United States Health Care System • Patchwork of Fragmented Combinations of Private and Government-Funded programs Primary Care in Community • Majority — 64% are enrolled in private health insurance programs Pharmacies: Is the Time Here? • 33% are in Federal programs (Medicare, Medicaid, CHIP, U.S. Department of Defense Programs, or Veterans Health Administration) Mark A. Munger, Pharm.D., F.C.C.P., F.A.C.C., F.H.F.S.A. • Health care Costs: 17.5% of GDP ($3.0 Trillion/$9,523/person) Professor, Pharmacotherapy; • U.S. spends twice as much on Health care as any other nation!! Adjunct Professor, Internal Medicine, University of Utah � U.S. is top consumer of sophisticated diagnostic imaging technology � U.S. is top consumer of prescription drugs (2.2 drugs/person/ ↑ ) 1. Economic Cooperation and Development Report 2013 2. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective 2 Top 5 Causes of Death in the United States What Do We Get for Our Health Care Dollar? • U.S. ranks 34 th in Life Expectancy at Birth (78.8 vs 81.2 median) Heart Disease Cancer 180 • U.S. has the Highest Infant Mortality Rate (6.1/1000 vs 3.5/1000 170 163 median) 135 40% of Deaths are • U.S. has the Highest Prevalence of Chronic Disease (68% vs 33- Chronic Lower 56%) Respiratory Diseases PREVENTABLE 90 • U.S. is the Most Obese Country (15% higher) Unintentional Injuries • U.S. has the Highest Mortality Rate from Ischemic Heart Disease Stroke 45 (128 vs 95 per 100k population) 42 39 36 • Positive: U.S. has the Best Mortality Rate from Cancer 0 Deaths per 100,000 standard population 1. Economic Cooperation and Development Report 2013 2. http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective 3. Stevens W. et al. Health Affairs 2015;34:562-70 Mortality 2014. 3 4
ACCORDING TO THE CENTERS FOR DISEASE CONTROL (CDC) http://calorielab.com/news/wp-images/post-images/fattest-states-2015-big.jpg Centers for Disease Control Prevention Checklist. Healthcare Delivery in 2020 CDC PREVENTATIVE HEALTH CHECKLIST Closer to Patient Patients Self-Care Web-based Diagnostics Primary Care IT Healthcare (M.D., Rx, Personal Health Complex Diagnostics Records) Minor Surgical OTC drugs for chronic Procedures and non-chronic Basic Diagnostics and conditions Prescribing by Mid- “Wellness” services Secondary Care Level Practitioners “Life Checks” Emergency Care Personalization Intensive Care Prediction Major Surgery Prevention/Disease Preemption Patient Responsibility Centers for Disease Control Prevention Checklist. http://www.cdc.gov/prevention/ 8
Need for Community Pharmacy Shortage of Primary Care Physicians Transformation? • By 2025: Shortage of � United States health care continues undergoing 61,700-94,700 physicians Proposed Total Physician Shortfall 2014-2025 tremendous transformation over access, quality, • Fewer physicians than most industrial countries and and cost physician visits/person/year � The pharmacy profession has been overlooked (4 vs. 6.5 median) • Primary Care Physicians in its potential to: to account for approximately � Be a cardinal touch-point for consumers to have access to the 1/3 rd of the shortage primary health care system • Projections incorporate � Provide Primary Care Services - particularly for those Physician Assistance growth that is accelerating faster consumers in rural and disadvantaged circumstances than rate of demand for healthcare services IHS Services. The Complexities of Physician Supply and Demand 2016 Update: Projections from 2014-2025. Economic Cooperation and Development Report 2013 9 10 Funded by the Skaggs Foundation for Research – Family History of Pharmacy Transformation � “First Transformation ” – 1900-1930s � Samuel Skaggs Sr. – Development of cash-only grocery stores with large- lot buying power “Standard goods at the lowest possible cost” An Audacious Goal � Samuel Skaggs Jr. – 1932 First Self-Service Drug Store Pay-Less Drug (Tacoma, Washington) � “Second Transformation” -1940s-2014 Third Transformation 2014-xxxx?? � Pharm.D. entry-level degree developed at UCSF and USC (Education) � Sustained development of hospital pharmacy with clinical pharmacy Community Pharmacy as Primary Care services (Practice) - Limited clinical service expansion into retail Clinics practice � Sam Skaggs Jr. – Rapid expansion of pharmacy/retail business model across the United States − Bringing drug/pharmacy knowledge/health care services closer to families, neighborhoods including rural and disadvantaged persons. 11 12
Background and Objectives As more individuals gain access to healthcare, there is a need to OptiPharm Study ensure that care remains high quality, affordable, and centered upon Research to Model the Demand for Primary Care Health the needs of patients and families. Services in Community Pharmacies: This may require a shift in how, who and where services are provided, A Linked Discrete Choice Model of Consumer, Pharmacist, and with pharmacies and pharmacists representing a potential resource for Payer Preferences some primary care services. Research Objectives Mark A. Munger, Pharm.D., F.C.C.P., F.A.C.C., F.H.F.S.A. Professor, Pharmacotherapy; The primary objective of the research is to model the Adjunct Professor, Internal Medicine, University of Utah demand for a range of primary care services to be Michael Feehan, Ph.D. delivered through pharmacies. Visiting Professor, Pharmacotherapy; The ultimate output of this quantitative research will be Adjunct Professor, Ophthalmology & Visual Sciences, University of Utah the “optimal” pharmacy configuration that maximizes demand for both Consumers and Pharmacists, and Prepared for: Joint Commission of Pharmacy Practitioners 11/29/2016 likelihood of reimbursement by payers. 14 Predictive Modeling Research Methodology � Model the perspectives of three key Three surveys of key stakeholders: constituencies who will shape the access � ~ 10,000 consumers of pharmacy services, aged 18+ screened to be to, the nature of, and demand for, representative of the US population pharmacy delivered primary care services � ~ 300 community pharmacists; Who work at least 20 hours during a typical week and do not work at a Hospital, Closed-Door or Mail-order � Consumers: What would they like to see Pharmacy in future pharmacy services, and what is their demand for potential new service � ~ 50 payer reimbursement decision-makers across a mix of plans, who options? are involved coverage and reimbursement policies and/or protocols for primary health care services � Pharmacists: What is their openness to new service models, their barriers and Conduct a Discrete Choice Experiment (DCE) opportunities to change? � Get consumers and pharmacists to choose their preferred pharmacies � Payers: What elements will payers to use or work in reimburse and cover the costs of? � Model and simulate the “ optimum pharmacy ” for each constituency � Validate the optimal pharmacy with payers in terms of likelihood to reimburse 15 16
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