Collaboration Necessary to Improve Health Care


Patient outcomes dependent on collaboration between specialty pharmacists and physicians.

Specialty drugs require increased monitoring and education provided by various health care professionals. More than ever, pharmacists are being included in innovative care teams to improve patient outcomes, especially when it comes to disease states, such as cancer.

Care teams may include a specialist, a primary care physician, a nurse, and a pharmacist who communicate regularly to ensure that patients are receiving optimal care at each step. The providers work together toward the goal of improving outcomes. Without open communication, patients may experience disjointed care.

In a 3-part interview with Specialty Pharmacy Times, Durral Gilbert, president, supply chain services at Premier Inc, and Greg Isaak, president of Commcare Specialty Pharmacy, discussed the future of specialty and how collaboration is key going forward.

SPT: Why is collaboration necessary to improve the health care system?

Gilbert: In a lot of respects, health care still operates as a cottage industry; when you think of 5000 community hospitals across the nation, and then you think of the massive number of non-acute points of care, all of them are operating independently. To get change to take hold, it really needs a facilitator. Also, because health care is such a science-driven, clinically-oriented area, people aren’t just going to change a practice because someone said so. They’re very used to peer collaboration and believing in what other health care practitioners are doing to change medicine.

I think the key is having a central organization that is large enough to convene and aggregate all these individual entities and provide them a forum for data-driven, scientific collaboration. That way, they can learn from each other in a 1-to-1, as well as a 1-to-many environment. Given the changes that are facing health care, it’s pretty critical to move productive change forward as quickly as possible, or else this cottage industry truly will have a difficult time.

Isaak: We’re not only dealing with very complex disease states, we’re dealing with people. We can whiteboard the process, and implement it exactly how it should work, but it only works until that 1 human, one patient, says, “I’m not doing it.” Like Acacia [Strachan, Commcare clinical pharmacist] talked about during her presentation [at the 6th annual Premier Inc Specialty Pharmacy Executive Retreat], you’re on the phone with a patient and they say “I’m feeling well. I’m not going to take my medication.” That might last for 24 to 48 hours, but in 72 hours, they may be in the emergency department or in the physician office. The physician needs to know that information, and the physician will not know that unless the SP communicates with their office. The collaboration between pharmacy, physicians, and patients is critical. To Durral’s larger point, it’s 1-to-many, because they’re all experiencing the same issues — how do we bring solutions to that to provide better health care?

SPT: How can collaboration between health care providers improve outcomes?

Gilbert: The collaboration between providers goes back to what I was saying earlier. They do value other clinical perspectives and also data. It’s really critical you’re giving them access to other clinicians and access to data, so they can look at their outcomes objectively and ask themselves “are my cases really more severe, and do they need different things?” Or is it more “by doing things the way someone else did, I may get that better outcome.”

When you take a disease state like MS [multiple sclerosis] or hepatitis, where you have multiple therapy options, if you’re not giving prescribers data to talk about which choices are better for the patients, it’s hard for the provider to believe that the drug they prescribe isn’t the best one. Show them the data from providers from other patients. I think that’s how you make a mark. You can’t just put 2 physicians, hospital CEOs, or chief medical officers in a room and expect them to collaborate. There really is a process that you have to continue to provide, not dissimilar to the conversation about IRBs (institutional review boards) and clinical trials. Once that rigor is in place, I think that’s really the art. Even when you’re dealing with patients as people, you’re dealing with providers as people. How do you provide that infrastructure to them? That’s the thing Premier does exceptionally well, having done so many national collaboratives using hospital systems.

Isaak: I refer to it as the initiator of the collaboration - that’s where Premier really drives value. As Durral was saying, there will always be differences in treatment and patient tolerance. But there’s another variable in play, and that’s the payer. The payer may have a completely different objective in terms of how a patient is treated.

Physicians don’t like to be told what to do by the payers, and so how do we provide data and evidence back to them so they can make the case for what they believe is the right type of treatment on the patient’s behalf. That way the patient doesn’t lose, because often, the patient is put in the middle of the process. They’re not getting better, they’re not starting treatment, and now their physician is at odds with their insurer. The collaboration point is really a critical point in this process.

Check tomorrow for part 2 of this 3-part interview series.

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