- The Washington Times - Sunday, October 18, 2009


With the Senate Finance Committee’s approval of its version of health care reform, Congress enters the next phase of final deliberations about changes to the health care system to cover more people while hopefully reducing costs. As the debate on this important initiative moves forward, I believe the guiding principle should be to build on what works.

From my perspective, here are the five things that work on which we should build:

(1) Increase government support for businesses to implement wellness, prevention and drug adherence programs to enable us to better manage chronic but treatable conditions like diabetes, hypertension and heart disease.

Experts estimate that about 56 percent of the increase in health care costs between 1987 and 2000 was attributable to the 15 most costly diseases. Getting patients to take their medications as prescribed could have a significant impact on driving down these costs while improving health care outcomes.

Indeed, the costs of nonadherence to prescription drug regimens have been estimated recently at nearly $300 billion a year - roughly 13 percent of total U.S. health care expenditures - by the New England Health Institute. CVS Caremark research has found that when patients faithfully adhere to their prescriptions, hospital readmissions can cut by more than half. Among our pharmacy benefit plan participants, we have seen that patients actively encouraged to participate in wellness programs and comply with their drug regimens make far better decisions that lead to healthier lives.

(2) Encourage the use of comparative effectiveness research to inform clinical decision-making and encourage procedures that are most effective at less cost.

Congress has already allocated more than $1 billion to support this type of research as part of the stimulus law. As a next step, government and private payers should be encouraged to use this information to make better-informed clinical decisions and reduce disparities in treatment, and providers should be compensated for improved patient outcomes. This policy could have a huge impact on improving the quality and cost effectiveness of health care. However, efforts to use this information to create rigid, one-size-fits-all treatment should be discouraged.

(3) Increase incentives for health care providers to invest in state-of-the art, interoperable health information technology (IT) that will help eliminate unnecessary administrative costs, reduce errors and lead to higher quality care.

The $1.2 billion in federal grants for health IT is a step in the right direction. The return on investment is a powerful inducement: The Healthcare Information and Management Systems Society has estimated that electronic medical records can save about $80 billion a year by providing increased safety and better care coordination. Research by IBM and the Information Technology and Innovation Foundation shows that a $10 billion investment in Electronic Health Records (EHR) and other health-related IT projects would create 212,000 jobs.

(4) Continue to encourage the use of cost-saving generic drugs by having Congress create a path for the efficient approval of safe and effective generic biologics, as 11 other countries have done.

“Biologic” drugs developed by our country’s world-renowned biotechnology industry are a critical part of our health care future, but also an increasingly large component of fast-rising health care costs. Without generic biologics, these lifesaving treatments remain out of reach for many patients, regardless of insurance status, because of the cost.

(5) Bring basic health care to people who now use more costly services, or do without, by more broadly encouraging the use of convenient and cost-effective retail-based health clinics.

These innovative clinics are on the front lines of health care, providing highly accessible alternatives for common medical ills at a much lower cost than alternatives such as emergency rooms and urgent care clinics. They can direct really sick people to physicians. Several hundred retail-based clinics staffed by qualified nurse practitioners have already been established by CVS Caremark and others at convenient locations across the country. With the right kind of government incentives there could and should be more. A recent study by Rand Corp., published in the Annals of Internal Medicine, found these clinics provide equal quality health care for common illnesses at a fraction of the cost of emergency rooms and other venues.

Over the long term, to further rein in health care costs, Congress will need to tackle difficult issues like tort reform and catastrophic insurance coverage. But at this critical juncture, we believe a “stepped approach” is the right one - adopting these five reforms that are practical and within reach. Taken together, they would help our country move toward significantly improved quality as well as greater effectiveness of the health care delivery system, while slowing the unsustainable rise in costs.

Thomas M. Ryan, a registered pharmacist, is chairman, chief executive officer and president of CVS Caremark.

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