Formulary guidance and transparency from P&T to point of care

Perspectives on Healthcare Leadership

Posted by Matt Breese on May 11, 2016

Find me on:


“The task of the leader is to get his people from where they are to where they have not been.”

~ Henry Kissinger, M.A., Ph.D.

Dr. Kissinger’s quote is particularly apropos in today’s changing healthcare marketplace. Pharma leaders must defend their company’s reputation against public stereotyping, whether rightly or wrongly gained, while also pushing their organizations to pro-actively engage in more patient-focused business strategies. Leaders in the insurance industry, who are frequently considered technology stragglers, must learn how to leverage innovation that is often driven by pharmacy benefits managers (PBMs). And physician leaders, who may have some of the greatest challenges, must renew their commitment to embracing value-based care, internal and external cross collaboration, and new technologies to improve the health and well-being of their patients and communities.

In every case, these healthcare leaders must confront future possibilities, understand the implications and wrench their organizations out of stagnation in order to grow, to keep pace with changes within the healthcare industry and to remain competitive.

Value-Based Care as a Stimulant

With value supplanting volume as the driving force behind quality, efficiency and reimbursements, organizations must transition out of their comfort zones and traditional healthcare delivery models of the past. The advent of value-based care is quite possibly driving the most significant changes in how patients, providers, payers and pharma interact and operate within the healthcare arena.

Americans are much more focused on healthy behavior than they were five years ago. That focus, when combined with improved access to quality information from providers, pharmacists, health plans — and from media outlets and the Internet — triggers healthcare and wellness decisions, including vaccinations, screenings and even the selection of the health plans and providers. Patient advocates, along with all levels of healthcare professionals, encourage individuals to become actively involved in their healthcare and to be informed healthcare consumers. If this trend toward informed wellness continues, is it possible that in the future hospitals and clinics will be filled with only the sickest of the sick, and individuals will be more effectively and responsibly managing their own health and well-being? And, will this translate into more efficiencies and cost effectiveness for hospitals, and health plans, as resources are more appropriately deployed and used?

Direct-care leaders have long championed the benefits of evidence-based medicine. Providers who successfully make the shift from volume- to value-based care now use technology and data, along with their expertise and experience, to drive honest conversations with their patients and to make treatment decisions. And they use their understanding of what it means to deliver patient-centered care to push operational decisions. For example, providers who acknowledge value-based care are good stewards of health system and individual finances by evaluating their prescribing decisions and seeking equally effective generic or lower-priced medications when developing a patient’s treatment plan.

Questions + Answers = Leadership

It’s not enough for a leader to be a great communicator or to be persuasive or assertive. Rather, the first strategic step for a leader is to ask the right questions and to gather information through effective listening. Today, hospital, pharma and payer leaders are asking very similar questions.

  • Are our strategies complementary or contradictory? Are we embracing the best of our past, while also pursuing new and less traditional strategies?
  • Do we see our patients or enrollees as unique individuals, while also enlisting common strategies of population medicine? Are we able to simplify the way we care for or interact with individuals and with the larger population? Have we developed global educational materials and communication methods that speak to the individual?
  • As the healthcare environment changes, are we changing? Have we looked at our core mission, vision and values to ensure our strategies are still appropriately aligned and pointing us in the right direction to experience success?
  • Have we fully integrated technology, metrics and innovation in our operations or are we losing our competitive edge due to antiquated processes or lack of data to support change?
  • Do we fully appreciate that patients are more than the receivers of our care or services? Have our strategies been developed with the understanding that patients are also healthcare consumers who have the ability and desire to make choices?
  • Have we championed change and engaged our organization, so they, too, recognize the value of where we are headed organizationally?
  • And — most importantly — are we continually looking into the future to identify the next change, the new focus and the next leadership challenge?

Subscribe to the MMIT blog for more pharma, provider and payer perspectives on key topics that affect the healthcare network.

Subscribe for Weekly Perspectives

Topics: Industry Trends, Market Access, Data & Analytics