When I was in grade school, President Kennedy issued the huge challenge that we would catch up and overtake the Soviets in the exploration of outer space. This started the “Space Race” and before my sophomore year in high school we had a man walking on the moon. Most people were still doing math problems on their fingers and toes and nobody dreamed of owning a calculator or a computer. In today’s technologically advanced age it is hard to believe we couldn’t initiate a similar national effort to control healthcare costs.
Over the last year or so a lot has been written about the 1% and the 99%, in an effort driven by the Occupy Movement to focus on the economic inequality that has emerged in the US. In healthcare we have a similar situation. I have discussed the healthcare numbers in several previous blogs, but have not emphasized enough the fact that 10% of the population utilize 70% of the healthcare budget (find article here). As you would expect, the curve gets even more dramatic with roughly 5% of the population spending 50% of the budget and 1% spending around 22%. This analysis allows us to focus on the problem, the high risk, high cost cohort. A national effort is needed to prevent patients from getting into this group and to then determine how to better manage the costs once they require these higher levels of care.
Perhaps it is time for our industry to focus on this problem like a laser beam. Pharmaceuticals can and should be one of the biggest leverage tools in this whole debate. Perhaps the biggest mistake our industry made in the Affordable Care Act negotiations was to give the money upfront and then allow others to decide policy. We were happy as long as the upfront payment protected our interests. The country needed the brains and the skills of our industry, not merely our money. I am somewhat biased, but I feel some of the best thinking and skills in the healthcare world are in the pharmaceutical industry.
Instead of just giving money to healthcare reform what if the industry had committed to setting up a “Health Corps” modeled on the “Peace Corps” that was also started by Kennedy. Instead of laying off reps that are not currently needed they could have dedicated a portion of their teams towards a national initiative to help physicians, help patients cut healthcare costs. Rather than merely laying off scientists, finance executives and analysts these people could have also been lent to the Health Corps to focus on cutting health costs and designing studies to prove the benefits of alternative ways of doing things.
Creative thinking is needed to help solve this problem. Over the years there have been a lot of articles written about those who make heavy use of emergency room services. The attached article is similar to a number of others I have read. The top users are often homeless, with no insurance, have some issues with substance abuse and mental health. It turns out that for some of the heaviest users it would be less expensive to rent them a home, help them with their substance issues and give them insurance then to have them continually walk into the ER to be treated. I think the industry that extended the lives of those living with AIDS for so long could figure out a way to fix this situation.
The costs for hospital readmission after a patient is released from a hospital are huge. Hospitals and insurers spend so much effort trying to prevent these readmissions due to infections, complications, and recurrences. What is really alarming is when readmissions occur due to lack of compliance with medications, misunderstanding of discharge instructions and lack of follow-through on treatment plans. It would seem that the branded pharmaceutical companies, that dramatically stopped the polio problem, could play a huge role helping with these issues if only they were welcomed into the hospital community.
I love to look through the mission statements of pharmaceutical companies and talk to the executives in our industry. Everyone seems to do this work because they feel it is a way to help people live longer, healthier and happier lives. The cost problems are obvious to everyone and now it is time to really start fixing the big issues challenging our collective futures. This is how partners work with each other, they address the big challenges and together come up with big ideas. I bet we could fully staff the Health Corps in about 90 minutes!