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Time to flip the script: Patients are not the burden - they are being burdened

Mike Gladstone

Imagine being a young professional who knows something is wrong with your health – but you can’t get any answers about what it is. You go through weeks, even months of tests and appointments.

The time this consumes is a hassle, but it’s nothing compared to the uncertainty and health anxiety that occupy your mind. When the answer finally comes – a life-altering diagnosis of an inflammatory disease – one kind of uncertainty is over.

But another is just beginning, as the bills are accumulating. It could be many thousands of dollars just to get that answer – with more to come as you set out on treatment. Imagine that frustration and discouragement – and the financial stress layered on top of your medical concerns.

Financial stress is one of the ways that chronic immuno-inflammatory diseases can have debilitating impact on the people living with them. Beyond their physical, mental and emotional impacts, they bring a disproportionate cost-of-care burden.

High-need, high-cost patient populations spend, on average, more than $21,000 for annual per-person spending. That is 82% more than average per-person healthcare spending.

The healthcare industry often falls into this habit of classifying patients in terms of the costs and burden they represent to the health system. But it’s time for us as an industry to flip the script and focus on the financial pressures that patients themselves endure.

None of the fault lies with the patient. These stresses stem from the lack of adequate disease and symptom management options, the disjointed care models, and the high costs of treatment that stand in the way of improved outcomes – and freedom from day-to-day suffering – for patients.

We need systemic changes to reduce these burdens and make life better for patients. I participated in a panel called “Achieving High Outcomes for High-Cost Populations” at ViVE 2022, where we discussed steps that we can take to lessen pressure on patients:

1.      Increase access to biosimilars. Making biosimilars more available can help increase patient access to essential medicines and provide value to the healthcare system by driving market competition that can lower the cost of care. However, too often, payer policies mandate they try older, less effective treatments before the treatments that may be better suited to the biology of their condition can even be an option. We must take a systemic approach to cultivating the use of biosimilars. This involves pharma companies bringing them to market, educating healthcare professionals about them and the biosimilar pathways, payers providing access to them with innovative arrangements, and improving awareness of their existence among patients.

2.      Understand – and account for – the entire patient journey. We must continue to center treatment and support approaches on understanding all of the ways a condition and its treatment manifest in their lives. For us, this involves researching the issues that impact patients’ quality of life, finding new ways to collect and innovate around real-world data, incorporating technology into clinical trials, and continuing to raise awareness of the toll immunoinflammatory conditions take on people.

3.      Support reimbursement models that encourage better, more integrated coordination of care and support. Value-based agreements, necessary to lowering costs and paying for future therapies, can incentivize health systems and providers to invest in long-term interventions. We must consider spending on medicines in the context of the outcomes they deliver and wider healthcare investments.

Overcoming the technical, structural, financial and political barriers standing in the way of these actions will take dialogue – intensive discussions and partnership between patients, clinicians, regulators, governments, payers, industry and even new healthcare entrants. Once again – imagine being a person having to discover all these burdens and obstacles while you worry about your health. Imagine what it would mean to you to have other people take the time to understand your experience and try to change it. Such dialogue is the only way we’ll flip the script and reduce burdens for our most vulnerable patients. 

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