Pharmacists and the Healthcare Puzzle: Opportunities and Trends

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Pharmacists and the Healthcare Puzzle
Opportunities and Trends

• Elizabeth K. Keyes, RPh
• Chief Business Officer
• Senior Vice President
• American Pharmacists Association
• Washington, DC
• ekeyes_at_aphanet.org

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Pharmacists and the Healthcare Puzzle

• Objectives
• Describe where pharmacists have demonstrated
  value and savings to the healthcare system.
• Explain how services such as MTM have impacted
  health outcomes and perceptions of pharmacists.
• Provide examples of opportunities and trends
  pharmacists are utilizing to enhance practice and
  improve care.
• Discuss how private and public partnerships have
  improved medication use and reduced healthcare
  costs.

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The Burden of Chronic Disease

• Includes generally incurable conditions
• Often preventable and/or manageable
• Causes 7 out of 10 deaths in the US
• Causes disability and reduced quality of life
• Affects 45 of the population 133 million
  Americans numbers are growing
• Source Partnership to Fight Chronic
  Disease/Chronic Disease Fact Sheet, October 2007

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Americanhealthcarereform.org
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Chronic diseases account for 75 of the nations
health care spending
During 2005, the U.S. spent almost 2 trillion on
health care
In public programs, treatment of chronic diseases
account for an even higher amount of spending
and 83 cents in Medicaid
More than 96 cents in Medicare
The United States cannot effectively address
escalating health care costs without addressing
the problem of chronic diseases. -- Centers for
Disease Control and Prevention
Source Partnership to Fight Chronic
Disease/ Chronic Disease Fact Sheet, October 2007
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The vast majority of cases of chronic disease
could be better prevented or managed

• The CDC estimates
• 80 of heart disease and stroke
• 80 of type 2 diabetes
• 40 of cancer
• could be prevented if only we were to do
  three things
• Stop smoking
• Start eating healthily
• Get in shape
• Manage medications
• Managing chronic diseases could also
  significantly improve patients access to
  preventive health care services (by nearly 56)

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Projected costs associated with seven of the most
common chronic diseases
If left unchecked, chronic disease will cost our
economy over 4.1 trillion By 2023.
This study evaluated the burden of seven of the
most common chronic diseases/conditions (cancer,
diabetes, heart disease, hypertension, mental
disorders, pulmonary conditions, and stroke.
Source DeVol, R, Bedroussian, A, et al. An
Unhealthy America The Economic Burden of Chronic
Disease. The Milken Institute. October 2007. Full
report and methodology available at
www.chronicdiseaseimpact.com.
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How Are Pharmacists Improving Care and Reducing
Costs?

• Supporting medication adherence
• Improving the use of medications
• Improving treatment outcomes

Medication Therapy Management
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Reasons for Poor Adherence
Wall Street Journal Online/Harris Interactive
health-care poll, March 29, 2005
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Medication Use in Society

• Drug products are essential
• Use continues to increase
• Critical weapon in fighting chronic disease
• Medication Use Process is complex
• Prescribing, Dispensing, Administering,
  Monitoring, Systems Management
• Drug-related morbidity and mortality - 1995
• 76.6 billion annually in U.S.
• 11 ratio with drug spend
• Drug-related morbidity and mortality 2001
• 177.4 billion annually in U.S.
• Sources Arch Intern Med. 1995155(18)1949-56.
• J Am Pharm Assoc. 200141(2)192-9.

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Whats the best way to improve medication use and
adherence?

• Put patients first
• Optimize medication use
• Improve communication
• Manage information
• Increase collaboration

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Creating the Basisfor a Preferred Future
www.APhAFoundation.org
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Project ImPACT HyperlipidmiaResults for 397
patients, 26 sites, 12 states over two years
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Diabetes Ten City Challenge hits the bright
lights of Broadway

• DTCC logo and website were featured on the
  Reuters billboard in Times Square (New York)
• 9 times
• during the week of April 6, 2009.

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• Results just published - Pharmacist as a coach.
• Total health care costs / patient / year reduced
  by gt 1000.
• A1c levels dropped from 7.5 to 7.1
• Influenza vaccination rates increased from 32
  to 65
• Eye exams increased from 57 to 81
• Foot exams increased from 34 to 74.
• Corroborated results from Asheville!
•  

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The Diabetes Ten City Challenge Diabetes
Triad Clinical Control A1C lt 7, BP lt 130/80,
LDL lt 100 mg/dL (n 573)
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The Diabetes Ten City ChallengePatient Care
Improvements
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The Diabetes Ten City ChallengeEconomic Total
Costs
Average Total Costs Reduced by 1,079 Per
Patient Compared To Projected Year 1
J Am Pharm Assoc
200949e52-e60
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The Care Model

• Voluntary Participation
• Education on Controlling Their Diabetes
• Patients Choose Pharmacist/Care Location
• Incentives (Established by the City)
• Free Glucometers
• Co-Pay Waivers on Diabetes Medications and
  Supplies
• On going face to face care with a personal
  pharmacist

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Pharmacists are a Key to Success because of...

• Patient accessibility
• Resources to provide advanced level of care
• Information management capabilities
• Motivation to expand care
• Education to provide higher level of care
• Demonstrated capabilities in existing programs

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Other Examples - Pharmacist Services Reduce Costs
and Improve Care

• Depression Improvement in adherence in patients
  with depression from 51 to 76
• Source Am J Health syst Pharm 2002591518-26
• Anticoagulation 73 reduction in
  hospitalizations and ER visits 77 reduction in
  bleeding events 1,600 savings per patient
• Source J Manag Care Pharm. 200713475-86
• Asthma Direct cost savings averaged 725 per
  patient
• Source J Am Pharm Assoc. 200646133-47

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Pharmacy-based Immunizations
Over 60,000 pharmacists trained
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Opportunities for pharmacists working with older
Americans

• Between 2005 and 2030, number of adults aged 65
  and older in US will almost double (to 20 of US
  population 70 million)
• More than ¾ of adults over 65yo suffer from at
  least one chronic medical condition that require
  ongoing care and management.
• Older adults account for approximately 34 of
  all prescriptions
• Only about 1 of healthcare professionals
  have training focused on taking care of seniors

Source IOM Report, April 2008
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• What you invest your energy in gets stronger
• What you dont invest your energy in gets weaker
• Tony Schwartz
• Author The Power of Full Engagement
  Managing Energy Not Time

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Inventing a Preferred Future
Patient Access to Needed Medications Pharmacy
Services
Interoperability of Pharmacy Health Information
Technology
Medication Use Quality Safety
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Thank You!

• Elizabeth K. Keyes, RPh
• Chief Business Officer
• Senior Vice President
• American Pharmacists Association
• Washington, DC
• ekeyes_at_aphanet.org