September 05 2018 | 0 Comments | 159 reads Average Rating: 3

Population Health & Prescription Drugs: Getting into a New Frame of Mind

by EXL Healthcare in Life Sciences

Healthcare organizations are moving toward value-based care and increasingly adopting population health programs. Doing so requires a whole new mindset – specifically when thinking about prescription drugs.

Here are three ways that risk-taking provider organizations need to think differently:

1. You can no longer simply focus on prescription drug costs in isolation but must zero in on how these therapies factor into the total cost of care. To do this, consider the benefits or the harms of a drug in terms of the impact that it will have on entire populations.

2. Your pharmacy group can no longer go it alone. Instead, pharmacy decision makers must interact with a variety of departments to ensure that everyone in your organization understands how each drug plays a role in the total cost of care for patient populations. By doing this, the pharmacy group could justify the promotion of high-cost drugs in lower tiers, when overall spending decreases. Similarly, if a low-cost or high-cost drug does not produce good outcomes, its use could be discouraged.

3. You should consider a variety of cost categories (inpatient, emergency department, ambulatory surgery, obstetrical care, etc.) and determine exactly how drugs can affect outcomes and costs in these situations. For example, drug prices could be thought of in the context of primary care. Consider the following: If only 50% of a risk-taking organization’s members with Alzheimer’s disease are on medications, leaders should ask why 70% or even 80% of these patients are not taking medications. Taking the time to find out why – and then to implement the interventions that will ensure that these members receive the appropriate drug therapy – could save substantial costs.

Pharma companies need to change their thought processes as well in this era of population health. Here are couple of ways that pharma companies need to think differently:

1. Instead of simply selling drugs based on price, you need to demonstrate how your drugs can improve patient outcomes, lower overall costs of care and enhance the patient experience – all important elements of success under population health programs.

2. Prove that your drugs are producing the desired population health outcomes. Through the use of advanced analytics, it is possible to hone in on exactly where the cost savings is coming from. For example, after implementing a specific drug therapy, it might be possible to determine if the cost savings specifically emanated from decreased emergency department visits.

This are just a few of the ways that risk-taking organizations and pharma companies need to change to succeed with population health. Can you think of any others?

This blog is based on the whitepaper entitled, Pharma Companies Need to Get in Step with Population Health Programs. For a more in-depth discussion of the role that prescription drugs play in the total cost of care, check out the whitepaper here.

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