Transcript Top Ten Emerging Health Care Trends

Top Ten Emerging Health Care
Trends: Implications for Patients,
Providers, and Educators
Ahead of the Curve
A project of the AMCP Foundation and
distributed in partnership with the American
Association of Colleges of Pharmacy
Introduction
• 20 years ago: The American Association of Colleges
of Pharmacy (AACP) issues the Janus Commission
Report, restating colleges of pharmacy’s
responsibility to navigate changes on the horizon
• Today: The pace of change is accelerating, and it
will be critically important for pharmacy educators:
– To comprehend today’s trends and their far-reaching
implications
– To assume leadership roles in moving the pharmacy
profession
– To prepare students for the challenges and opportunities
ahead
2
Introduction (cont’d)
• This module helps delineate today’s most critical
changes, identify trends that are inter-related, and
identify opportunities for pharmacy leaders,
including educators, to reshape their organizations
to meet today’s and tomorrow’s challenges.
• Ahead of the Curve presents the results of a survey
that identifies and links these changes, and
suggests ways pharmacy educators can prepare
the leaders of tomorrow.
Outline
• Study Background and Objectives
• Top Ten Emerging Health Care Trends
• Implications for Pharmacy Educators
4
Study Background
• The US health care system is in
a constant state of change
• The Patient Protection and
Affordable Care Act (ACA)
placed the “Triple Aim” of
health care center stage
Improving Pt Satisfaction and
Care Quality
5
The Education of Pharmacy Students Must Reflect
Today’s Changes and Emerging Trends
• Health care stakeholders are increasingly asked to
do more with less
– Costs of medicines escalating in parallel with growing
requirements for improved patient outcomes
– Migration from volume to value in the health care
marketplace
• Current need to identify and assess the impact of
the rapidly changing dynamics in the US health
care system to proactively prepare for expected
changes
Goals of the Research Initiative
10
Top
emerging trends in US health
care impacting managed
care pharmacy in the next
5
years
RESEARCH GOAL:
•
Identify the top ten emerging health care trends expected to have a
significant impact on managed care pharmacy organizations in the next five
years
ADDITIONAL STUDY OBJECTIVES:
•
Provide real-world insights on key health policy priorities relevant to a set of
broader health care stakeholders
•
Develop a comprehensive reference resource for managed care provider
organizations, health care payers, policy makers, and other stakeholders
7
Advisory Panel for “Ahead of the Curve”
THOUGHT LEADER
PROFESSIONAL AFFILIATION
Joseph Biskupiak, PhD, MBA
Research Associate Professor & Associate Director, PORC at the University of
Utah College of Pharmacy
Chris Dawe
Former Health Care Policy Advisor, the White House (National Economic
Council)
Jeffrey Dunn, PharmD, MBA
Senior Vice President, VRx Pharmacy Services
Jeremy Nobel, MD, MPH
Medical Director, Northeast Business Group on Health (NEBGH); Executive
Director, NEBGH Solutions Center
Sandy Robinson, BA, MPA
Senior Vice President, Avalere Health
Rebecca Snead, RPh
Executive Vice President and CEO of the National Alliance of State Pharmacy
Associations
Mark Snyder, MD
Specialist Leader, Deloitte Consulting
JoAnn Volk, MA
Research Professor and Project Director, Center on Health Insurance Reforms
at Georgetown University Health Policy Institute
Mitzi Wasik, PharmD, BCPS
Director of Medicare Pharmacy Clinical Programs at Coventry Health Care,
Inc./Aetna
Jed Weissberg, MD
Senior Fellow, the Institute for Clinical and Economic Review
8
Outline
• Study Background and Objectives
• Top Ten Emerging Health Care Trends
• Implications of Emerging Trends for Pharmacy
Educators
9
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Health care everywhere
10
10
Health Care Everywhere
• The Location of Care is Shifting Beyond Health Care
Facilities
• Non-Physician Care Roles are Expanding
• Innovations in Technology are Fueling Enhanced
Patient Engagement
• A New Generation of Health Care Roles Will Emerge
• New Care Settings Bring New Challenges in
Coordination
11
Current Trends:
10
Health Care Everywhere
CHANGING THE PLACE
OF CARE
REDEFINING PATIENT
OUTREACH
MEDICALIZATION OF
CONSUMER DEVICES
12
Looking Ahead:
10
Health Care Everywhere
Opportunities Ahead
• Expanded role for retail pharmacies
• Technologies and devices to enable physician extenders
• New roles in the health care workforce
Challenges Ahead
• Care coordination and continuity of care
• Data portability and technology integration
For Educators
• Focusing on coordination-of-care training
• Expansion of pharmacy practice areas: patient care and outreach
• Offering experiential training in innovative settings
13
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Increasing patient cost sharing
Health care everywhere
14
Increasing Patient Cost Sharing
• Patient Cost Sharing is Increasing
• New Provider Payment Models May Increase
Patient Financial Risk
• Non-financial Approaches are Needed to
Effectively Engage Patients
15
9
Current Trends:
