Thoughts on Accountable Care

Our company publishes a newsletter for our clients and others in the industry, and one of the topics we recently wrote about was Accountable Care Organizations (ACOs). To learn more about ACOs specifically you can read that issue of our newsletter on our website (http://ldmgrp.com/Newsletter/April2014), but I wanted to address the larger concept of “accountable care” in this column.

The Challenge And The Opportunity

Accountable care as a concept represents both a challenge and an opportunity for pharma marketers. How you address it may have a very big impact on the performance of your brand. And surprisingly, you may already be either a participant or a bystander in this important market evolution.

The term “accountable care” is used largely because the U.S. government created a program that included “Accountable Care Organizations,” via the Centers for Medicare and Medicaid Services (CMS). CMS states that ACOs are “groups of doctors, hospitals and other healthcare providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.” Discussions of ACOs focus on the entities themselves (i.e., the organization) but it’s also important to understand the concept behind them. ACOs were created under the Affordable Care Act to help bring down costs in the Medicare program by using a “carrot and stick” approach, in which providers are rewarded for delivering healthcare within a controlled budget and hopefully with better health outcomes than would be achieved without the ACO. But let’s be very clear about something: The concept of “accountable care” exists whether or not a provider is part of a formal ACO, and the move toward accountable care represents a shift away from the episode- and illness-based way that medicine was practiced for many years. To replace that system, providers and organizations engaged in accountable care are focused on what is commonly called the “Three-Part Aim:”

1) Improving the experience of care for individuals.

2) Improving the health of populations.

3) Reducing the per-capita costs of healthcare.

This has implications not only for healthcare providers such as physicians and hospitals, but also for suppliers of products including pharmaceuticals.

To many, the most prominent and even frightening of those potential implications is a reduction in the use of their branded pharmaceutical product. That’s an understandable concern, but it may significantly overemphasize the third part of the Three-Part Aim at the expense of the other two goals. Pharmaceuticals account for less than 10% of all healthcare spending in the U.S., yet they are responsible for the control of chronic and often expensive medical conditions by millions of people.

Thus, if properly utilized, pharmaceuticals offer the potential to spend a relatively small amount of money to prevent a much larger expense, while also preventing even larger costs to society such as lost work hours, additional dependent care expenses, and other productivity losses. Granted, there are situations in which a generic or lower cost product can achieve the same clinical outcome in some patients as a more expensive brand. But that type of comparison is nothing new to pharma, and the industry can often make significant contributions toward the other two goals of accountable care that can be evaluated along with the price of the actual product.

Measuring The Value Of Brand-Sponsored Education

Take, for example, the value of brand-sponsored patient education. Our clients measure the value of these programs in many ways, but the primary metrics often involve whether or not a patient stayed adherent to therapy longer than patients who did not participate in the educational program. Having a patient learn more about their medical condition and the therapies prescribed for them can do wonders toward the first goal of the Triple Aim: “Improving the experience of care for individuals.” Enhancing a patient’s knowledge and understanding—particularly when the time of delivery opens up an opportunity for an HCP discussion if necessary—can also contribute to the probability that the patient continues on therapy.

We also see opportunities related to programs that educate caregivers. If we want to improve a person’s experience of care, educating the people they rely on to receive that care while in their home makes perfect sense. And again, pharmaceutical marketers can play an active role in this effort through educational programs delivered at either the point of care or at the point at which medications are dispensed (a common point of interaction for caregivers).

Improving the health of patient populations is another area where pharmaceutical marketers can play an active role, and the information necessary to enable those contributions may already be available.

Population Health Management

We wrote about Population Health Management as well in our client newsletter (http://ldmgrp.com/Newsletter/June2014), but the concept is not that difficult to understand nor too cumbersome for pharma to play an active role. Essentially, a “population” is any defined group of patients. So, if you are a primary care physician your population is essentially the same as your patient list. Now, let’s say that as a pharmaceutical marketer you sponsor educational programs at the point of care and provide access to those programs through a variety of channels including rep delivery, through the web and through the HCP’s electronic medical record. If that physician or their practice decides that they want to focus on the medical condition that your product manages or treats, your materials can easily be included within that physician’s “population health management” program, contributing yet again to the concept of accountable care.

When we reduce the concept of accountable care down to its core elements, it’s not that difficult to grasp, nor something that pharmaceutical marketers should fear. Yes, there are many ways for a pharmaceutical company to become formally involved in accountable care programs and with ACOs, and most companies have at least one or two individuals studying these organizations and the change they can bring. But for most pharmaceutical marketers, accountable care simply requires a focus on the things that are already required to build a successful brand:

  • Help the patient understand their condition and therapy, and be involved in their own care.
  • Help the provider educate and engage their patients.
  • Deliver programs that add value beyond just the molecule itself.

Do these three simple but important things, and you can proudly call yourself both an active contributor to “accountable care” and in all likelihood, a great marketer.

  • Mark Heinold

    Mark Heinold is CEO of PDR, the largest EMR and digital communications network. PDR connects prescribers, pharmacists and patients to improve health outcomes through targeted communications, and is the publisher of the renowned Physicians Desk Reference. PDR delivers health information designed to positively improve health behaviors through a variety of digital, office-based and pharmacy-based channels.

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