Outcomes Research Is Alternative To Focus On Cost, AstraZeneca Exec Says

The pharmaceutical industry must be actively involved in determining health care outcomes or risk having the focus remain solely on drug costs, AstraZeneca Strategic Planning & Business Development Director Kim Slocum said during the World Health Care Congress Jan. 27 in Washington, D.C.

"We can either run away from this, in which case we will have no one but ourselves to blame if the agenda is diverted to something that we don't believe is fair and equitable, or we can get a seat at the table," Slocum said.

The Medicare law signed Dec. 8 authorizes $50 mil. in funding for the Agency for Healthcare Research & Quality to begin to develop an outcomes research agenda (¹ (Also see "AHRQ Comparative Trial Funding Awaits Supplemental Appropriation" - Pink Sheet, 15 Dec, 2003.), p. 14).

"The pharmaceutical industry needs to be an active participant...not just to protect our interests, but to protect the interests of average Americans against the hijacking of these agendas for cost minimization as the sole goal of health care," he said.

The Pharmaceutical Research & Manufacturers of America has taken the first step to allow industry to be more involved, adopting a statement of principles on government-funded outcomes research (² (Also see "PhRMA Adopts Outcomes Research Policy; Set For Cost-Effectiveness Debate" - Pink Sheet, 19 Jan, 2004.), p. 16).

The first step for the drug industry is to increase its investment in information technology, Slocum said.

"It is hardly surprising that our system has uncaptured outcomes," he said. "The pharmaceutical industry is unable to document the things that are important: the value of the lives that we save, the value of the lives that we improve and extend, the medical treatment we avert, and the workplace creativity we create."

The health care IT system "was written by accountants for accountants and was designed to pay bills," Slocum declared.

"I think everyone in the room and everybody in health care understands that most of what we do is improve intermediate clinical markers," he said. "We improve diagnostic scores, we improve lab tests, we improve function, we improve signs and symptoms, we improve quality of life."

Slocum suggested that third parties may see only the costs and not the benefits of prescription drugs.

"We in the pharma industry, who have access to the granular clinical trials data, understand the productivity gains and all the things I talked about because we see it in the controlled situation of the regulatory environment," Slocum said.

"But our payors see none of this. They see only the bills and that's what we have to correct to create a common language," he said.

The Medicare Rx law includes provisions for IT and voluntary electronic prescribing programs which could serve as an opportunity for the industry to "document value."

While "most of us paid enormous attention to the enactment of Medicare Part D, how many of you have read the details in the Medicare Act that relate to information technology, e-prescribing, [and] the creation of medical records?" Slocum asked.

"There are some potentially frightening things in there that may allow the agenda to be permanently hijacked to cost minimization if we are not careful," he said.

"We are heading into a world where the only concern is how much I'm paying, where the focus is on component costs," Slocum maintained. "This leads to uncoordinated and poor quality care, and highly adversarial relationships."

To begin to engage in discussions of health care outcomes, first society must resolve: "what is it that we want the system to do, and what do we want to pay for it?"

"Secondly, how do we create the metrics and the measurement systems so that when those goals appear in the system, we will recognize them?"

Only then should the dialogue turn to the question: "how do we create compensation plans to align incentives so that people do the right thing?" Slocum said. In health care "we keep trying to have the third dialogue before we have the first two," he said. "These problems have to be solved in parallel."