Consumerism, health care costs and patient-centred “homes”

Health objectives in Australia are shifting from fee for service models to capitation models in a bid to simultaneously improve quality and reduce costs.
The idea of a patient-centred “home” led by a doctor is touted as the principal model of care.
i2P has always pointed to the fact that any business model led by a doctor will inevitably be an expensive model and would also not promote the idea that other models led by a range of health professionals could work less expensively, but still include the collaborative use of doctors as recipients of referrals for complex patients.

One such model already exists, and it is called the Community Pharmacy.
It is in various stages of development globally, with some having walk-in clinics and collaborations with a range of other health professionals, including GP’s (physically or by teleconferencing).
It is a model that is vigorously opposed by doctor organisations in Australia because they realise that community pharmacies could provide a competitive threat to doctor-led primary health care equivalent services.
Hence we see the AMA and the RACGP continually generating media releases that infer that turf wars are a common feature of doctor-pharmacist relationship and that pharmacist services are not competent or are generated solely as a source of profit rather than for an actual need.

Recently, a UK-based consultancy group (LEK Consulting) published a report (Healthcare-Consumerism_Rising-Costs_LEK-Executive-Insights_1806), and concluded that its impact would be minimal if it relied solely on the consumer to drive the potential benefits.
What was left unsaid was that an enormous opportunity for pharmacy and government exists if community pharmacies became the fulcrum to lead the way for lower cost and higher quality health services performed collaboratively from a community pharmacy environment.
Given the positive and long track record that community pharmacy has established with consumers i2P would state further that a moral imperative exists for pharmacy to partner with consumers and lead them to the “promised land” of economical and exceptional health choices.

Pharmacists have not realised that the high level they already practice in professional service delivery already surpasses that which exists in other health modalities.
Doctor organisations in doing their due diligence for their members have long realised the significance of the services and potential services that pharmacists could provide and this is why they run disruptive campaigns against the pharmacy profession and its serviced consumers.

Pharmacy leadership organisations have been slow and low-key in defending and developing pharmacy’s natural role in managing health expectations of the consumer and the selling of the solution to government, to receive appropriate and adequate financial support.

L.E.K. is a global strategy consulting firm with offices across Europe, the Americas and Asia-Pacific.
Founded in London in 1983 by three partners, they now employ more than 1,200 professionals worldwide.

LEK have observed that U.S. healthcare is nearly twice as expensive per person as it is for other developed countries — and the treatment outcomes are worse.
Yet elements of the US system are starting to be found within the Australian system with more to come.
According to a recent Commonwealth Fund report on healthcare systems, the U.S. ranked last overall among the richest 11 nations on measure of health outcomes, quality and efficiency.
The usual culprits for the cost are Big Pharma, insurance companies and excess litigation.
 In reality, the excess cost is driven by high-priced and unnecessary procedures mostly driven by specialist doctors, who have no real interest in empowering consumers, discounting services or even reducing the number of services.
Note that in this behaviour they demonstrate that what they already engage in is what they accuse pharmacists of attempting to do –it is an example of the pot calling the kettle black!
It is for this reason alone That i2P states that the medical profession, except for a small number of coalface practitioners, are not genuinely interested in developing a true collaboration with pharmacists but more a method of controlling the type and direction of pharmacist services.

In their report LEK examined why a more engaged consumer — despite their increasing optimism — will not be nearly enough to bend the healthcare cost curve or even stop the rising of costs in a substantial way.

In the current system 45% of patients receive the wrong diagnosis, 25% receive an inappropriate prescription and nearly 20% of hospital patients are readmitted for the same condition within 30 days.
This will also be reflected in the Australian experience with its current healthcare system version.

In the U.S., healthcare reform has dramatically altered the playing field for payers and delivery systems, putting emphasis on quality and cost with continued pressure on reimbursement. 
The unique American hybrid payer system (with limited direct out-of-pocket payments) creates complexity, mixed incentives and uneven quality and outcomes. 

Major change is underway, but the history of healthcare teaches that evolution trumps revolution.
We know the U.S. system will migrate away from fee-for-service toward outcomes and quality, but this will be an uneven ride by geography, provider type, and overall impact on members.

There is a better way, and it will be found in community pharmacies developing their model to evolve, host and support collaboratively, a range of health practitioners utilising an income sharing system whereby the community pharmacy provides infrastructure, staffing and systems support to enhance practitioner services with an infused pharmacy flavour to become a functional “health precinct”, able to deliver a health support service with a wide scope and depth.

A coalface collaboration will be the driver of both quality and lower cost.
Performed in genuine partnership with consumers, health services will be understood and ‘owned” by its users.
It will also underpin stability for health providers and provide a matrix that could support research projects that would create future directions.

What is urgently needed is for pharmacy leadership organisations to get behind the concept and take the fight right back to the medical profession and stop all the stupidity and disruption.
Medical profesionals need to sort out their own problems.
Pharmacy is not their problem but we are part of a solution.

One response to “Consumerism, health care costs and patient-centred “homes””

  1. I’d like to take the opportunity to welcome you back Neil from
    your health ordeal letting you know that you’re an incredible source of inspiration, because in the middle of your pain you were worried about ensuring your i2p publication was published on time for your readers.
    I can not but express my gratitude towards your courage and dedication.

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