Guest Commentary: Health Care Crossroads—Where Do We Go from Here?

JANUARY 01, 2009
Christopher L. Cook, PharmD, PhD

Dr. Cook is a senior manager of Applied Outcomes and Analysis, Health Management Innovations, at GlaxoSmithKline.

Most of us recognize that when it comes to health care, our country is charting an unsustainable course and must change direction. Nearly half of us have at least one chronic disease, such as asthma, diabetes, or heart disease, and $3 of $4 spent on health care goes toward treating chronic diseases. Yet, these diseases and their devastating complications are often avoidable. If we can prevent and effectively manage diseases to avoid costly complications, we would be a healthier nation that saves money on health care. Seems like an obvious solution, right?

Unfortunately, as we know all too well, the common response is to focus on the components of care—cutting reimbursement, price controls, and limiting access to treatment—instead of directly addressing the primary driver of health care costs: chronic diseases. To have a sustainable impact on cost and the quality of care, however, we must look beyond cost-containment silos to the total costs of health care—hospital, medical, and pharmacy—and measure the effects of our efforts on the health outcomes of our patients. Our focus must be on prevention, comprehensive care management, and investment in medical research and innovative systems that bring better treatments to patients.

Increasingly, these issues are being addressed through coordinated patient-centered care initiatives. For outpatient community pharmacists, this means greater responsibility for ensuring that patients achieve their clinical goals. Hospital and long-term care pharmacists have taken on this role with great success. Community pharmacists can help to improve both patient health and economic outcomes by targeting prevention and control of chronic diseases, by addressing barriers, reducing drug therapy problems, and encouraging medication adherence.

Although these skills have been underutilized, our profession must now meet the systemic challenges of working with physicians, employers, insurers—and especially patients—to add our unique expertise and value in providing optimal pharmaceutical outcomes to the mix. We have seen many successful variations of this model, including the Asheville Project and the Diabetes Ten City Challenge; the North Carolina Medical Home Model; the Lancaster, Pennsylvania, County Business Group on Health's Bridge project; and the Minnesota Medication Management Systems model.

My employer, GlaxoSmithKline, understands that we all must change our approach to chronic diseases to lessen the impact on patients and our pocketbooks. We accept that, as a responsible employer, we must be part of the solution. Like other large employers, we face rising costs due to chronic diseases, and we see that not enough of our employees are adhering to their medication regimen. We also know that medications represent one of the most effective and affordable ways to manage chronic diseases and help prevent complications that require costly inpatient care.

GlaxoSmithKline is committed to creating a culture of health by supporting our most valuable assets, our employees, in maintaining their health. By removing the barriers to care in benefit design and supporting disease awareness, screening, education, and medication adherence, our goal is to enable each employee to succeed in his or her care.

With the promise of change in the environment, we face a crossroads. Which direction change takes will depend on how we respond. Will our profession choose to address the challenge in how we practice, have our voices heard as part of the solution, and accept the new responsibilities to improve the health of our patients?

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