Archive for the ‘Healthcare’ Category
Pharmacy and integrated Health
The regulations reflecting the revisions to the Transparent Drug System for Patients Act in Ontario have been approved by the government of Ontario and are now posted.
The reaction by pharmacy organizations was predictable. They hate what the government has done and in so doing, they want to hold patients (especially seniors and the chronically ill – as they say) hostage in the process.
Not surprisingly the business sections of major daily newspapers have reacted by issuing a reduced strike price for publicly traded pharmacy organizations and in some cases have downgraded some organizations to a “hold” on their stocks.
In all, it’s a bad start for the retail pharmacy guys who could have come out of this exercise as the real champions in an integrated health care system, currently en vogue worldwide.
As a frequent speaker across Canada on drug reform, I’ve heard from large and small organizations seeking to wade through the confusion on drug benefit plans and formulary management issues with real answers. The Ontario government has stated that it wants transparency on all drug prices plain and simple. It has passed the legislation to do that and posted the regulations that reflect it. The fight is now over! Or at least it should be. What is pharmacy doing? It’s threatening to cut back on services that make patients better. Not good.
Concessions on the regulations governing the Drug Act in Ontario have been made by government and I like to think that some of us whose voice for the effective role of pharmacist in integrated health care was heard – the role of pharmacist has been made more effective. I only hope that pharmacy can see this and cut back on the vitriol.
We still have a lot of work to do to encourage government in Ontario to increase the cognitive service fee they offer to pharmacists and we can start today by encouraging other governments in Canada to realize the ROI on effective pharmacist services to patients.
The recent legislation on drug reform in Ontario.
Major media outlets have covered the legislative process quite fairly over the past few months as the government of Ontario has moved to stabilize drug prices in Canada’s biggest province. Nothing new here, the costs of public sector formularies have been increasing at anywhere between 5% to 15% annually. When I was CEO of the Ontario Pharmacists’ Association, I implored the Board at the time to work with government and insisted that we play the Pharmacist as health care provider card when tackling the issues associated with the original reform brought in by the McGuinty Liberals in 2006. The tack we took was to demonstrate the value of pharmacists and the work they do in community pharmacy, long term care pharmacy, specialty pharmacy and hospitals across the province.
The initial legislative framework (Bill 102) had taken draconian and, frankly, chaos inducing steps to transform the drug program in Ontario. The steps we took in 2006 to counter these moves proved fruitful and beneficial to pharmacy and pharmacists. In fact, the initial financial impact of Bill 102 was some $680 million dollars out of pharmacy. Our efforts at Ontario Pharmacists’ Association, at the time, was to appeal to the issue of fairness, integration in healthcare, a new reimbursement model and the use of collaborative efforts such as Information Technology to increase competition among pharmacies. Our efforts paid off and instead of the initial $680 million dollar hit, we got back in programs and other concessions some $450 million dollars. The unintended consequence of these efforts was the establishment of a two-tiered drug pricing regime that has taken hold across the country. This means that private sector plans would pay more for the exact same drug and services as provided to public sector plan members (ODB for example).
In the ensuing years after Bill 102 was passed as the Transparent Drug System for Patients Act (TDSPA), the government has moved to integrate pharmacists into their health teams with minimal uptake from the pharmacy sector. The Meds Check program which was announced coincidentally to the TDSPA was supposed to provide some $50 million dollars to pharmacists to provide extra service to patients on their drug regimens. The program was initially a success, but pharmacy more or less blew it off in many parts of the province. The Pharmacy Council, which was also announced in the TDSPA has now become a joke.
In the ensuing years since the TDSPA was made law, there have been charges laid against pharmacies, wholesalers and manufacturers for fudging required reporting to the Ontario Public Drug Program’s Executive Officer. The Canadian Association of Change Drug Stores (CACDS), which is the de-facto negotiating body for pharmacy, or the Ontario Pharmacists’ Association have barely attempted to licit potential models that could benefit patients and the customers they serve with ways to improve the drug system. This noted, quarter after quarter publicly traded pharmacy
organizations have seen average double digit profits this in an era of economic austerity.
The trouble is that patients, plan members, formulary designers and public drug plan providers remained afflicted with cost increases. In the TDSPA there is a provision that the government will review the Act every 2 years. Last summer (2009) the then Minister of Health in Ontario announced a review of the TDSPA. Stakeholders were invited to provide their views on how to better the system.
Many stakeholders took the process seriously. It was sad to see that pharmacy did not. When the government moved to enact legislation in 2010, it seemed to take pharmacy by surprise and they reacted with faux indignation. In fact, had they been more engaged , more attuned to the needs and wants of the patients and customers they purport to cherish, they world not have used them as pawns in this massive game of chess that they have lost so publicly.
The latest polls have suggested that Ontarians overwhelming (some 93%) support the government’s initiative. So enough bitching. Here’s the deal pharmacy should stop immediately their diatribes on how they will be forced to make very difficult choices “as they evaluate the level of care they provide to all patients, especially seniors and the chronically ill”. It is sad to see that THIS rhetoric would be their response rather than engaging the public in a dialogue about an increase in cognitive services fees.
