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NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Comprehensive Medication Management Organization Overview • GlaxoSmithKline (GSK) is a global healthcare company that develops pharmaceuticals, vaccines, and consumer healthcare goods • The company runs commercial operations in over 150 countries, with its largest R&D centers in the UK, USA, Belgium, and China • GSK strives to “improve the quality of human life by enabling people to do more, feel better, live longer.” Background Comprehensive Medication Management (CMM) improves the effective and safe use of medications to optimize patient outcomes and reduce overall healthcare costs. This systematic approach to medication usage was envisioned with the early support of the pharmaceutical industry in the 1990s. Advocates of CMM believe that the “shotgun approach” to medication therapy needs to be replaced by precision medicine and guided by science, genomics, and proven outcomes. CMM ensures that all of a patient’s medications are reviewed for safety, appropriateness, and effectiveness, in order to improve healthcare outcomes and reduce system-wide costs. CMM has the opportunity to vastly decrease US healthcare costs by an estimated 13% and save over 1.1 million lives a year, based on a New England Healthcare Institute report published in 2009. While CMM has existed for several decades, it continues to evolve with the healthcare industry, as care coordination efforts become more central to care delivery. CMM programs have recently expanded their reach beyond free clinics and Federally Qualified Health Centers into integrated delivery systems, Accountable Care Organizations, and other coordinated care environments that take on risk for patient outcomes. Program Details GSK has directly supported the implementation of CMM guidelines and programs in the field, including: • The Asheville Project –– An early model for coordinated care for city employees in Asheville, NC • Patient-Centered Primary Care Collaborative –– An organization dedicated to advancing comprehensive, coordinated primary care • First in Health –– A patient-centered medical home available to GSK employees in NC Additionally, GSK has supported policy and legislation at the federal and state level (including in CA, MA, MO, NC, WA, and others). As a common thread in all of these initiatives, GSK has been a proponent of integrating clinical pharmacists into team-based care settings via collaborative practice agreements. An Initiative of the 15 | Comprehensive Medication Management
NDHI NAT IONAL DIALOGUE FOR Healthcare Innovation Value Delivered CMM efforts have demonstrated: • Improved clinical outcomes • Reductions in ER/hospital visits • Increased identification and resolution of medication-related or drug therapy problems • Expanded patient access to primary care and specialists, by redirecting medication management away from physicians In addition to improved patient care delivery, CMM also demonstrates positive cost savings: • Some states, such as Minnesota, have used CMM services for Medicaid for over 10 years, with positive ROIs • Fairview Health Services published an ROI of 1:1.3 for a 10-year CMM program, while the VA has estimated an ROI of 1:28 Path Forward Fair pricing for innovative medications can only be realized when the medication is used safely and effectively to achieve the intended goal of therapy. CMM integration enables the optimal use of medications and will impact how medications are priced in the paradigm shift from “cost of medications” to the “value of medications.” GSK’s long-term goal is to have comprehensive medication management services available for all patients. As legislation, policy, and regulatory environments begin to create opportunities for value-based contracting for pharmaceuticals, it will be necessary for CMM to expand relationships with patient advocacy groups, providers, and health plans. GSK will continue to push for regulatory, policy, and agency level education and action to further expand CMM availability to patients in need. While recent changes to the payment environment represent some progress for CMM initiatives, there are still barriers to realizing the full value of CMM: • Currently, pharmacists are not recognized as providers under Part B of Medicare, so they have limited reimbursement opportunities for these advanced level services • CMM services are most effective when integrated within coordinated care systems, such as PCMH and ACO environments. However, Part D MTM is currently a siloed medication/product service. Because CMM is iterative and focused on clinical goals of therapy, it is not compatible within a Part D framework GSK has drafted model state and federal CMM legislation that would improve access to, and increase the value of, CMM. To realize the full potential of CMM programs, GSK advocates for the following policy changes: • Broad adoption of CMM by CMS, including legislation that mandates CMM as a core benefit under Medicare Part B • Inclusion of CMM as an integral part of value-based and alternative payment systems –– The PPACA called for demonstration projects that reflect CMM level services, but these have not been implemented • Mechanisms to appropriately reimburse clinical pharmacists for these services Comprehensive Medication Management | 16
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