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One of the highlights of the recent National Association of Chain Drug Stores Pharmacy & Technology Conference was the appearance of Dr. Mark McClellan, who, after serving as commissioner of the Food and Drug Administration, oversaw implementation of the Medicare prescription drug benefit for the Bush administration.
In an intensive, hour-long presentation, McClellan, now a senior fellow at the Brookings Institution, talked about what the reform of the nation’s health care system means for community pharmacy.
After painting a stark portrait of the impact Medicare and Medicaid spending is having on long-term federal budget deficits, he said traditional approaches to managing health care are clearly not working. New ideas about the delivery of patient care and the financial mechanisms that support it need to be found to improve outcomes and reduce overall expenditures. Failure to reform the system will bring continued downward pressure on remuneration for providers, cost shifting, and quality and access issues.
McClellan said that while the result of the November elections could affect the fate of the Affordable Care Act, which Republicans have vowed to repeal and replace, the reform process will go forward. He predicted that capitated health coverage will become increasingly prevalent in both the public and private sectors, and that government expenditures for Medicare and Medicaid will be more tightly controlled.
In that environment, community pharmacies and other health care providers will be required to shift their focus from the volume and intensity of the services they provide, long the basis of remuneration, to the results they deliver and their ability to help contain total costs. McClellan said that more emphasis needs to be placed on preventive services, effective management of chronic diseases, the coordination of care, and targeting treatments to individual patients.
“These changes won’t be easy to bring about, and they can’t be done from Washington,” he said. “They will require new collaborations between payers and providers.”
McClellan’s remarks put the recent efforts of retail pharmacy operators in perspective, confirming the direction in which they are headed is the right one. The increasing availability of services that go beyond the traditional role of dispensing medications — a list that includes medication therapy management, immunizations and diagnostic testing — is in step with the needs of a health care system that requires greater accessibility and efficiency.
For pharmacies to take full advantage of opportunities in preventive services, acute care and chronic disease management, McClellan said they need to forge partnerships with other health care providers, including doctors and hospitals, and develop the means of measuring the positive effects of the care they provide — in terms of both patient outcomes and return on investment.
If pharmacy operators can do those things, they should be able to leverage the accessibility and trust they enjoy to become true community health care centers.
