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‘It’s All about Med Adherence’: Atrius Health’s Dr. Steven Strongwater Discusses Accelerating Change in Healthcare—and Cracking the Code on Improved Care at Reduced Cost (Part 2)

Posted By John W. DeWitt, Wednesday, September 26, 2018

“A lot of non-value-adding costs need to be cut out of the chain,” asserted Steven Strongwater, MD, CEO of Atrius Health, in his thoughtful and data-packed presentation during the ASAP Leadership Forum meeting on opening day of the September 24-26, 2018 ASAP BioPharma Conference in Boston. When it comes to prescription drugs, for example, “it’s all about med adherence. The problem is very practical. In New York, there are ten thousand homeless children. How compliant are they going to be with their asthma meds? Instead they go to the emergency rooms.”

The urgency of reducing soaring US healthcare costs while improving outcomes is a constant mantra for Strongwater and Atrius Health, which serves 720,000 patients in the state of Massachusetts with 1,300 clinicians and 825 physicians across 32 clinical sites in over 50 specialties. The non-profit accountable care organization (ACO) generates about $2.1 billion in revenue and is the top-ranked ACO for quality of care in both New England and nationally.

Regarding the challenge of prescription and therapeutic adherence, there are of course many factors and interdependencies involved, from drug costs and prescription protocols to care models and patient behavior, all of which means you need to ask, “What’s the full delivery chain?” His ask of the biopharma partnering execs in the room was specific: “How will you not only sell [pharmaceuticals that help patients], but also help us manage down the total cost of care?”

One biotech executive immediately responded that “drug companies care a lot about adherence—we talk about it every day.” Dr. Strongwater replied, “We don’t hear it—but if that’s the case, there are 560 ACOs who’d be interested in working on this with you.” (Strongwater describes ACOs as groups of providers that collectively accept responsibility for overall spending and quality outcomes for attributed beneficiaries. There are 561 ACOs nationwide as of May 2018.)

Stuart Kliman, CA-AM, partner at Vantage Parners, introduced Dr. Strongwater and moderated the leadership forum discussion. At this point, he interjected with an example of a company that is taking a holistic approach to adherence, commenting that “we should be thinking about adherence as a total solution—are we in the drug business or the solution business? And what is that [total solution] going to look like?” Which of course begs the money question: Which organizations in the life sciences and healthcare space are going to invest in holistic delivery solutions?

“We on the front lines do not have the R&D budget to study this,” Dr. Strongwater noted. “This is basic lab research funded through grants, mainly NIH [National Institutes of Health]. Operations research around adherence, compliance—there’s no funding stream to do this kind of delivery-at-the-front-end work. And we really do need help.”

Strongwater spent a slide discussing the frontlines challenge of compliance in diabetes—providing another thoughtful illustration of the entangled drivers of rising healthcare costs. He offered a case example of “a 48-year-old woman who weighs 200 pounds, has two children, and works as a medical secretary making $45,000 a year. She has diabetes and hypertension—but can’t afford her insulin on a regular basis.” Atrius has an analytics tool that can predict, with 80 percent accuracy, the likelihood of a high-risk patient requiring hospitalization—but a doctor probably wouldn’t need that tool in this all-too-common scenario for diabetes patients. “About half of diabetics skip care because of the cost of drugs and 45 percent cut back on treatment. Insulin costs spiked eight percent last year,” he added, noting that insulin price has nearly tripled since 2002 and that three manufacturers control the insulin market.

Strongwater then described one way Atrius is tackling the cost challenge for its diabetic patients—“an initiative within Atrius to switch to lower cost test strips.” With 80 percent utilization, this initiative will save Atrius itself nearly a million dollars a year. Patients still pay their usual copay, but get a free new meter and, if they pay out-of-pocket, they will be able to pay less for their strips.

Stay tuned for more about the ASAP Leadership Forum discussion—including Dr. Strongwater’s analysis and recommendations for collaboratively cutting healthcare costs—as well as the ASAP Media team’s onsite coverage of the 2018 ASAP BioPharma Conference. 

Tags:  accountable care organization  Atrius Health  Dr. Steven Strongwater  Healthcare  healthcare reform challenge  improving outcomes  Stuart Kliman  therapeutic adherence 

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