9
Increasing Patient Cost Sharing
COST SHARING FOR
PHARMACEUTICALS IS RISING
BENEFIT DESIGNS ARE INCREASING
PATIENT FINANCIAL RISK
PATIENT ENGAGEMENT
IS IMPORTANT
IMPACT OF COST SHARING ON
CARE SEEKING BEHAVIORS
1. Magellan Pharmacy Solutions 2012; 2. CVS Caremark 2013; 3. PwC Health Research Institute 2013b; 4.
Blumenthal 2013;
16
Looking Ahead:
9
Increasing Patient Cost Sharing
Opportunities Ahead
• Promoting the use of high value services
• Increasing patient ownership over disease management
Challenges Ahead
• Balanced risk sharing models are needed
• Changes in provider payment and health system delivery
For Educators
• Raise awareness that greater patient cost sharing has the potential
to limit adherence with therapies, without appropriate balances
• Understand that methods to optimize patient decision making will
require novel consumer-focused technologies
17
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
18
Role of Technology
in Patient Engagement
8
• The Rise of Health Care Technologies is
Empowering Patients
• Technology Tools Support Communication and
Decision-Making
• Patients are Becoming “Consumers”
• Patient Education and Technology
Coordination are Keys to Success
• The “Digital Divide” is a Risk for Some
19
Current Trends: Role
of Technology
in Patient Engagement
8
PATIENTS WILL DRIVE
TECHNOLOGY USE
TECHNOLOGY IN DISEASE
MANAGEMENT
TECHNOLOGY IN
MEDICATION
MANAGEMENT
DEMOGRAPHICS IMPACT
USAGE
20
Looking Ahead:
Role of Technology in Patient Engagement
Opportunities Ahead
• Improved patient health care decision-making
• Patient ownership over disease management
Challenges Ahead
• Patient education including health literacy and e-literacy
• Coordination of technologies
• The digital divide
For Educators
• Technology will play several roles in connecting to patients
regarding their pharmaceutical care and cost sharing
21
8
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
22
8
Growth and Performance of ACOs 7
• ACOs are Expanding
• Early Data on ACOs are Promising
• ACO-Type Thinking is a Necessary Transitional
Step
• Data and Analytics Will be Key for ACOs
• A Broader Culture Shift is Needed to Bend the
Cost Curve
23
Current Trends:
7
8
Growth and Performance of ACOs
PUBLIC & PRIVATE ACOS ARE ON
THE RISE
PIONEER ACOS 
MIXED RESULTS
APPEAL OF THE ACO MODEL
1. Muhlestein 2013a; 2. Gold 2014; 3. Ignagni 2013; 4. Sanofi 2013; 5. Petersen 2013; 6. Muhlestein 2013b; 7.
CMS 2013; 8. Gold 2014
24
Looking Ahead:
7
8
Growth and Performance of ACOs
Opportunities Ahead
• Dual focus on cost and quality
• Data-driven insights
Challenges Ahead
• Reduced provider autonomy
• Sharing revenue
• Fragmented health system
For Educators
• ACO and shared-savings models offer opportunities for pharmacy
• Shared savings through better adherence and persistence?
• University-based health systems and ACOs: an opportunity for
student experience?
