Pharmaceutical Industry: Focusing on Prevention and Disease Control Yields Results
As Puerto Rico faces a so-called Medicaid cliff in the next few months that could leave over 1.3 million beneficiaries of Mi Salud at risk, the Pharmaceutical Industry Association (PIA) is promoting a model of health sustainability that focuses on prevention and disease control to help improve lives and yield savings.
“This model will work if all sectors are aligned to one goal, but right now the system is fragmented,” PIA President Felipe Palacios said during the recent Puerto Rico Manufacturers Association Convention.
Meetings have been held already with insurance companies, providers and the Puerto Rico government with the mission of focusing on what is best for the patient, he continued. “However, I don’t think everyone is working under the premise of what is good for the patient,” he said.
Puerto Rico is facing a healthcare cliff that not only consists of a loss in millions in federal healthcare costs, but also the exodus of doctors, in particular, medical specialists.
For instance, while 14% of the population has Type 2 diabetes, there are only 100 endocrinologists in Puerto Rico, Palacios said. Endocrinologists are among the health professionals who treat people with diabetes.
The routine manner in dealing with the island’s healthcare crisis is cost containment, which Palacios said is the worst that could be done. He said that instead, the central government should focus on prevention and disease control, which consists of dealing with those who are already sick.
According to government data, more than 50% of Mi Salud patients, who are medically indigent, are suffering from four major diseases. These are diabetes, asthma, hypertension and rheumatoid arthritis. Palacios said focusing on dealing with patients suffering these conditions, which are the most prevalent on the island, will yield savings. In France, the healthcare sector began saving about 40% when they began to treat patients with medications that were more costly but more effective, he indicated.
“Without any doubt, dealing with those four diseases will increase costs at first, but then you will have savings…. Even if you introduce medications that are more costly, you are going to end up saving in other areas…. But if you focus only on the budget, that is not going to happen,” he said.
Palacios also noted the importance of dealing with prevention in an effort to stop the development of certain diseases. For instance, he stressed the importance of helping individuals who have “pre-diabetes” to reduce their blood-sugar levels.
PIA has joined other entities in promoting its own healthcare model. In the past, Medtronic, the island’s largest medical-device manufacturer, has been championing a transition to value-based healthcare, which means developing and deploying products, services and integrated solutions that improve care with reduced costs. The initiative involves finding the most effective manner to treat patients to reduce hospitalizations.
While Puerto Rico is expected to receive some $296 million in federal funds for the island’s Medicaid budget for fiscal year 2018, which starts July 1, enabling the island to sign contracts with managed-care health insurance companies that administer the Medicaid program, it still needs an additional $300 million to fund its entire Medicaid budget for fiscal year 2018.
Puerto Rico’s estimated $2.8 billion Medicaid budget has been funded in part by a one-time pool of money provided to the U.S. territories under the Affordable Care Act, but the money is expected to run out this year, at which time the federal funding cap of $321 million would be reverted.
The Medicaid funds are used for the government’s Mi Salud health plan for the medically indigent, which receives 55% of its allocations from the federal government.