Do you have a missing partner in moving to value?

September 8, 2017

PART 1

 

Recently in our blog, you read about patient challenges with high deductible health plans and how health systems are working to improve the health of communities from my colleagues, Marya Upchurch and Leslie Barden. Add to those challenges the struggle that providers are experiencing to achieve the quality and cost measures of value based care, and we have the perfect opportunity to get really creative, unconventional even! What I am about to suggest is going to require a little healing of old wounds for both patients and providers. The wounds of the old practices of the pharmaceutical industry for clinical trials run deep, when patients were properly informed. Providers have also made no secret of their disapproval of the pharmaceutical industry’s direct campaigns to patients. However, a clinical trials partner may be just what the doctor ordered to help cure what ails our systems of care.

 

Several years ago I had a conversation with an executive in the clinical research industry during which we realized that we were using the term “provider” to mean two entirely different things. She was referring to contract research organizations, whereas I meant physician or health care system. It sparked a major effort to build a bridge of communication and shared objectives between the clinical research/pharmaceutical industry and health care providers. We realized that we all really did want the same things and there was a way to work together to achieve them.

 

First and foremost, advanced pharmaceuticals help everyone; there is no denying that. For diabetes alone, the life expectancy, severity, and quality of life have improved dramatically in the past few decades. We owe that in part to the patients who participated in trials and the physicians who supported their participation. Secondly, with cost of care skyrocketing and more patients and physicians having “skin in the game”, clinical trials offset the cost of patient care for some of the most expensive disease categories. Many health care organizations have demonstrated that as more patients participate in clinical research, they have achieved significant improvements in both cost and quality measures. Finally, patients want access to cutting edge treatments. Patients want to feel that their health care team (which I propose should include a clinical research partner) will turn over every stone to help them.

 

Providers often feel that clinical research investigators are stealing their patients, that “big pharma” is getting in the way of their ability to effectively manage their patient panel. While those can be valid issues, there are ways to build operational and communication processes to minimize disruption and maximize benefits.  As a patient with a chronic neuromuscular disease and a child of a diabetic, I can count on less than one hand the number of times in over 20 years that my father or I have been offered the opportunity to participate in a trial by our physicians. I have personally sought out participation on clinicaltrials.gov and have only been responded to once.  Frankly, I feel cheated of an opportunity to not only find relief but to contribute to improved treatments for all, and maybe even save a buck or two on medications. The irony of all of this is that the pharmaceutical industry spends 20% of its drug development dollars on patient recruitment. We all agree that we must address the high costs of drug development and medications and this is a large percentage that could be reduced in a way that doesn’t compromise safety and results in a number of other positive outcomes. Collaborating to improve patient recruitment is a strategy that would help reduce costs in so many ways for almost every aspect of health care.

 

As a patient, family member and health care professional, I believe we need to move on. While we must maintain stringent regulations to prevent the sins of the past, it is important to recognize the value of research to all health care stakeholders; patients, providers, and yes, even payers. It’s time to break down the barriers to patient participation in clinical trials, be they operational, communication, or otherwise. I recently worked with a large physician group and their clinical trials partner to do just that. It isn’t easy, but there are shared objectives and it can be a very rewarding outcome for all. In my next blog, you’ll hear more about the key elements that lead to success.

 

 

 

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