25
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
26
Migration to Value-Oriented
Health Care Marketplace
6
8
7
• Migration to Value-Oriented Marketplace is
Occurring
• Defining “Value” Will be Necessary
• Meaningful, Measurable Patient Outcomes
Must be Defined and Tracked
• Multi-faceted Approaches Will be Needed
27
Current Trends: Migration
to Value-Oriented
Health Care Marketplace
DRIVING VALUE THROUGH
INCENTIVES
CHALLENGES IN
PAYING FOR VALUE
FINANCIAL INCENTIVES
ALONE MAY NOT DRIVE
VALUE
28
6
8
7
Looking Ahead: Migration
to Value-Oriented
Health Care Marketplace
6
8
7
Opportunities Ahead
• Era of value-based marketplace
• Paying for value instead of services
Challenges Ahead
• Lack of consistent definition of “value”
• Lack of available data
For Educators
• Ensure pharmacy students grasp the concept of value in health
care treatment (from both the patient’s and system’s perspective)
• Champion a dialogue on standard benchmarks for value
• Establish procedures to iteratively evolve the definition of value
29
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
30
Medicaid Expansion
due to Health Care Reform
5
8
7
6
• Medicaid Enrollment is Increasing
• States Hold the Power to Drive Expansion
• Cost Reduction and Care Efficiency Will be Key
• Medicaid Expansion Will be a Hot Bed of
Innovation for Change
• Improved Outcomes With Lower
Reimbursements Will be Necessary
31
Current Trends: Medicaid
Expansion
due to Health Care Reform
5
MEDICAID ENROLLMENT WILL
RISE
STATE RESPONSES WILL VARY
MEDICAID EXPENDITURES
WILL RISE
EXPANSION WILL HARNESS NEW
CARE DELIVERY MODELS
1. Sanofi 2013; 2. Cannon 2012; 3. KFF 2014; 4. The Advisory Board Company 2014; 5. Rudowitz 2014; 6.
Kocot 2013
32
Looking Ahead: Medicaid
Expansion
due to Health Care Reform
5
Opportunities Ahead
• A “hot bed” of innovation
• New roles
Challenges Ahead
• Potential trickle-down effect of financial risk
• Difficult processes for treating and paying for the uninsured
For Educators
• Greater opportunities for pharmacy to play new roles in primary
care and on the care team
• More need than ever for pharmacy students to deeply understand
the evolving health system and grasp new innovations and their
effect on traditional provider roles
33
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Spending and utilization for specialty pharmaceuticals
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
34
Spending and Utilization
for Specialty Pharmaceuticals
4
• Specialty Medicine Spending and
Utilization Will Continue to Grow
• Biosimilars Have the Potential to Shift the
Cost Curve
• Scientific Advances Can Help Get the
Right Treatments to the Right Patients
• Promoting Optimal Use of Specialty
Medications Requires New Approaches
35
Current Trends: Spending
and Utilization
for Specialty Pharmaceuticals
4
SPECIALTY BOOM WILL
CONTINUE
HEALTH PLAN RESPONSES
TO
SPECIALTY SPENDING RISE
BIOSIMILARS BRING
MARKET OPPORTUNITY
36
Looking Ahead: Spending
and Utilization
for Specialty Pharmaceuticals
4
Opportunities Ahead
• “Personalized” or “precision” medicine
• Improved patient outcomes
Challenges Ahead
• Final regulatory framework for biosimilars
• Over-specialization of care
For Educators
• Prepare new pharmacists with focused education on specialty and
biosimilars, including the challenges for bioequivalence, safety,
and efficacy
• Differentiate the nuances of the pharmacy vs. medical benefit in
pharmacy practice in teaching/experiential learning
37
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Widespread use of data and analytics in patient care
Spending and utilization for specialty pharmaceuticals
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
38
Widespread Use of Data
and Analytics in Patient Care
3
•
Patient Data Assets are Multiplying
•
Data and Analytics-Based Insights Will Drive
Care Efficiency
•
Collecting the “Right Data” is Increasingly
Important
•
Integrated Systems are Primed to Lead the Way
•
Organizational and Operational Barriers Must
be Addressed
39
Current Trends: Widespread
Use of Data and
Analytics in Patient Care
EXPANDED USE OF ELECTRONIC
HEALTH RECORDS
MULTIPLE SOURCES OF
DATA WILL ARISE
LACK OF RELEVANT AND
MEASURABLE PATIENT OUTCOMES
PRESENT BARRIERS
NEW DATASETS WITH NEW
PURPOSES
1. Hsiao 2014; 2. Charles 2013; 3. ASCO 2014
40
3
Looking Ahead: Widespread
Use of Data
