The Collaborative Forum

In a recent post (July 24, 2009), I introduced the topic of medication adherence and decribed three pillars of system reform that would seek to address the nearly $300 Billion in annual costs related to patients not taking their medications.  Recall, these pillars were: improved drug regimens, reduced cost barriers, and patient behavior.  In today’s post, let’s describe 5 of the 10 levers as put forth by the New England Healthcare Institute (NEHI) that represent high value opportunities to improve medication adherence. Read the rest of this entry →

I had the privilege of attending an expert round table meeting in Boston yesterday sponsored by the New England Healthcare Institute focusing on the healthcare waste associated with medication non-adherence.  The conference, entitled appropriately: “Thinking Outside the Pillbox – A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease”, was a deep and thoughtful discussion led by Cliff Goodman.  The blue ribbon panel included the likes of Troy Brennan, MD, Chief Medical Officer of CVS Caremark, John Fallon, MD, Chief Physician Executive of Blue Cross Blue Shield of Massachusetts, and John Halamka, MD, Chief Information Officer of Harvard Medical School, to name just a few.

The frame-up of the “problem” for discussion was a 2007 report by NEHI updating the cost estimates of poor medication adherence.  Key findings in the report, entitled “Waste and Inefficiency in the Health Care System – Clinical Care: A Comprehensive Analysis in Support of System-wide Improvements” and updated in the July 2009 NEHI Research Brief on Medication Adherence for Chronic Disease include: Read the rest of this entry →

President Obama has made healthcare – and rising healthcare costs – a national priority, and it’s easy to see why.  As a country, we spend 2 Trillion dollars a year on healthcare, yet one in two Americans, or close to 200 Million of us, suffer from chronic diseases that decrease quality of life and increase healthcare costs. 

Click on The Value Quadrant To Enlarge

Chronic disease is a problem that many physicians see daily in their clinical practices…I sure did.  It is one that causes countless unnecessary and avoidable hospitalizations.  This problem largely reflects a lack of simple coordination of information and care processes, as well as a lack of programs and approaches for patients with chronic disease to become more involved in their daily self-care.

Unfortunately, the burden of chronic disease falls largely to the elderly and vulnerable, in other words, Medicare and Medicaid beneficiaries.  As an example, if you are a Medicare beneficiary with congestive heart failure, you and your peers consume 40% of the Medicare annual budget.  A short list of chronic conditions account for 95% of Medicare expenditures, and over 80% of Medicaid costs.  It is a small wonder that the Medicare Trust Fund is predicted to be insolvent by 2018!

So…how can healthcare reform properly focus on achieving the biggest bang for the buck?  (In other words, move to the Value Quadrant). Read the rest of this entry →