In March 2009, the Institute of Medicine (IOM) undertook a study, requested by Congress in the American Recovery and Reinvestment Act of 2009, to determine national priorities for comparative effectiveness research. The Committee on Comparative Effectiveness Research Prioritization will have issued its final report by June 30, 2009.
At the recent Foundation for Managed Care Pharmacy industry symposium, Moderator Sean D. Sullivan, Director of Pharmaceutical Outcomes Research and Policy Program at the University of Washington, asked the panel what disease states they would want the IOM to prioritize. Various disease candidates were mentioned, but nothing definitive came out of it. Afterward, I suggested to Dr Sullivan a different way to approach this important matter of prioritizing research: anything that keeps patients out of nursing homes. He liked this and wished I had voiced it at the microphone; I am compensating for that deficit here.
The bald reality facing healthcare is the inexorable march of the baby boomers into old age. No matter how determined this generation is in denying the aging process, they tend to age one year at a time, and the economic implications of the epidemiologically driven healthcare needs should instill a sense of purpose and urgency into the healthcare system, by simply asking what fundamental conditions stand to tear it apart. The answers that leap to mind are pandemics, a global depression, and diseases that place large numbers of aging patients into nursing homes.
The reason this last item belongs grouped with the other two is that nothing consumes healthcare resources like hospitalized care, unless it is long-term care. The labor costs of nursing home care for the population it now serves are already straining budgets; when the baby boomers enter the retirement era, their entry into nursing homes at the current rate for the medical conditions that send today’s nursing home residents there could shock and cripple the system. Thus, the need to find significant new cures and preventive measures are vital and predicable means of preserving our healthcare system.
Alzheimer’s disease, stroke prevention, fractured hips—these are among the worthiest of targets for accelerated research and preventive management, for their containment will ensure that the basic premise of manage care is realized: the management of overall healthcare resources consistent with our ability to pay for care.
In an effort to deal with these epidemiologically predictable enemies of health, American Health & Drug Benefits hosted a summit on transient ischemic stroke and recurrent stroke this past May, which was Stroke Prevention Month. We celebrated it by observing that there is a way that healthcare stakeholders can align their energies to head off the crippling effects that stroke brings—in terms of health and of finances.
The need for payers and purchasers to aggressively pursue stroke and heed its risk factors to prevent its onset at every opportunity is just one example of how payers, providers, and other healthcare stakeholders can stumble onto formidable levels of “found money,” and with it, equally impressive levels of found lives.
The current approach to stroke is unnecessarily passive— wait until it happens, then do something about it—when the real savings in cost and life are found in aggressive preventive measures. This requires a synchronization of providers with payers, purchasers, researchers, and pharma. It means ensuring that guidelines are heeded and acted upon. Nothing is more deadly to the healthcare system than diseases/conditions that maim but do not (necessarily) kill.
The special supplement we will issue later this year on stroke prevention will show stakeholder collaborative efforts to keep patients free of the effects of just one of these priority disease states that particularly threaten the elderly.We urge payers and purchasers to keep their eyes on the prize: not just overall healthcare resource allocation in the here and now but also resource allocation as it is being redefined by demographic shifts. The effects of the baby boomer generation’s aging give a neat way of preparing for the increasing challenges coming our way very soon. Keeping patients well enough to stay at home will be the fundamental measure of a healthcare system that is fiscally sound for the best of all medical reasons: preserving the health of patients through preventive strategies.