10 Ways To Build P&T 2.0
March 10, 2021
Pascal’s Wager postulates since we cannot possibly know if God exists, the wise thing to do is to live as if He does. (And, capitalize He.)
If we do and He does exist, we gain heaven. On the other hand, if we don’t and He does, we miss out on heaven, and may end up in purgatory.
The consequences are so significant that we disregard likelihood altogether.
Pascal’s Wager causes us to take the Cadillac when the Ford will do just fine, or no car was needed in the first place. It’s the reason we overprescribe opiates and antibiotics. Though healthcare providers are trained to do no harm, our first instinct is to act when we’re presented with a possibility of harm, which causes us to over screen, over diagnose, over treat, and over monitor.
Providers don’t like taking the Cadillac instead of the Ford (or not going anywhere at all), but they just don’t have the data to tell the difference.
Enabling healthcare providers to make more evidence-informed decisions has shown to significantly save money and promote quality. The largest study ever done found hospitals with a Drug Information pharmacist-led Pharmacy and Therapeutics (P&T) initiative saved $5.2 million and 45 fewer deaths per hospital per year compared to hospitals without such a service. Another estimated cost savings of $2,532.47 per question based on a study of 77 clinical responses.
Ochsner Health System is working to build the P&T committee of the future. Here’s how:
- Ban sales reps- why do we need the same people that sell to us to also educate us?
- Expand the mission- evaluate pharmaceutical products in the context of total clinical and financial outcomes
- Broaden multidisciplinary membership- allows for input on effect of a product across the full continuum of care plus greater output increases buy in afterwards
- Expand further to include finance personnel to evaluate the impact of contract decisions on reimbursement strategies- new payment models require that P&T members understand hospital’s role in an integrated system of health care
- Undergo pharmacoeconomic training- understanding cost effectiveness as an important contributor alongside safety, effectiveness, and kinetics
- Improve patient engagement - non-compliance affects every patient and adds significant costs to care
- Stop relying on 80/20 reports (showing the products that comprise the top 80% of drug spend) – focus on outcomes that reflect a product’s place in therapy and total cost of care
- Start reviewing 80/20 reports- after weighing drug costs against clinical outcomes (e.g., length of stay), operational outcomes (e.g., turnaround times), and financial outcomes (e.g., reimbursement), look for opportunities to drive clinically appropriate, cost-effective utilization
- Forecasting- Drug costs will rise 5% in our industry next year. But some 7 and some 2, and we’re starting to better project which.
- Since the 1980s, hospital reimbursement has generally been based on fixed payments, case rates, or a per diem schedule. In this environment, drug expenditures have been viewed as costs to the system, and especially painful because they directly hit our budget. As a result, most P&T decisions have historically been based on a product’s clinical differentiation characteristics plus its direct acquisition cost, and most hospital-based P&T committees have traditionally focused on a cost-minimization strategy as a result. Forward thinking ones are adapting.