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Health Care Megatrends For Strategic Thinkers

American society is in a period of unprecedented and rapidly accelerating change regarding how health care is financed and delivered, according to Dr. Timothy Covington, executive director, Managed Care Institute and Bruno Professor of Pharmacy, Samford University, Birmingham, Alabama. Rather than trying to preserve the status quo, Covington suggests a strategic focus toward the future of health care delivery and financing. The following are some of the 26 megatrends Covington predicts will reshape America's health care system:

• Ultimate payor groups (employers, Medicare, Medicaid) will become more prudent purchasers of health care goods and services and will increasingly steer patients to cost-effective, outcomes-oriented hospitals, physician networks, pharmacy networks, and other providers in an effort to secure quality, cost-efficient health care.
  
• Local providers (physicians, pharmacists, hospitals) will be further integrated into mega-regional networks with the hope of better positioning themselves to control referrals, confront managed care organizations, and negotiate fees.
  
• More and stronger business coalitions and consortia will emerge as employers pursue direct negotiating and contracting opportunities with local providers. Employers will force change, influence health care delivery and, in time, diminish the role of the third parties (e.g., the traditional managed care organization).
  
• Employers will lead efforts to increase preventive health care and wellness initiatives. This high horizon strategic initiative will yield significant health care dividends relative to reduced cost and improved quality of life for years and decades into the future.
  
• The number of Americans with minimal or catastrophic health care coverage will increase over time because of state and federal mandates and welfare reform.
  
• Managed care organizations will offer more chronic care programs such as managed long-term care, assisted living, adult day care, home care, and hospice care.
  
• Application of managed health care principles will accelerate in the Medicare and Medicaid populations. A Medicare HMO enrollment of 15 million is projected by the year 2007, and the Medicaid beneficiary population is expected to increase from the current 37 million to 42 million by the year 2000.
  
• The growing pool of elderly patients will increase demand for health care goods and services. By the year 2002, nearly 80% of all health care expenditures are expected to be for the care of patients over 50 years of age.
  
• All health care enterprises will embrace leading-edge technology, especially information systems that address administrative inefficiency, outcomes assessment, provider profiling, and electronic transfer of patient-specific information.
  
• The need for distributive pharmacists will decline rapidly. Mail order, automated dispensing, and physician dispensing will grow.
  Covington encourages practitioners to think deeply about the potential implications-both positive and negative-of these megatrends, and begin to prepare for the changes they will bring.
  

�1997 by Facts and Comparisons.
Adapted with permission from DRUGLINK 1997; 1(9): 66-68 St. Louis, MO:
Facts and Comparisons, A Wolters Kluwer Company.

USP To Study Usefulness Of Patient Education Leaflets

In its ongoing commitment to improve the value of patient drug information, the U.S. Pharmacopeia (USP) will conduct a six-month study of the format, content, readability, and distribution factors that make drug information leaflets most useful to consumers.

In addition, the study will determine how these factors compare with varying consumer attributes such as perceived need, history of receiving written drug information and/or counseling, disease severity, and demographic characteristics (age, gender, educational level, ethnicity). The study will be completed in August 1998.

In announcing the USP Patient Information Leaflet Study, USP Executive Vice President Jerome A. Halperin noted that the recipients of USP's own patient education materials clearly will benefit, since the organization plans to incorporate study recommendations for enhancing its own medication information leaflets.

Copies of the RFP can be obtained by contacting USP Division of Information Development Vice President and Director Keith W. Johnson, 12601 Twinbrook Park-way, Rockville, MD 20852.

Medication Errors Council Recommends Changes In Packaging And Labeling

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) says medication errors can be reduced by improving product labeling and package design. The Council has developed eight recommendations for manufacturers of pharmaceuticals and devices and an additional eight for regulators and standard-setters. For example, the Council recommended that manufacturers employ machine-readable coding (e.g., bar coding) in the labeling of drug products; encourage printing the drug name (brand and generic) and the strength on both sides of injectables, IV bags, containers, and overwraps; use innovative labeling to aid practitioners in distinguishing between products with very similar names; and avoid printing company names and logos that are larger than the type size of the drug name.

For regulators, the Council recommends that the FDA restrict the use of any printing on the cap and ferrule of injectables except to convey warnings; encourages the development of FDA's error-prevention analysis efforts to provide consistent regulatory review of error-prone aspects of label and package design; and encourages USP and FDA to consider simplifying package inserts and the labeling of other pharmaceutical dosage forms.

The Council's recommendations are based upon a review of error reports sub-mitted to USP's Medication Error Reporting Program, and are supported by representatives of 16 member organizations from medicine, pharmacy, nursing, industry, government, health care facilities, and standard setting. For a complete list of recommendations adopted by NCC MERP, contact Diane Cousins at 301/816-8215.

Survey Shows Consumer Satisfaction With HMOs

Nearly nine out of 10 HMO and PPO members rated their health care coverage as "excellent" or "good" in a survey conducted by ABC News. The poll, according to a September 15, 1997 Washington Post article, suggests that previous reports of alleged problems with managed care "may have been widely and unfairly exaggerated." Results showed 88% of those sampled who are enrolled in HMOs said they were satisfied with the quality of care they received. Similarly, 92% of PPO and point-of-service members sampled reported they were satisfied. Seventy-nine percent of HMO and 71% of PPO enrollees are happy with their health plan cost. When asked if they would recommend their health plan to others, 79% of HMO enrollees and 77% of PPO enrollees would recommend their health plan to others. The American Association of Health Plans (AAHP) published a recap of the poll's major findings in the September 25, 1997 issue of AAHP Health Notes.

St. John's Wort Study

The National Institutes of Health is conducting a three-year clinical study of St. John's wort, an herb widely used in Europe to treat depression. The study will include 336 patients. During the eight-week trials, one-third of the patients will receive a uniform dose of St. John's wort, another third will be given placebo and the final third will take a selective serotonin reuptake inhibitor, a type of commonly prescribed antidepressant.