The hope of healthcare – the value circle

I had just walked into the pharmacy in Punxsutawney, Pennsylvania, when my co-worker approached me about a problem he was in the middle of trying to solve. I do not recall the specifics of the problem, but I do recall our conversation about care.

There are far too many times when a patient is diagnosed, a medication is prescribed, and the timeline to assess success or failure of the therapy is not defined in a timely or meaningful way. It is like a circle that is incomplete.

Our conversation was on completing the circle. 

What needs to happen to make sure this circle is completed? Perhaps more importantly, who should, or who could, play a role in completing this circle?

Allow me to link back to a previous article. Recall that value is created when one person solves a problem for another.

In completing the circle, there is the creation of value.

Value for the patient. 

Value for the prescriber. 

Value for the pharmacist.

The opportunity to create value is everywhere!

Sadly, this value is not created often enough.

Perhaps it is due to the presumption of value. We presume value is created in the same way we may presume the correct diagnosis was made, or the correct therapy was prescribed, or the patient will adhere to the therapy.

I can recall having a conversation with a health plan in California many years ago. At the time, performance measures were just beginning to gain some momentum and many people had a lot of questions. As this was my sandbox at the time, it was not uncommon to be asked to explain or interpret something for someone throughout the company. In this particular case, I was helping my colleague in our managed care department understand the measures. She invited me to join a call she had scheduled with a health plan. The call went well with one exception. As I had understood things, there was an expectation that providing better care, as measured by these performance measures, should be rewarded. What became obvious was better care was the expectation.

I had suggested a preferred reimbursement rate based on patients taking their medications as prescribed. But I was met with resistance. I was met with this question: “Don’t you already have the incentive to fill more prescriptions for your patients and help then take their medications as prescribed?”

The truth is, we did. The truth is, we still do!

There is always an incentive when creating value.

One of the most obvious, and most needed, is in completing the circle.

When we complete the circle, we are identifying and resolving drug related problems, if any exist. That is so valuable!

I very much hope my experience is the exception, but I am afraid it is not. You see, I was trained to believe that if a patient was getting a refill, then he must be experiencing therapeutic success. But that may not be the case at all.

For pharmacists to be the hope of healthcare, we must look for the needed and perhaps obvious ways we can deliver value to our patients and the healthcare system.

Deep down inside, I believe we all know this intrinsically. We know there are many ways to deliver better value. We also need to have the courage to do the new things that deliver that value.

Sometimes, we seek to deliver value, and our efforts miss the mark. We will explore this area next time.

Between now and then, I encourage you to dedicate some time to think about ways you create value for others. How do you do this. More importantly: how can you create more value?

Until next time

Jesse McCullough, PharmD

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