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March 2010

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Remarks from Solutions in Drug Plan Management Discussions

Tuesday, March 2, 2010 @ 10:03 AM

Here is my speech entitled “A Challenge for Innovation”, the entire document is reproduced below.

Good morning everyone, and my thanks to Rogers for hosting another series of solutions based discussions and inviting me to be part of this one on Solutions in drug plan management.

If you’ll permit me a stream of consciousness for the next while, I want to talk to you about the opportunities in the market place – in particular for pharmacists.

We, as a profession, are in an extraordinary position at present.  At a time when integration and collaboration are the buzzwords in the health care system, pharmacists appear to be part of the solution.

For the most part, in Ontario most especially, pharmacists are staring straight at change. We might not all agree on whether its good  – but we all agree much is based on Bill 102.

As you may know, Bill 102 brings the most significant change in history to Ontario’s public drug system.

The government’s motivations with Bill 102 can be stated as “the right drug for the right patient at the right price.”

The objective, said the Minister of Health George Smitherman, is better value for taxpayer dollars.

The way to get there, he suggested, is a more efficient drug system, more accountable and transparent, and better drug pricing that reflects the volumes the province purchases.

The target, said the Minister, is a drug system where patients get better access to drugs they need, taxpayers get better value for money, and retailers, pharmacists, doctors and manufacturers get treated fairly.

My purpose here today is to try to shed a little light on the pharmacists’ perspective on this Bill.

But let me begin by stating clearly one inescapable truth: We have to move forward. If there is one principle we have to come together on the same page about, it is that the status quo on the drug system is not acceptable and not sustainable.

Keeping the public system sustainable and the private system affordable for business is not just good policy, it’s critical to this province’s economic competitiveness.

Do you think for one minute that the best economic news in the province this year – the announcement by Linamar, the number-two auto parts maker in the country, that it’s investing 1.1 billion dollars in Guelph and creating 3,000 new jobs – would be happening in this province if we did not have a public health-care system, including a drug system, that supports internationally competitive labour costs?

Take the health care and drug piece out of that puzzle and I’ll tell you what you end up with – a parts plant in Tennessee or Mexico, and a weaker and less productive economy here in Ontario.

We should never take our drug system for granted – and never be short-sighted enough to just attack outright a government that undertakes to ensure its long-term sustainability. And don’t think for one second that the need to take on that challenge would be ignored by any government in any province, Liberal, Conservative, NDP or any other.

What is incumbent upon pharmacists to do today – as a major health care stakeholder– is to make certain that changes to the drug system aimed at ensuring its sustainability do not in turn undermine the sustainability and viability of community pharmacy.  We have worked hard over the past weeks to ensure that this will not happen, and that Bill 102 does not put at risk the ability of pharmacists to deliver value-added services to their patients.

The world has been moving very quickly for pharmacists over the past eight weeks since the introduction of Bill 102, and I do understand those who share our concerns. The facts are complicated, not simplistic. Change can be intimidating and frightening for some.

But most pharmacists look forward to change. In fact, we recently completed our annual conference where the theme – Ready for Change – was embraced quite openly and enthusiastically.

But I also want to point out that fear of change can quite often be tied to a lack of knowledge and understanding. And with Bill 102, part of the problem is exactly that.

The Bill was introduced on April 13th. Five days later, on April 18th, we went into the field with a massive public opinion survey to measure awareness and support for Bill 102.

What we found was very revealing. Leger Marketing interviewed 1,000 Ontarians in the two weeks following the introduction of Bill 102.

What Leger found is that only one in five Ontarians, 22 percent, had heard about the government’s plan. And only 2.8% had a high level of familiarity with it.

When they were provided with a summary of the plan stating the government’s objectives, just under half – 47 percent – approved of it. And nearly as many – 41 percent – could not even understand what the government has proposed.

These findings describe a public that needs to hear more and understand more.

The remarkable thing about Bill 102 is that when the people understand its intent, they like what they hear.

We asked Leger to describe the key aspects of the Bill to Ontarians and determine their approval. Here’s what we found.

92 percent of Ontarians approve of ensuring that the voice of patients is taken into account in determining whether new drugs are covered under the province’s drug plan.

They approve of that – and it’s in the bill.

The survey goes on.

82 percent of Ontarians approve of increasing the level of involvement of pharmacists in making decisions about the province’s drug system. Another massive majority approval – and it too is already in the bill.

