Healthcare costs have been on a steady rise in the U.S. in the last few decades, more so given the global economic impact of the coronavirus pandemic and how the pandemic affected drug manufacturing and supply chains. Since the pandemic emerged, there has also been a great increase in the prevalence of chronic disease, which has also aggravated the cost of accessing healthcare. People are now on the verge of going into massive debt for seeking healthcare.
Evaluating the current models of healthcare delivery has revealed many factors influencing the rising cost of care, including unnecessary treatments, managing medicine-related problems, and the huge cost of prescription drugs. This burden is not only pushing health buyers into financial stress but is also pushing them away from accessible healthcare for fear of incurring more debt.
There is, therefore, a need to rethink these healthcare models and provide innovative solutions to not only tackle the raging healthcare costs but also improve outcomes. One key innovative model is one that fully integrates clinical pharmacists into healthcare decisions and planning.
The conventional model of healthcare keeps pharmacists focused on the medication dispensary and supply aspect of patient care, with limited access to the decision-making process. Given the enormous knowledge and expertise of the clinical pharmacist in rational and cost-effective use of medicines, their role as key health decision-makers may be the missing link in driving positive patient outcomes.
The Edelheit Experience spoke with Jessica Lea, Pharm D, EMBA, BCPP, in a recent interview to discuss how the clinical pharmacist plays a pivotal role in addressing the burden of rising healthcare costs and improving the quality of care. Jessica, who is the Founder and CEO of Tria Health, describes how pharmacist-provided services are remodeling healthcare and synergizing with other healthcare professionals to achieve these results.
Her company, Tria Health delivers pharmacist-led chronic disease management, leveraging collaborations among the three players in healthcare delivery: the pharmacist, patient, and healthcare provider, to optimize care outcomes and reduce overall healthcare costs.
Jessica starts by emphasizing that the goal of healthcare is primarily to cure disease and lower the risk of complications and that the healthcare costs go beyond the price of one drug, to the overall effectiveness of that drug in achieving these primary goals.
“The cheapest drug may be the most expensive if it is not effective at producing the desired results,” Jessica says “For example, if you use the cheapest medication for your blood pressure, and it does not lower your blood pressure enough to lower your risk of stroke and heart attack, then that is the most expensive medication.”
Ultimately, the patient incurs more healthcare costs in dealing with heart attack and strokes as more medications and other medical interventions become necessary. This is a key gap in healthcare only clinical pharmacists can fill.
The choice of the right medication is hinged on many factors, including a patient’s medical history, metabolic function, co-existing medications, and the dynamics of that medication in that individual’s body. These factors vary between individuals, and so while one blood pressure or antidiabetic medication may be effective for one individual, it may be less effective for someone else.
Failure to understand these patient-related and pharmacological differences may mean that one patient suffers poorer outcomes, and ultimately more healthcare costs, while the other gets to see improved outcomes.
Jessica further cited polypharmacy as another source of waste and unnecessary treatments driving healthcare costs without improving outcomes. People with chronic diseases often have to use multiple prescriptions at the same time. In many cases, some of these medications are treatments for side effects of older prescriptions or additive medications to supposedly boost the efficiency of older prescriptions.
But there’s a catch; some of the medicines are unnecessary. Physicians may not be aware that the patient is not using medication correctly. Medications that work better at night, for example, may be taken during the day, or medications may be taken at smaller or larger amounts by the patient, both yielding poor outcomes. Eventually, these patients may get more medications and pay more.
“Physicians have about 49 seconds to tell the patients about their prescriptions and may not have enough time and expertise to go over each of them in great detail,” Jessica says. What this leads to is patients potentially not complying with the use of some medications that may be the most important out of their medication regimen because they are unaware of their functions and significance
Medication non-adherence is associated with disease progression and poor outcomes, and data shows that 33-69 percent of medication-related hospital admissions may be caused by poor medication adherence. Strong collaboration with clinical pharmacists helps physicians identify poor compliance and address this early on. Given their knowledge of medicines, clinical pharmacists can provide education and counseling to the patients and health buyers at the point of supply about the role of each medicine in reversing disease processes.
Prolonged hospital stays, multiple hospital visits, and avoidable medical interventions that arise from inappropriately prescribed medications are also major contributors to high healthcare costs as Jessica noted. When a clinical pharmacist advises against a potentially inappropriate medicine, they lower the risk of future adverse drug events or drug-induced disease, which, in turn, limits healthcare utilization and ensures cost avoidance.
Without treatment guidance from clinical pharmacists, physicians may prescribe medications, such as antibiotics, painkillers, and anti-inflammatories, which may well resolve ongoing disease conditions but could cause much more severe and potentially life-threatening health conditions long-term, including kidney damage, cardiac arrest, liver failure, and death.
A large study revealed that adverse drug reactions accounted for 6.5 percent of hospital admissions, while another meta-analysis demonstrated that as high as 16.9 percent of hospitalizations were caused by adverse drug events. The report found that patients who suffered adverse drug events had their hospital admissions prolonged by 2 days, at an extra cost of $2000-2500.
These data demonstrate the link between medication-related problems and high healthcare costs, revealing the urgent need for clinical pharmacists, who have unique expertise in the use of medicines. Stakeholders, therefore, need to leverage this expertise and remodel healthcare to ensure stronger collaborations with clinical pharmacists in the healthcare decision-making process.