Shake Things Up to Best Serve Patients with Complex Chronic Conditions

Shifts in process and procedure may seem like something that could endanger a medically fragile patient. However, in a MedCity News article, health care technologist Tesh Khullar challenges the status quo to shift away from the bureaucracy and administrative processes embedded in health plans and pharmacy benefits manager (PBM) operations. These opaque procedures are denying treatment and therapies to those with serious, chronic ailments.

Khullar calls for a shakeup of the utilization management hurdles that patients must clear to access the treatment(s) and medication their care team determines are medically necessary. Rather than subjecting a chronically ill patient to “a maddeningly long and winding process that weaves through insurance companies, pharmaceutical distributors, PBMs, and specialty pharmacies, all of whom are motivated to preserve their piece of the pie and control costs to generate profit,” he recommends Medically Integrated Dispensing (MID) as an option to connect patients with the specialty medicines needed to treat their condition. MID is when a patient’s prescribing doctor also dispenses and administers their medication; it keeps treatment close to the patient.

By integrating medication dispensing, doctors can nimbly adapt a patient’s treatment regimen – change of dosage, medication adjustment, etc. – as needed. This means patients receive the right dose of the right medication at the right time in the right setting. It also reduces the amount of prescribed drugs that go to waste. Along with these gains in treatment efficiency, MID keeps costs low because of a reduction in the number of middlemen who take a profit along the meandering path medications take as they make their way to patients.

MID puts patient need, not bureaucracy or middlemen, first. Patients and Providers United also prioritizes keeping patients, providers and caregivers at the center of medical decision making, not health plan middlemen.