Let me be clear – this new role for pharmacists, as partners with government in making decisions about the future of the drug system – is a huge victory for our profession. A new model for pharmacists and it has rock-solid support by the people of this province.

Government cannot legislate line-by-line how we do our business. It can, however, enable us to do our job and provide the funding and resources to better serve patients.

That expanded range of professional services includes chronic disease management, medication management, patient education and other patient services of enormous benefit. As accessible, highly trained health care providers, pharmacists are perfectly positioned and fully prepared to deliver these services directly to patients with tremendous effectiveness.

And what we know today, thanks to the Leger survey, is that patients are right there with us.

86 per cent of Ontarians told Leger they agree with the following statement:

I would not hesitate to consult with my pharmacist for information on health-related issues other than filling a prescription.

75 percent of Ontarians say:

I would not hesitate to seek education services and patient care from my pharmacist for smoking cessation, diabetes, asthma or another health condition.

These are extraordinary statements on what the patients of Ontario already know about their pharmacists – which they have the skills, the knowledge, and the expertise, to step up and play a powerful new role in health care delivery.

What Bill 102 has laid out is the potential for a new model. It’s bold.

Like it or not, we have an opportunity to define the future for the public drug plan, and I believe the private sector too.

At present, community pharmacy is recognized as a commodity service.  There are innovators – and many of them out there.  But we still see discounted fees, waiving co-pays and various other schemes to create foot traffic in many community pharmacies.

What government and the private sector want is cost containment for the ‘drug file’ and the service we provide and that, my friends, led to the introduction of Bill 102.

What we have always wanted to see is a blended model.  A new model that blends traditional pharmacy practice with some kind of professional service. Something like what is proposed in Bill 102.

As I stated earlier, the reason you’re hearing so much noise about Bill 102 is that many don’t know or haven’t put their minds to what that potential new business model could look like.  They haven’t followed through on the thinking.

If you consider for a moment what the Ontario Ministry of Health has recently announced – it’s new vision. It has moved to break down its traditional silos.  It has introduced horizontal integration.

In effect, it is laying the groundwork for a future where cause and effect are the order of the day. If you spend so much on the one hand for a service, the Ministry will experience a decrease in cost for another service on the other.

We agree with this approach and it has infected our strategic planning.

Let me explain.

The classic service mentality respecting pharmacists pervaded government and third party payers – you all believed that pharmacists cared only about fees and not about patient outcomes nor did many of you think we could impact same.

In three short years, we have assembled a team of clinical, financial, policy and organizational expertise that has made us one of the premier advocacy organizations in North America.  Our opinion matters and the work we do and have done matters.

What we have moved to do is position pharmacists in the marketplace where their role and the work they do in counseling patients, collaborating with physicians and other providers and the programs we have developed for disease management and medication management can impact on drug plans and the system writ large.

We are working with the Group Health Centre in Sault Ste Marie, the OMA and Canada Health Infoway on a project that will link all the community pharmacies in and around the Soo on an integrated net-based drug platform.  The project is in the development stage at present, but is being heralded as a true collaborative model to ensure better compliance, better outcomes and better service for patients – with the best outcome being the right provider at the right time. That’s true horizontal integration.

Governments and the private sector share similar issues related to drugs.  The payers have to get value for the money being spent.

Whether it’s a tax-payer, an employer, an employee or a third party payer.  We have to work together to uncover common solutions.

I trust that my remarks here today have enlightened you a bit about where we can play a role to help realize a common thinking and solutions to those issues.

I used a word there that I want to close on this morning: Trust.

This is a time when government, industry, employers and employee groups and indeed pharmacists need to trust one another. Trust that the right programs and the right intent will benefit everyone.

We have a lot of work to do.  This is a time to build on those giant steps forward.

For our part, and those pharmacists in the audience, we’ve been put on notice by the government that our opinion matters and that item Bill 102 represents the greatest opportunity we have seen in generations to rewrite the role of the pharmacist in health care – to create the kind of efficiency you’re all starving for.

We have to take up that challenge together. It’s not just good for us. It’s something our patients are telling us they want.

And that too, is all about trust.

Because there’s something else we found in the Leger survey that blew us all away.

Back in November 2004, we were pleasantly surprised by a Decima survey we conducted that showed 97 percent of Ontarians trust their pharmacists.

In our most recent survey, which concluded this month, Ontarians were asked once again: Do you trust your pharmacist?

And this time, 98 percent said yes.

- Marc Kealey

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