The government has announced some $100 million dollars in cognitive service fees with an additional amount for Meds Check and diabetes management. In an era where medical models of treatment are becoming teams (like a Family Health Team) pharmacists can and should integrate themselves into these models. This could prompt a call for an additional, say, $300 to $400 million in cognitive services fees. Who’s leading these pharmacy organizations? They seem to have hit every stupid button and made asses of themselves throughout this whole process. The sad reality here is that instead of looking to modernize an antiquated drug distribution process and embracing the trend of integrated healthcare, these pharmacy organization seem to think that the patients and consumers and shareholders they purport to care about are treated like lemmings and will, unfortunately, continue to fight to their own bitter end.
Pharmacists are Canada’s most accessible health professionals.
Pharmacists are Canada’s most accessible health professionals and play an important role in promoting, maintaining and improving the health of the communities they serve. Health promotion is now firmly on Ontario’s healthcare agenda and there is both an opportunity and a need for community pharmacists to become more involved in delivering public health services.
Every day Ontario pharmacists work as advocates for health. They support self help. They are local and accessible and provide patients with important health advice. Pharmacists promote health not just by advising on the proper use of medicine but also by counseling patients in areas such as diet, sexual health, and reducing tobacco and alcohol consumption.
Health spending is increasing at a rate far greater than other provincial government spending. As the population ages and the prevalence of chronic conditions increases the growth in new diagnoses for chronic conditions such as hypertension, diabetes, and arthritis actually exceeds Ontario’s population growth. The increase in diagnoses of chronic conditions is a key driver of health spending growth in Ontario.
As front-line health care providers, Ontario pharmacists are uniquely positioned to help the Ontario government achieve its objectives to improve health outcomes and control costs in our healthcare system. By helping patients comply with treatment regimens, by providing counseling on lifestyle changes, by helping to reduce the complications associated with chronic conditions and by ensuring symptoms are properly managed, Ontario pharmacists can make a big difference in improving the health of Ontarians.
Patient health management is a health care intervention that allows patients to be more involved in managing their own health outcomes. By engaging in patient health management both public and private health insurers can commit healthcare resources to keep people well and to manage diseases and conditions in a manner that avoids the costly complications associated with chronic conditions. Effective patient health management programs contain health costs by reducing the need for other more costly health care interventions. It also helps the elderly maintain independence and keeps our aging population as healthy as possible through prevention, early detection, and proper management of symptoms.
Physicians know what needs to be done to provide appropriate care consistent with clinical practice guidelines, but often lack the tools, the resources, or the time to do it. Pharmacy-based patient health management addresses this issue with significant health care delivery advantages. Involving patients in their own health management increases the patient’s sense of ownership and control (patient centered care). Patients are able to remain healthy, active & productive members of society for longer through greater disease control. There is increased compliance and adherence to treatment and, with improved patient health outcomes health care costs are contained.
In many jurisdictions pharmacists are recognized as key members of primary care teams. In the United Kingdom, the Department of Health recently launched a program for pharmaceutical public health by publishing Choosing Health Through Pharmacy. The U.K Minister of Health describes this as “a commitment to publish a strategy for pharmaceutical public health in 2005 which will expand the contribution that pharmacists, their staff and the premises in which they work can make to improving health and reducing health inequalities.” In North Carolina, the City of Asheville took a proactive approach to contain its rapidly rising employee health costs by instituting a pharmacy-driven patient health management program that was so successful in improving health outcomes and containing costs that it is now being replicated in major cities across the country
Community pharmacists in Ontario are ready, willing and able to increase their involvement and contribution to public health in collaboration with government, physicians and other health professionals. Pharmacist-based patient health management can achieve better health outcomes. The results are healthier patients, and more cost-effective use of precious health care resources.
Adam Radwanski in the Globe – “Drugstores poised to become true health-care hubs”
Another interesting article by Adam Radwanski in today’s Globe and Mail.
But now Dalton McGuinty’s government is positioned to leap to the front of the pack in transforming the profession.
Not only has it empowered pharmacists to perform certain services traditionally restricted to doctors – such as giving vaccinations and prescribing some medications – but it has the chance to provide a groundbreaking incentive to take on those tasks, turning pharmacies into health-care hubs.
Before Christmas, the Ontario legislature unanimously passed Bill 179, which permits pharmacists (along with nurses and nurse practitioners) to perform services normally limited to doctors – services they have already begun to provide in other provinces, including British Columbia, Quebec, Alberta and New Brunswick.
Pharmacists have been poised to assume a leadership role in healthcare in Ontario for decades. The lure of rebates has been the single biggest reason why community pharmacists (either independent or part of a chain) have never really fully engaged in a scope of practice that would sincerely garner public trust in their role as part of the health team.
The McGuinty government has done more for the profession in the past 6 years through landmark legislation like the passage of Bill 102, which gives pharmacists the opportunity to assume a rung in the ladder of primary care through Meds Check. It also passed Bill 171 which increased the scope of practice for Pharmacist techs which has opened the door for pharmacists to assume an even greater role as Mr. Radwanski points out through the recent passage of Bill 179.
There is much more work to do. Long Term Care and Specialty Pharmacists play a vital role in the health care of patients and their issues need to be addressed. Hospital pharmacists have long been a part of primary care teams among health professionals. Moving pharmacists out of the basement of hospitals and onto floors, so to speak, has been a boon for patient care.
The opportunity exists through all the drug reform initiatives that are occurring across the country for pharmacists to rise to the occasion and fill a role that patients want for them to be a competent part of their health care team.
Remarks from 5th Annual Health Policy Summit
Here is my speech entitled “Cross-border Prescriptions and the Impact on Canadian Health Care“, the entire document is reproduced below.
