MHE: What approaches work best for managing care (i.e., education, care management, medication therapy management, etc.)?
Manzi: They are all equally important, but I am a big believer that patients have to be educated about their illness and actively involved in the management of their care. The days of passive patients and authoritative physicians with no room for discussion are gone. We have very informed patients. As providers of care, we are responsible for getting them reliable and accurate educational materials, and we have to accept the fact that they are going to come in much more aware than they used to be. There has to be shared decision making about what drugs to use and when.
We have to leverage our care managers to keep our patients engaged in preventative practices and therapy plans, whether it’s telephonically, using innovative devices, or with community partners. This is a very different model from what traditional healthcare delivery systems have provided in the past.
Finally, medication adherence is not only important, but it is a major driver of unnecessary cost to the system. It is shocking to see how frequently people either forget or choose not to take their medications, and even more surprising how infrequently they admit this to their physicians. Think about the cost of that behavior as you escalate therapy because you think it is ineffective, when they were never taking it in the first place. Measuring drug levels to assess compliance is becoming a more favorable approach. This can stimulate a discussion around adherence and may avoid changing treatment unnecessarily.
MHE: Are there any pipeline drugs that are going to have a big impact?
Manzi: There are so many drugs in the pipeline for autoimmune diseases. Some of the newer biological therapies for RA have changed the course of the disease. When I was training 20 years ago, physical disability from joint deformities was the norm. I now tell our medical students and residents that they may never see this again in patients who are getting adequate treatment. Are these agents cheap? No. But the return on investment may be high with less disability, work loss, hospitalizations, etc. The pipeline is endless and some may ask why we need so many options. The answer is, what works like a miracle in one patient may have no impact in another. We need options.
MHE: What resources are available to health plans to better manage their members with autoimmune disorders?
Manzi: It seems as though there is less attention on autoimmune diseases and much more attention on other conditions. A lot of it is justified—heart disease and diabetes are big issues. But cumulatively, autoimmune diseases make up a large portion of the membership in a health plan and the drug costs can be extremely high. Working together, payer and provider, to standardize our approach to managing these disorders is the best path forward. In the end, we want the same thing: a healthy, productive population of people who are managing their chronic conditions in the best way possible. Ultimately we are working together toward prevention of disease altogether.
Tracey Walker is content manager for Managed Healthcare Executive.