It’s Working (2)

We definitely are in chaotic times in the healthcare industry with the Affordable Care Act about to be fully implemented in a few months.  Healthcare providers are working to figure out how to handle an increased workload.  Primary care is becoming increasingly important.  NPs and PAs are in high demand to help with the anticipated inflow of new patients after the first of the year.  Health insurance exchanges are rapidly becoming a reality.  States are working with the federal government to determine the appropriate role for each in 2014.  There is change everywhere, with perhaps the brightest sign of improvement being the Accountable Care Organizations (ACOs).

Take a look at this New York Times piece that is describing the incredible change brought about by the Advocate Health Care ACO around Chicago.  Note that the hospital admissions, days in the hospital and length of hospital stays are all down.  Quality of care is not being compromised, merely cost of care.  It is important to understand that this and most other ACOs are impacting both the government and the commercial markets.  Healthcare costs across the country have grown for the last 3 years at the lowest rate since records were kept 50 years ago, and this is not just because of the economy.  Progress is being made.

The article points out that this is not easy and there is no guarantee that progress at this rate will continue.  Advocate has been at this a long time.  Coordination of care is critical and this takes tremendous organizational ingenuity.  The good news is that the ACOs are learning from each other and the learning curve is being bent.  It is very interesting that the cost savings are not limited to just the hospitals and patients in the ACO because providers are truly changing the way they practice and this has spilled over to other parts of the community.  If you think this is not a potential issue for your brand or company take a look at your market share within the Advocate system.

The NYT article points out that there are now approximately 428 ACOs up and running and they are handling 4 million Medicare lives and millions more on the commercial side.  Not bad for something that many predicted would never get off the ground.  These organizations will definitely be a key piece to the implementation of healthcare reform and may be central to controlling healthcare costs and the national budget deficit.

The concern when reading the piece is how little mention there is of pharmaceuticals or our industry.  There is a comment about a pharmacist making sure drug levels were right, but that is about it.  Doctors everywhere are talking about healthcare reform and ACOs, but I am not sure how central this is to the pharmaceutical industry.  I will ask one simple question.  How different is your annual planning process this year compared to last?  If it isn’t dramatically different you are going to be left behind.

Ok, I’ll ask a few more.  Who handles the ACOs in your organization?  What are the marketing plans for this group?  How are they databased within your company?  Which healthcare providers are connected with each ACO?  What are their policies and treatment algorithms?  Most importantly, how do they view drugs?  Are they viewed as costs or tools to save costs?  Do they understand the value of your branded drugs or do they rely almost exclusively on generics?  These are monster issues that may lead to an even lesser role for our industry if we don’t get involved very quickly.  Keep in mind ACOs are just one of the many changes we will face in 2014.

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