Quality Through Coordination

We all found our way into the pharmaceutical industry through a variety of unique paths, but I find the one thing that bonds us is the desire to help improve healthcare in our country.  I know we all want to sell our products and help our companies succeed, but when I really dig in with people, I find most do this work to help patients.  In this way, our personal goals are often consistent with the goals of the payers and providers we work with every day.  So how are we all doing and are there lessons to be learned?

Each year, the Agency for Healthcare Research and Quality (AHRQ) puts out extensive studies that track the progress we are making year over year on the quality and disparity of care across the country.  Take a look at their website for the reports and note some of the key findings for this year.  Progress has been made, but it really needs to be accelerated if we are to have quality care for everyone in our country.

The reports conclude that we have a lot of issues with ethnic and low income populations.  Quality is improving, but access and disparities are not.  Immediate attention is needed in diabetes, cancer screening and in the southern part of our country.  Progress is being made, but it is uneven and choppy throughout the country.  The reports have an incredible amount of information that is well-worth digging into if you are committed to improving healthcare in our country.

One of the more interesting parts of the reports is where they break the results down by states.  Take a look at figure H.8. and see if there are any patterns in the quality of care by states.  Note that the best care in the country seems to be in the Northeast and Upper Midwest.  What is different about these areas?  Why are things so much better there than in the rest of the country?

One possible explanation is that there might be more coordinated care in these areas of the country.  In the Upper Midwest it is interesting to remember that historically physicians grouped together to form large clinics such as Mayo and had patients come to them rather than spreading themselves all over the countryside.  The thought was that if physicians were all together they could deliver more efficient and better quality care.  In the Northeast the same type situation developed through the dominance of medical schools and teaching hospitals located in very tight geographies.  Physicians talked and worked with each other through integrated networks.

One of the things for the pharmaceutical industry to consider is the role we are playing in this work.  I think it is interesting that the states that ranked the best are some of the states that we have trouble working with as an industry.  Our reps don’t have access and it is tough to break through the managed market formularies.  The attached article from Minnesota celebrates their status as the best state in the survey and we know it is perhaps the most difficult state for the industry to work.  The areas that do the worst in the survey are often the states where we do best.  Think about where your reps have the best access and where your market shares are the highest and just match that up with the states in the upper and lower quadrants.  Is there a pattern?

In many ways, our model is designed to win where there is less coordination of care.  We do much better where physicians each make their own choices and are not restricted by formularies that in some ways try to coordinate care.  That is why we have thousands of sales representatives who try to work the system from the bottom up.  We do try to work with payers through our managed market folks but quite frankly it is difficult for us to really have a seat at the policy making table.  It is very important to note that this survey looked at quality of care, not cost containment.  We often argue that states where we don’t do well don’t want to spend money on our products.  That may be the case, but it does not seem to be hurting the quality of their care.

Change is needed if we are to start being a part of the movement to improve quality care in our country.  We need to quit trying to find holes in the system where we can win and try to become a more integral part of the coordination of care.  We will need to really prove our products provide value to the system and then work to integrate rather than go around the system.  There are tons of ways this can happen, but it might mean really digging through the data to look for opportunities.  I might suggest going to the chapter on coordination of care as a good starting point.

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