What do pharmacists and teachers - and an awful lot of other people - have in common?
David Stanley, RPhOne thing I've learned over the years is that one of the easiest ways to break the ice with a stranger is to get them talking about their job. Ask a person what they do for a living, and follow their answer with “That must be hard,” and you'll be well on your way to getting through that awkward dinner party or reception full of people you've never met.
You might also gain insight into some of the problems in your own profession, as happened when I struck up a conversation with a teacher more than happy to vent about the challenges of dealing with modern education policy.
“You’re actually penalized for trying to make a difference for the people who need you the most,” she said.
Metrics, metrics everywhere
As she explained it, evaluations for teachers and financial terms for districts are based, in increasing part, on meeting the metrics handed down from above by inflexible bureaucrats who make no accommodation for the unique challenges of individual situations.
Land a job in a posh, well-funded community full of supportive parents and motivated students, and the numbers may very well take care of themselves. End up in a poverty-stricken neighborhood with kids facing problems that their peers in better-off places never dream of, and you'll be working much harder and very likely end up penalized anyway.
It wasn't until a few weeks later, when I received a letter from one of the major PBMs outlining new changes in its provider contract, that it started to sink in how much pharmacists are in the same boat as the people who educate our children.
According to the new “take it or leave it” terms dictated by the insurance company, it will now be implementing a $5 per prescription fee on every claim, with the chance for the pharmacy to earn that money back by meeting certain “quality measures” as defined in the new contract.
Finish toward the top percentile of your peers, and you'll most likely get your money back. End up in the bottom half, and your dollars - and most likely your chance to make a profit with this plan - are gone forever.
The penny drops
It didn't fully kick in until I started to make some MTM calls. The first patient I got on the phone was a regular. “Gonna make another easy five dollars are you?” he said, and we both chuckled.
His doctor, who has been adjusting his cholesterol medicine for months now, is one of those physicians who has the annoying habit of just telling the patient the new dose, rather than writing out a new prescription with new instructions, which means that the patient has been showing up on my “appears to be nonadherent” list pretty consistently.
The first time I called him, I explained the whole MTM ritual, as well as how I was getting paid a little bit from his Medicare Part D plan for my effort.
“Thanks for checking up on me,” he said, to end the conversation.
Of course, had that patient's primary language not been English, or had he come from an environment suspicious of traditional western medicine, or had he never been educated as to what cholesterol actually was, or if he were financially unable to afford his co-pay, that five dollars wouldn't have come so easy.
And with this new contract, the money will be structured not as a reward, but as a penalty for not meeting the numbers handed down from an inflexible, distant paper-pusher.
Meet the metrics
So I've come to learn that two of the most important jobs in our society, educating our children and taking care of our health, are in the process of becoming nothing more than drives to meet the metrics, with fairness nowhere being considered.
I have a feeling this management style isn't limited to kids and pills.
I'll report back after the next dinner party.