Perry Cohen

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As 2019 turned into 2020, we saw the first cases of COVID-19 come into the global spotlight. Many people had never heard of a place called Wuhan, but it wouldn’t be long until the entire world was looking toward this town in Eastern China.

China quickly learned of the severity of this disease, ultimately building two hospitals to specifically combat this illness in about a week. The world watched on as they eventually quarantined people in their homes to stop the spread of this virus.

Italy was the next country to really feel the effects of COVID-19, beginning with a few cases and little alarm from the locals. But as the virus spread, so did the strain on the health system and it wasn’t long before Italy was in a full-blown crisis. Doctors stayed in hospitals to treat the infirm for over three weeks before returning home. Many healthcare workers (over 400 in mid-March) were seriously ill with the virus, requiring treatment and resources themselves, in addition to the public that was crying out for care.

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The World Health Organization officially called COVID-19 a pandemic as it swept across the globe and into the U.S., especially New York City. With little information available and no vaccine or treatment ready to be administered, we were forced into a trial by fire. The incubation period of the disease tends to be between two and six days, but some outlier cases took up to 27 days. How does a community, or an entire country, combat a virus like this? Cue social distancing, self-quarantine, moratoriums on social gatherings, and all the efforts to “flatten the curve.”

Hospitals in hotspots have been overwhelmed by people with COVID-19 and hospitals nearly everywhere prepared for a huge wave of patients. According to the Johns Hopkins Center for Health Security, by the end of April there were 2.54 million confirmed cases around the world and almost 176,000 deaths. The Johns Hopkins tally for the United States was 890,000 cases and 50,114 deaths.

The pandemic is far from over. There are more questions than answers about testing, treatments, and, what we need most, an effective vaccine.

But this much is certain; we’re the most connected we have ever been as a global society. We have all the power in the world to talk to each other-distance, language, geography offer no barriers-and yet we don’t take advantage of it. This has to change.

There are many websites and organizations tracking the COVID-19 cases 

, hospitalizations and deaths, including, of course, the CDC.

It’s clear there is no better time than now to start really looking at healthcare with a global eye. We need to study what other countries are doing, how they've combated COVID-19, where they are successful, and where they could have done better. This type of analysis will help every country, not just the U.S., tackle COVID-19 more effectively. We must not only come together within our communities to support local businesses and protect each other from contamination, but we must learn from our international counterparts so we can avoid their pitfalls and follow their formulas for success.

Perry Cohen is co-founder and CEO of The Pharmacy Group, a pharmaceutical  industry consulting company, and a member of the Managed Healthcare Executive editorial advisory board. Cohen is also the head of TPG International Health Academy, which hold educational summits for healthcare executives around the world. The academy is currently reviewing its plans for 2020 in light of the COVID-19 pandemic.

Articles

The Managed Healthcare Executive Editorial Board Member explains the fight for the cure or to "flatten the curve" is far from over until we all look at healthcare with a global eye.

COVID-19 Shows the Need for Global Perspective on Healthcare

It’s like “dÃ©jÃ  vu” all over again! This phrase summarizes the world of pharmacy in 2019.

As the cost and use of pharmaceuticals is now on the front page of newspapers and a top priority for employers, government, and individuals, some people think that this is a new phenomenon. However, drug costs have been discussed and analyzed for decades. As you plan for 2020 and beyond, here are some key questions to consider:

1. Who is the customer for pharmaceuticals and pharmacy services?

The customer is changing from a physician-centric to a patient-centric world. 

2. What are appropriate pharmaceutical pricing strategies?

Employers are questioning the value of new drug treatments and their price. As patients pay more of the cost of these expensive therapies, drug companies are trying to develop value-based contracting ties to outcomes to address the cost problem.

Drug companies are also launching more “specialty drugs” that are covered under the medical benefit, so these drugs cannot be managed.

The current conversation around the future of rebates is interesting, but drug companies will always discount their products or purchases that can drive market share.

As prescription dispensing is increasingly handled by automation and pharmacy technicians, pharmacists will need to manage a patient’s drug therapy and be connected to others on the healthcare team (e.g., physicians and homecare providers). Using information technology can enable timely communication.

Yes. As companies like Amazon impact the drug distribution model for pharmacy and reshape the consumer experience in buying prescription drugs, pharmacy needs to invent care models to remain relevant.

5. What is the value of pharmacy benefit management (PBM) companies? 

Created in the 1990s to consolidate purchasing power for employers and health plans, PBMs have done a nice job getting discounts from pharmacies and drug companies to lower the cost of the pharmacy benefit. Serving as the middle man between drug companies and pharmacies, PBMs have also amassed large databases of pharmacy claims data to analyze drug utilization and track financial performance. They used this role to “manage” the cost of the pharmacy benefit while simultaneously creating new ways to create profits for themselves.

