The Senate Health Education, Labor & Pensions (HELP) Committee released its piece of the comprehensive health care reform bill on June 9. Despite being 615 pages long, several key provisions of any health care reform legislation are not in the HELP Committee bill because they are issues that fall under the jurisdiction of the Finance Committee. Most of the issues related to Medicare, Medicaid, other public options, and taxes (basically how to pay for expanded coverage) will be proposed in the Finance bill, likely coming out next week.

But HELP is first to the table, and may start marking up this bill as early Tuesday, June 16. So it’s worth looking at the bill and asking: What key features of it facilitate more patient-centered health care delivery?

Perhaps most importantly, the provisions of the Wyden-Gregg “Empowering Medicare Patient Choices Act” (see here for overview) that fall under the jurisdiction of HELP are included in Sec. 217, Program to Facilitate Shared Decision-Making (pp. 301-311). Much of the meat of this bill (Medicare carrots and sticks) comes under the jurisdiction of the Finance Committee, but this is a critically important start.

Sec. 212. Grants to Establish Community Health Teams to Support a Medical Home Model provides several opportunities for driving patient-centered care delivery and the provision of information therapy (Ix), though much will depend on how it is implemented. Opportunities include emphasis on “payment that recognizes added value to patient in a patient-centered care; [sic]” (a few typos aren’t surprising when those Hill staffers are working round-the-clock these days). There is also a recognition that support should be provided to PCPs to “provide quality-driven, cost-effective, culturally appropriate, and patient- and family-centered health care” and “promote effective strategies for treatment planning…sharing information, treatment decision support…”

The role of Ix in patient-centered discharge planning and reducing readmissions is highlighted in both the medical home section and in Sec. 216. Reducing and Reporting Hospital Readmissions (see here for discussion of Ix role in this area). Ix and patient-centered HIT are also an important part of the solution for Sec. 213. Grants to Implement Medication Management Services in Treatment of Chronic Disease.

Admittedly, I haven’t finished all 615 pages, so I’ll probably find more in here over the weekend. If you think I’ve missed answers to my question (What key features of it facilitate more patient-centered health care delivery?), please add in the Comments section.

I posted on February 19 about the launch of our Ix for Rx Management work. We are embarking on research to examine how information therapy (Ix) strategies can address the huge problems associated with inadequate medication adherence, safety, and selection.

This work will lead to a series of public webinars and one or more white papers in September and October of this year and probably additional events, learning collaboratives or other activities in 2010. As we launch this work, I’d love to have input from as many people as possible as to where the most important issues are and what are the best leverage points for addressing them.

I welcome comments on the following questions:

• What are the greatest barriers to medication adherence (from list below or others)?
  • Knowledge
  • Motivation
  • Health literacy
  • Cost
  • Provider support
  • Social support
• What are the best Ix levers for improving medication adherence (e.g.,email/cell phone reminders targeted to moment in care)?
• How can Ix strategies be deployed to reduce medication errors?
• What Ix tools are most useful in ensuring appropriate selection of medications for an individual?

“Drugs don’t work in patients who don’t take them.” So said former U.S. Surgeon General C. Everett Koop, MD. Back to something I wrote last week on this blog, sometimes a statement obvious on its face can be profound.

The question, of course, is: Why? Why do people take only about half of the medications that they should to help them prevent disease, recuperate from acute illness, and manage chronic conditions? Why do an estimated 125,000 people die every in the U.S. because of medication non-adherence? And what could we do with the $100 billion our country will spend in 2009 because of this problem?

There’s no shortage of research to help us answer these questions, one of the best sources being the Cochrane Collaboration review on “Interventions for enhancing medication adherence.” In fact, many information therapy (Ix) interventions have proven at least somewhat successful; Ix has been a critical component of the successful interventions below.

• Targeted information
• Timely reminders
• Self-monitoring
• Reinforcement
• Counseling

I attended a stakeholder meeting today convened by the National Consumers League regarding a proposed national medication adherence campaign. One of the big issues that arose is the degree to which a public relations campaign designed to raise consumer awareness can lead to substantial increases in medication adherence.

Although awareness certainly is an important precursor, it may be the easiest step in the pathway that takes the average consumer along the road to information consumption, then knowledge accumulation, and ultimately leading to behavior change. We know there’s a large body of research that tells us that, in order to be successful, our Ix initiatives need to “meet people where they are.” More specifically, we need to target the information to the individual’s particular moment in care and tailor it to their particular needs and circumstances.

With that in mind, the Center for Information Therapy will soon embark on a new body of work around “Ix for Rx Management.” The goal will be to summarize research — on the problem but even more so about the solutions — then stimulate innovation and diffuse best practices.

Although medication adherence is one of the top issues, we will also explore other Rx management issues to address medication safety, poly-pharmacy, and other issues. Over the next few weeks, we will roll out more details on our plans in this arena, and I urge those interested in our work to get in touch with us.