Even as the Supreme Court continues to debate the legality of the Obama health care law, most specifically the Affordable Care Act’s individual health-insurance mandate, many key initiatives of the plan’s overall intent are here to stay. Critically, they are already changing the entire healthcare landscape and cannot be ignored. To ensure a full share of the benefits, Pharma needs to engage with HIT now and fully understand the new landscape unfolding.
Better living through technology
While most other major industries such as music, publishing, and banking have already seen the disruption and reinvention of the digital revolution, healthcare has been characteristically slow to the party. Fortunately, the HITECH ACT of 2009, designed to promote the adoption and meaningful use of health information technology, has helped to greatly motivate the digitization of healthcare.
HITECH is the first big push into digitization and it is accomplishing its goals. Over $6 billion of the $27 billion allocated has been spent to date. According to recent CDC data there’s been a 33.8% adoption rate for EHRs in NY and over 60% of physicians are using tablets in daily practice (presumably to view EHRs). And judging by the hundreds, even thousands of presenters, exhibitors, and attendees of eHealth conferences such as HIMSS, Health2.0, and the mHealth Summit, the overall market for HIT is extremely robust. Until you walk the many miles of the HIMSS exhibits it’s hard to understand the growth of this market. EHRs are just the tip of the iceberg as entrepreneurs launch new apps and sites while major players like Phillips, Cisco, GE, Dell, and countless others line up to help drive the connected future of healthcare.
Joel White, Director of the Health IT Now organization, a lobbying group for the HITECH ACT, recently said he wished they had gone beyond the adoption of EHRs and pushed for connectivity and interoperability as well, since that is where the most obvious benefits really accrue. Regardless, the whole effort will continue to have a major impact on how healthcare is delivered with increasing focus on the patient and patient-centric technologies.
For example, mobile technologies such as Sanofi’s iBG Star Diabetes Manager and dermatology applications such as Skin Scan are already improving patient management and adherence. A recent article by Chambers, et al, in the Journal of the American Academy of Dermatology concluded that, “A patient centered online model may be an effective alternative to in-office care for follow-up management of psoriasis.”
And in the American Journal of Managed Care, Jain, et al, takes things even further, writing, “In new care delivery models that integrate online communications into their work flow, clinicians may engage patients with common conditions within their practice to help manage one another’s conditions.”
Interestingly, HIMSS Analytics, reporting in February 2012, on the benefits of meaningful use stages 6 and 7 identify that many of the benefits to users actually accrue to Pharma. Much of the reporting on use of EHRs focused on ADEs with 73% of users reporting an overall reduction of ADEs. Good news for Pharma.
Obviously overall HIT adoption and use is still in the early stages, but one can see how we quickly move from simple electronic health records to integrated patient centered care that leverages everything from mobile apps to social media and to data sets that change how Pharma does business. And we’re not done yet.
Accountable care goes viral
Another game changing component that is rapidly moving forward is the Accountable Care Organization (ACO) model that completely upends the current fee for service model.
The overall focus of the Affordable Care Act (ACA) of 2010 was to address the divergence between value and expenditure, and the need to create a coordinated system supporting disease prevention, chiefly through the Medicare Shared Savings Program (MSSP), which is the accountable care initiative of the ACA.
Importantly though, the ACO model now extends beyond those approved by the Centers for Medicare and Medicaid Services (CMS) to include ACOs formed by private health insurance providers. These private ACOs have fewer restrictions as they’re not constrained by the ACA and can therefore be far more reaching.
What does healthcare look like when physicians are compensated based on measureable patient outcomes rather than on number of office visits? When HIT and patient participation become paramount to providers in order to prove results and earn a living.
And for Pharma, parity drugs that formerly succeeded on marketing muscle and rep relationships could end up costing prescribers income. This could mean the entire pharmaceutical development process be reconsidered to favor drugs with clearly identified success points and/or healing claims. R&D processes, clinical trial design, labeling and marketing could all be up for a thorough review.
Patient adherence programs will be become ever more critical to realizing drug therapy benefits. Missed dosing will mean far more than missed income, it could mean that a drug is replaced by one that is easier to take and therefore able to provide fuller benefits.
Where Pharma fits in
HIT is forging brave new eHealth world but Pharma does clearly fit in. As mentioned herein there are many opportunities for Pharma to benefit as HIT transforms our industry. From the use of EHRs to improve accelerated clinical trials to better adherence programs and improved interaction with social media, Pharma is at the core of the industry and has the resources to benefit from the significant changes.
However, in an informal survey of several Pharma associates, it seems that brands are lacking in overall direction. While awareness and understanding of these evolutionary changes varies dramatically among respondents, there is a universal sense of “but what do I do about it?” And this is understandable.
However, the disruption and reinvention of healthcare will indeed continue and the answers are not at all clear. The healthcare leaders and status quo of today will not be the same in three to ten years so waiting it out is not an option.
Pharma needs to be fully engaged in the process, today and at the Brand level – attending the HIT conferences, seeing the myriad patient sites and apps, appreciating the scope of “non-Pharma” interest in the healthcare pie, understanding the interests of the varied stakeholders – to realize the massive opportunities that lie ahead. Those who don’t engage will surely be left behind. Long playing album anyone?