Humanizing chronic care

MODERATOR’S NOTE: It should come as no surprise that 7-in-10 deaths in the United States today are caused by, or related to, a chronic condition. At least 45% of our current population suffers from a chronic condition. By 2025, 164 million Americans — nearly half of the population — will have at least one chronic condition.

America is increasingly being defined by complexity and multi-morbidity. According to an October study by Emory University’s Rollins School of Public Health in Atlanta, the co-occurrence of two or more chronic medical conditions is really becoming more predominant in our society. So when we think about chronic conditions, it may not be just one condition; it may be multiple co-morbidities, and it’s something that each one of the retailers and vendors who participated in this panel discussion in December is actively working to address today.

WENDLAND, HAMACHER RESOURCE GROUP: There has been a lot of change in health care.… How do you see… the future state of health care [evolving]?

MIKE WOLF, WALGREENS: The most important thing to focus on is the consumer.… It has to be very easy for her to navigate this ecosystem and… the solution really in effect has to be… easier than the current solutions [out there].

The next piece here is technology, and we’ve seen a great evolution on the technology side of things. When we started collecting data, we saw a lot of protection of that data by the people who collected it. It was their data… The new realization… is the openness of sharing, whether it’s EHRs or APIs — we’re finally realizing that the data really belongs to her; it’s the patient’s data. How they want to use it is up to them.

The other piece is data overload. So, as the healthcare system has evolved, there’s data everywhere — from hospital records, flu shot records, clinic records and pharmacy records. We even talked a little bit… about FitBits and the records that are coming in from devices. So the key to the new ecosystem will really be data refinement and actually using the data… to change behavior and ultimately improve outcomes.…

The [last piece] is security. With some of the financial data breaches we’ve seen, we’re… hearing a lot from her around the importance of security.

WENDLAND, HAMACHER RESOURCE GROUP:… How has retail pharmacy evolved,… and what do you see on the horizon?

MATTHEW RUTLEDGE, MD LABS: Well, a big question is who in this room has heard about pharmacogenomics this past year?… This technology effectively is under the umbrella of personalized medicine, which the president has mentioned in the past two State of the Union addresses. The new president coming in is saying it’s something he wants to support, so it’s something that’s going to affect all of us, not just as healthcare providers but as patients. And we can now look at your genetics and understand what medications you should avoid; what’s right for you, so the concept of introducing this into health care is now old. The concept of introducing this technology and empowering pharmacists to be the nuclei, to be the keepers of this information, that’s relatively new. And I’ve met with most of the major retailers in here and have talked about it; it is the future that we all see. It’s going to elevate and empower pharmacists to utilize their license to the best they can and drive a lot of the profit measure that we’re all looking to drive.

The question now is when and when are the infrastructures going to be built to enable it? When are patients going to show up and ask for it and demand it? When are insurance companies going to pay for it?

WENDLAND, HAMACHER RESOURCE GROUP: Len, [your company] has evolved as well through the years… Where [does] Johnson & Johnson see itself today beyond just a products company?

LEN GREER, JOHNSON & JOHNSON: At Johnson & Johnson, we really believe there are three key ingredients to making this work. One is behavior science. We talked a lot about medication adherence. Medication adherence is largely about behavior; there are a great number of influences. Why is it so hard to get people to take their medications as they should? Understanding those forces and putting them to work in solutions… is critical.

Another is starting with the patient.… You must take a patient-centered approach, apply design thinking and think through the whole journey of someone through a health condition or surgical episode, even beyond chronic conditions.

Third is analytics. Knowing … where to aim, how to prioritize, what’s working; using machine learning to improve.…

If you believe those things are key…, then you also have to believe that the retail environment is essential to making it work. It’s not an app; it’s not something delivered to your home.

WENDLAND, HAMACHER RESOURCE GROUP: Brendon, you and I were talking about the importance of the pharmacist intervention along the patient’s health care journey. What do you think is going to help enable the pharmacist to be most effective in that role?

BRENDON HILL, BD MEDICAL: Re-education can make a significant impact on both patient outcomes as well as quality of life. In partnering with healthcare professionals, we know that simply talking to a patient about how to properly inject their medication can significantly reduce A1C.

There are 29 million Americans with the disease. [In terms of] access for these patients,… there are about 5,500 endocrinologists compared with almost 300,000 pharmacists and 400,000 pharmacy techs. In addition, patients are in the pharmacy much more frequently, and pharmacists are always at or near … the most trusted professions. As such, pharmacists are ideally positioned to help the patient. At the same time, it’s critical that simple but effective interventions are developed that can be integrated into pharmacists’ busy workflow.

… I think the one thing we [should look at is] the evolving role of the pharmacy tech…to identify patients that would disproportionately benefit from the pharmacist’s intervention.

And then finally, we need to identify more progressive ways of enabling the engagement.

WENDLAND, HAMACHER RESOURCE GROUP: Kathryn,… nearly 16 billion injections worldwide involve reused or unsterilized syringes. Is that an issue… we [should] be concerned about that?

KATHRYN DUESMAN, RETRACTABLE TECHNOLOGIES: It is a big issue. When you look at the number of people that are self-injecting now — most of the research shows 8 [million] to 9 million people in the United States — which equates to about 3 billion injections every year in the United States. That’s a lot of sharps floating around, and some studies have shown… there’s a lot of inappropriately disposed of sharps.

Health care is moving out of what we used to call ‘traditional health care’. Now health care is in your home, and I — like probably most of the people here — travel all the time. So health care is taking place in hotel rooms; it’s taking place in restaurants; it’s taking place in sports or recreational facilities. These non-traditional settings are often where injectables are being administered.

The need for safe technology is so important. Retailers play a pivotal role in educating patients, not only about their medications… but on what technology to use and how to use it safely.

… Technology plays a huge role.… A truly nonreusable safety device may not be a silver bullet but it is a huge catalyst for behavior change, which is always hard. So the combination of the educational piece that pharmacists provide, along with technology that ends the lifecycle of used injection devices, makes us all safer.…

WENDLAND, HAMACHER RESOURCE GROUP: Tammy,… [how does] Rite Aid’s We Care program fit into chronic care management?

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