and Analytics in Patient Care
3
Opportunities Ahead
• Data driven insights
• Transparency in the care provision process
Challenges Ahead
• Fragmented patient data
• Reluctance of many clinicians
• Availability of meaningful patient metrics
For Educators
• Introduce to students the concepts of EHR and HIT in general, and
the contributions/roles of pharmacy in collecting data
• Discuss with pharmacy students the benefits and challenges in
using analytics to track patient care
41
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Consolidation of health care stakeholders
Widespread use of data and analytics in patient care
Spending and utilization for specialty pharmaceuticals
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
42
Consolidation of Health Care Stakeholders
2
• Consolidation of Health Care Stakeholders is
on the Rise
• Decision-Making Will Become Centralized
and Standardized
• The Balance of Market Power Will Shift
• Consolidation Creates New Opportunities in
Health Information Technology
43
Current Trends:
Consolidation of Health Care Stakeholders
HOSPITAL MERGERS ON THE RISE
INCREASED HORIZONTAL
INTEGRATION
REACTIVE CONSOLIDATION
COORDINATED
DECISION-MAKING
1. Enders 2014; 2. Brooks 2012; 3. Genentech 2012; 4. Hernandez 2013
44
2
Looking Ahead: Consolidation
of
Health Care Stakeholders
2
Opportunities Ahead
• Increased use of data and technology
• Increased care efficiency
• More negotiating power
Challenges Ahead
• Gaps in data on longitudinal patient outcomes and the health care
supply chain
• Shifts in the conventional provider role
For Educators
• Ensure pharmacy students are prepared to work in an environment
characterized by changing payment models and IDNs and can
critically analyze the pharmaceutical purchasing/supply chain
45
Top 10 Trends Countdown
1
2
3
4
5
6
7
8
9
10
Migration from fee-for-service to new provider payment models
Consolidation of health care stakeholders
Widespread use of data and analytics in patient care
Spending and utilization for specialty pharmaceuticals
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
46
Migration from FFS to
New Provider Payment Models
1
• Focus on Paying for Accountability
• Stakeholders are Employing a Variety of
New Models
• Payers Hold the Responsibility for Designing
Balanced Models
• Payment Changes are Shifting Care Delivery
Practices
47
Current Trends: Migration
from FFS to
New Provider Payment Models
1
BUNDLED PAYMENTS IN
ONCOLOGY
BUNDLED PAYMENTS IN
HOSPITALS
BUNDLED PAYMENTS ARE
SUCCESSFUL
COLLABORATION IS KEY IN
DESIGNING NEW MODELS
1. Magellan Pharmacy Solutions 2012; 2. Zellmer 2013; 3. RWJF 2013
48
Looking Ahead: Migration
from FFS to New
Provider Payment Models
1
Opportunities Ahead
• High-quality patient outcomes
• Reduced costs for government and commercial
• New approaches for care delivery
Challenges Ahead
• Lack of long-term data on performance
• Potential abandonment/reduction of care for certain high-cost
chronic diseases
• Ability of providers to identify and reduce waste
For Educators
• Payment reform will need to be an evolving process
• Illustrate opportunities for pharmacists to provide value in such systems
49
Top Ten Emerging Health Care Trends
1
2
3
4
5
6
7
8
9
10
Migration from fee-for-service to new provider payment models
Consolidation of health care stakeholders
Widespread use of data and analytics in patient care
Spending and utilization for specialty pharmaceuticals
Medicaid expansion due to health care reform
Migration to value-oriented health care marketplace
Growth and performance of accountable care organizations
Role of technology in patient engagement
Increasing patient cost sharing
Health care everywhere
50
Outline
• Study Background and Objectives
• Top Ten Emerging Health Care Trends
• Implications of Emerging Trends for Pharmacy
Educators
51
Implications For Pharmacy Educators
Opportunities Ahead
• The role of pharmacy will continue to expand
• Pharmacists will be more integrated on patient care teams
• Utilization of health information and patient technologies by
pharmacists
• Improving value through improved medication adherence and
persistence
Challenges Ahead
• Continuing to demonstrate pharmacy value in evolving systems,
especially in coordination of care
• Managing specialty pharmaceutical trends
• Understanding the complexities of payment reform and risk sharing
52