PBMs are currently selling commodity services (e.g., pharmacy claims processing, pharmacy network contracting,  and drug rebates) to employers and health plans.

As the focus for drug cost management moves to the drugs covered under the medical benefit, PBMs will try to position themselves to manage these medications.

6. What technology enabled services will impact pharmacy?

As pharmacies strive for greater efficiency, two technologies are emerging that ensure every patient is receiving the right medication in the prescribed dosages: (1) using digital imaging makes it much easier and faster for the tech and pharmacist to verify the prescription and (2) improvements in machines specifically engineered to count dosages ensures that the pill count is correct.

Technology such as telemedicine extends pharmacy services to the internet. Individuals in remote locations can fill prescriptions that can then be mailed to their location.

How to Successfully Transition to Value-Based Care

Pharmacies will increasingly use analytics such as EHR (Electronic Health Records) systems to gain a better picture of the overall health of the patient and in turn provide better services to its customers. In addition, pharmacies will use business analytics to identify customer choices and take action to improve its brand.

Pharmacies will be impacted as consumers embrace technologies (devices and applications) that give them greater access to relevant information. For example, technologies that provide consumer awareness of drug pricing disparities between retail pharmacies will impact their decision on where to get the prescription filled.

7.  What is a managed healthcare executive to do?

A forward-thinking healthcare executive should have a process to scan the industry for innovative applications for consumer-centered healthcare and be willing to make incremental strategic investments that can benefit their members.

For example, you need to focus on lowering drug costs by having a “state of the art” fraud, waste, and abuse program.

Redefine the role of the PBM in your organization and focus on total cost care benefits when approving new drug coverage.

Perry Cohen is an editorial advisor for 

 and is Chief Executive Officer, The Pharmacy Group.

How to manage drug cost in a value-based world.

Seven Pharmacy Questions to Consider for 2020 and Beyond

U.S. healthcare had quite a year in 2018. Employers, the federal government, and patients are not happy with the way healthcare is delivered and financed. Hospitals, physicians, and pharmacies try to remain relevant as new technologies are developed to commoditize healthcare services and enable patients to become true consumers.

Pharmaceutical companies continue to improve healthcare with new therapeutic agents. The value of these new drugs can benefit society, but even more so, their impact on healthcare economics is staggering. Specialty drugs to treat certain patients present new challenges for health plans and pharmacy benefit managers (PBMS).

As pharmaceuticals grow to consume 30% of the healthcare dollar, traditional care models need to change in order to deliver the best healthcare outcomes and real value or they will become obsolete.

Currently, drugs covered under the pharmacy benefit are distributed through community pharmacies, mail service pharmacies, and specialty pharmacies. PBMS utilize proven systems (e.g., online drug claims processing, pharmacy network contracting, and drug rebates) to manage unit drug cost.

In the future, drugs covered under the medical benefit, many of which are specialty drugs, will need new systems and processes to manage these drugs administered through the physician office, home infusion, and hospitals.

Mail order (e.g., CVS and Express Scripts)

These models are: facility driven by site of care, healthcare-professional driven, expensive, and inefficient.

The key shortcomings of the current care models are that they:

Do not use a population health approach to identify the patients to treat

Make the patient come to the site of care (e.g., hospital, pharmacy, or physician office) to receive care

Dispense pharmaceuticals with a “one-size-fits-all” approach and creates excessive waste

Make minimal use of information technology

Require each facility work in its own silo with no integration of overall patient care activities

New care models are being created that are patient driven, leverage technology, and improve accessibility.

Multi-dose strip packaging (e.g., PillPack, Pack4U)

Patient-centered home (e.g., ExactCare Pharmacy and MedAppropriate)

The key benefits of the new care models are that they do one or more of the following:

Use data analytics to identify the patients that would benefit the most from these new services

Deploy pharmacists into the patient’s home to provide “high-touch” care

Dispense pharmaceuticals in the most effective way to minimize waste

Leverage information technology (e.g., Bluetooth, wireless communications, and smartphones)

Integrate pharmacy with the overall patient care activities

Additionally, online retailer Amazon, is disrupting the current business model in the retail and grocery industries and will do the same in the community pharmacy industry. 

This will give employers and the federal government new choices in how healthcare is delivered. However, they will need a digital health strategy to leverage these new services to make sure the sickest patients can be treated in the patient care setting that can deliver measurable health outcomes improvement.

As a result, there will be new benefit designs and ways to finance care.

Perry Cohen, is an editorial advisor for 

, and is chief executive officer, The Pharmacy Group.

As pharmaceuticals grow to consume more and more of the healthcare dollar, traditional care models need to change in order to deliver the best healthcare outcomes and real value. Here are five new models on the rise.

Author | Perry Cohen

Articles

COVID-19 Shows the Need for Global Perspective on Healthcare

Seven Pharmacy Questions to Consider for 2020 and Beyond

The 5 New Pharmacy Care Models