Category: government

How Pharmacists Can Help Cut Healthcare Costs

R.PETE VANDERVEEN, dean of USC’s School of Pharmacy:

This article originally appeared at POLITICO.

“How do we get patients – especially those with chronic conditions like diabetes and hypertension — to take their medications faithfully?

Hundreds of billions of dollars are riding on the answer. Spending on prescription medicines in the U.S. annually amounts to $301 billion, about 10 percent of the nation’s total health care tab. But almost as much — $290 billion — is spent each year dealing with the medical effects of Americans not taking their drugs correctly, according to the New England Healthcare Institute.

Getting patients to comply with their prescriptions could significantly cut health care costs.

It won’t be easy. Consider that researchers offered heart-attack survivors a seemingly irresistible incentive to take their medicine: “free” drugs with no co-payments. But the free drugs only modestly improved the survivors’ adherence rates, according to a study published online recently in The New England Journal of Medicine. If free drugs don’t do much, what could make a more significant dent in the problem? Pharmacists could. But the federal government doesn’t recognize them — unlike most other health care professional — as providers, which minimizes their role in helping patients correctly take their medicine and squanders tens of billions of dollars in potential savings.

Research shows that if pharmacists played a treatment role in addition to filling prescriptions, they could considerably lower health care costs. At Kaiser Permanente Colorado, for example, pharmacists set out to help patients with coronary artery disease hit their blood pressure and cholesterol targets.

Working under physician-approved protocols, the pharmacists monitored drug therapies, adjusted dosages, ordered lab tests and added medications when needed. The results? An 89 percent reduction in patients’ overall mortality and a nearly $22,000 annual savings in health care costs per patient, according to a 2007 study.

One of the largest physician-pharmacist collaboration projects is in Asheville, N.C. The city first hired pharmacists to work with its employees who had diabetes in 1997, seeking to improve their health and lower treatment costs.

The results exceeded expectations. From 1997 to 2001, the city reported that annual direct medical costs per worker dropped, on average, by $1,200 to $1,872. The city has since expanded the project to cover other chronic diseases, including hypertension and asthma. It saves an estimated $4 for every $1 invested.

These kinds of improved health outcomes and cost savings could become more widespread if Congress changed provider law to make the expanded services performed by the pharmacists at Kaiser and in Asheville part of standard health insurance coverage.

The training today’s pharmacists undergo qualifies them for provider status. They must complete a four-year postgraduate program focused on managing complex medications – more than 10,000 prescription drugs and counting – that are central to today’s drug treatments.

This knowledge is increasingly in demand. Already, more than half all Americans have one or more chronic diseases, and for 90 percent of them medications are the first-line of treatment. Health experts expect chronic-disease rates to rise as the population grays.

Yes, allowing pharmacists to play a treatment role in patient care, and collect fees for doing it, may initially increase medical costs. But over time, as the Asheville project demonstrates, it saves money.

When you factor in improved patient adherence to prescribed drug regimens because of regular pharmacist oversight, overall savings could be significant.

The Affordable Care Act offers an opportunity to put new pressure on Congress. Under the health care law, every plan sold on the new insurance exchanges will be required to cover a set of “essential health benefits,” like physician services and hospitalizations. The Department of Health and Human Services and the individual states are to decide the definition of those benefits. Making pharmacist-supervised medication management an essential benefit would help bring our health care system into the 21st century.”

Redevelopment Is About Building Communities, Not Money

WILLIAM FULTON, senior fellow at USC’s Price School of Public Policy:

This article originally appeared in the Los Angeles Times.

“The most telling thing about the death of redevelopment in California was what Gov. Jerry Brown said about it — or, more to the point, what he didn’t say. After the California Supreme Court last month upheld a state law eliminating the state’s redevelopment agencies, Brown issued a one-sentence statement saying the decision “validates a key component of the state budget and guarantees more than a billion dollars of ongoing funding for schools and public safety.”

The Next Immigration Challenge

DOWELL MYERS, demographer and planning professor in USC’s Price School of Public Policy:

This article originally appeared in the New York Times.

“The immigration crisis that has roiled American politics for decades has faded into history. Illegal immigration is shrinking to a trickle, if that, and will likely never return to the peak levels of 2000. Just as important, immigrants who arrived in the 1990s and settled here are assimilating in remarkable and unexpected ways.

Taken together, these developments, and the demographic future they foreshadow, require bold changes in our approach to both legal and illegal immigration. Put simply, we must shift from an immigration policy, with its emphasis on keeping newcomers out, to an immigrant policy, with an emphasis on encouraging migrants and their children to integrate into our social fabric. “Show me your papers” should be replaced with “We

Meet the Republican Ego — and Id

DAN SCHNUR, director of USC’s Jesse M. Unruh Institute of Politics: “The political, personal and psychological state of war that currently exists between Mitt Romney and Newt Gingrich provides a valuable insight into the conflicted mindset of the Republican Party…