This vaccination gap exists despite significant advances in vaccine innovation for adults, an overabundance of evidence regarding their benefits, and greater accessibility as a result of pharmacist immunization initiatives. Perhaps the reason for the stark difference between adult and pediatric vaccination rates is that unlike pediatric vaccinations, we don’t have a structured mechanism in place for adults. For example, all 50 states have school entry requirements around vaccinations.
One approach to encourage adult vaccination is an initiative introduced by the California Medical Association Foundation involving publication and dissemination of a vaccine schedule for adults as well as public service announcements in English and Spanish to raise awareness about the importance of adult immunization. Another simple step is for businesses large and small to take the initiative to encourage their workers to be vaccinated, perhaps during a routine workplace meeting before the flu season, by scheduling a time when office mates could walk across the street to Walgreens or any community pharmacy to receive their annual flu vaccine.
The second example of a cost-saving preventative intervention is medication adherence. One the most cost-effective ways to improve patient adherence is pharmacist-led medication synchronization. Medication synchronization is a service that has been offered for the past several years by pharmacists to patients who take multiple chronic medications.
A pharmacist collaborating with a physician and in consultation with the patient ensures that all of the patient’s medications are refilled on the same day. Pharmacists operationalize the concept by making an appointment with a patient to pick up their medications every month, or at 60 or 90 days — depending on the refill schedule — and to discuss other issues pertinent to their care such as over-the-counter medicine usage, smoking cessation needs or vaccination requirements. Medication synchronization has not only reduced the number of trips a patient has to take to the pharmacy and lessened the administrative burden for pharmacists and physicians, but most importantly, it has led to better patient medication adherence and cost savings overall.
For example, in 2014, the Centers for Medicaid and Medicare Services decided that patients enrolled in Medicare Part D plans should have the opportunity to synchronize their medications if they choose to and if it is deemed appropriate by their pharmacist or physician, not only because it improved adherence but also because of the overall health care cost reductions. In their analysis, CMS stated, “while the estimated total 6-year cost of this rule to Part D sponsors is $0.5 million, the savings to Part D sponsors and beneficiaries is $1.8 billion.” More recently, an article published in the American Journal of Managed Care in September concluded that, “additional medication expenditures due to improved adherence associated with Appointment Based Medication Synchronization enrollment were offset by lower disease-specific medical costs.
Medical savings per additional dollar spent on medications ranged from approximately $1 to $37 depending on the medication and medication class considered.” This is why 18 states, through legislation and regulation, have taken the lead from CMS to allow all patients in need to benefit from medication synchronization. In addition, several chain and community pharmacies have decided to offer the service specifically targeting all Medicare recipients and commercial patients in those 18 states. Patients who are interested in synchronizing their medications can go to www.simplysync.net to find a list of pharmacies that offer this service. As we strive for better care, it will be important to ensure patients under 65 in the remaining 32 states have access to medication synchronization by enacting appropriate legislation or regulation.
No one denies that saving health care costs is a noble cause, and everyone agrees that it is not an easy task. However, policymakers should not solely focus on the side of the ledger marked “cost” but instead they ought to implement policies that guide us towards the goal of disease prevention as a way to achieve the ultimate end point of reducing health care costs while improving patient outcomes.
Dr. Robert Popovian is the Senior Director of Pfizer US Government Relations. He has two decades of experience in the biopharmaceutical health care industry and has published and presented extensively on the impact of pharmaceuticals and health care policies on health care costs and clinical outcomes.
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