BETHESDA, MD 04 May 2009—Midway into one of the five White House Regional Forums on Health Reform this spring, a governor turned the discussion to specifics.
"What do you want to see changed specifically within the existing system or in a different system?" South Dakota Governor Mike Rounds asked the approximately 500 people gathered in Des Moines, Iowa.
He invited people to address the four moderators.
"I’m Matt Osterhaus; I’m a pharmacist from Maquoketa."
With that introduction, pharmacy owner Osterhaus told the South Dakota and Iowa governors, the director of the White House Office of Health Reform, and an Iowa senator how involving pharmacists in preventive care would benefit patients and improve the health care system.
"I think one of our biggest problems and the thing we really need to reform first is to get out of the silos of health care," he said. "Pharmacy is a great opportunity to do that. We’ve got a very skilled work force that [is] ready to be involved in prevention."
Pharmacists as preventers. An editorial in the Des Moines Register on the same day as the two-hour forum had stated that more than 30% of every health dollar spent in the United States goes to hospitals.
Much of that money to hospitals, Osterhaus told the forum’s moderators, was the result of prescription medications not being used properly.
"Our current system does not incentivize pharmacists to be in that prevention mode."
Osterhaus explained that the United States must change reimbursement levels for pharmacists and better integrate pharmacists into the health care system.
Once those changes are made, he said, pharmacists can work "up-front getting the right meds to patients and getting them to use them properly and monitoring them as they go, rather than have people take the wrong medicine and not take the right medicine properly."
Solution for high costs. A week earlier, at the two-hour forum in Vermont, Kevin Marvin saw his opportunity to speak out about health reform and pharmacists.
An older woman with an autoimmune disorder had just told the moderators about the high cost of a medication that keeps her alive and that should have become available as a lower-cost generic several years ago.
White House Office of Health Reform Director Nancy-Ann DeParle said President Obama wants to lower health care costs for all Americans.
DeParle then asked, "What’s the single most important thing that I can take back to Washington to tell the president that we need to do to improve our health care system?"
Marvin raised his hand first.
"Hi, I’m a pharmacist," Marvin said, explaining that he works as a consultant at nearby Fletcher Allen Health Care and worked previously at the National Institutes of Health Clinical Center.
"One issue that I see specifically around medications is the need to align incentives towards cost containment as well as towards optimal outcomes from use of medications," Marvin said.
He went on to explain that rebates from the pharmaceutical industry can be used to adjust incentives. "That is one aspect," he told DeParle, "that will help reduce costs of medications, potentially to the level that we see in Canada."
In support. Paul W. Abramowitz, pharmacy director at University of Iowa Hospitals and Care in Iowa City, was part of the pharmacist contingent with Osterhaus.
On seeing hundreds of people seated at the forum, Abramowitz said, the contingent’s members realized that only one member at best would get to speak. They chose Osterhaus.
Abramowitz said the White House representative heard from Osterhaus about some of the "tangible things" that come from pharmacists managing medication therapy, particularly in the area of chronic disease.
Iowa Pharmacists Association executive Thomas R. Temple said the half-dozen members of the contingent had strategized by e-mail before the forum. They discussed the important points to make if given the opportunity to speak.
He said the contingent’s overall goal was to point out that medication misuse is a problem in the current health care system, "and pharmacy can provide a meaningful solution to that problem."
Follow-up move. Greg Baran and Larry Wagenknecht of the Michigan Pharmacists Association and Ernest Boyd of the Ohio Pharmacists Association attended the forum in Dearborn, Michigan.
They came ready to speak but were not given a microphone.
"But immediately afterwards," said Baran, director of his association’s governmental affairs, "we did approach and speak with the White House representative, and then I did make personal contact with two of our congressional delegates that were in attendance—Congressman John Dingell and Congressman John Conyers Jr.—and shared with them again . . . what pharmacists can bring positive to health reform and health care reform."
"Congressman Dingell did promise me he would not forget pharmacy," Baran said.
In addition, he said, the White House representative at the forum received the association’s packet of information on the value of pharmacists beyond dispensing. The packet included the booklet Changing Perceptions, by the Michigan Pharmacists Association and its pharmacy practice section Michigan Society of Health-System Pharmacists.
Ready and willing. Dennis M. Williams, an associate pharmacy professor at the University of North Carolina (UNC) at Chapel Hill, called the forum in his state "a pretty exciting environment."
Williams and Michael Nnadi, regional pharmacy director for Novant Health, based in Winston-Salem, attended the forum courtesy of the invitations that ASHP secured from the governor’s office.
"I was pretty hopeful to be able to say something," Williams said later.
But the event, he said, "was pretty well scripted," even after the opening remarks.
He said Governor Bev Perdue announced that the forum, after the opening, would first hear residents describe their issues with health care. From there, the discussion would turn to the cost of health care, some of the health care initiatives in North Carolina, and then individuals who have issues with health insurance.
Williams said he quickly realized that discussants had to be careful about sounding self-serving. "That’s not really what people wanted to hear."
When William L. Roper, head of UNC Health Care System, spoke about the need to make better decisions and spend money more wisely, Williams said he spotted his best opportunity.
"I wanted to jump in," he said, to tell the forum that if pharmacists were recognized as providers of care, efficiencies in health care would follow. "But believe me, there wasn’t a microphone anywhere near me."
Williams said he intended to submit his comments to the Obama administration via the website for the forums, http://healthreform.gov.
The website also has videos from the forums in Iowa, Michigan, North Carolina, and Vermont. A fifth forum occurred in California.