“Active Evolution”: The Supreme Court Can’t Turn Back Time.
Posted Jun 27 2012 10:01pm
Posted on | June 27, 2012 |
As we await the Supreme Court’s decision on Health Reform, many hospitals, insurers and health professional leaders have said a negative decision will “not matter”. Their point is – like it or not – the health care world is changing. We are in a state of “active evolution”. And the opponents of President Obama’s bill may think they can turn back time, but they can’t.
A perfect example of this is the announcement this week that the CDC is funding a program of free HIV tests provided at pharmacies and for the first time staffed by pharmacy personnel. The details in a moment. But let’s stop and consider what this represents from a health policy perspective.
First, access. With a major focus on assuring most people have health insurance, the country needs to expand even and responsive access to basic preventive services cost effectively. For years we’ve known that pharmacies, pharmacists and their staffs have been underutilized.
Second, we have witnessed major investment and expansion of pharmacy chains throughout America, replete with advanced integrated and secure information systems.
Third, advanced medical technologies are providing increasingly reliable simple testing for many disease states.
Fourth, we know that other countries have been using pharmacy manpower more effectively than we have as a first line of providers for decades.
Finally, convenient access to these outlets is widely available in rich and poor neighborhoods throughout our country, even those where access to primary care clinicians is nearly non-existent and emergency department over-utilization is pervasive. And yet, until now, expanded use of pharmacies and pharmacists have been actively opposed by many major health providers.
Active Evolution: We have now crossed a tipping point. Demographics of aging, the internet, engaged consumerism, and financial strain have created a new reality. What was unacceptable in the past is “worth a try” now.
Back to the challenge at hand – the need to expand HIV testing in the US. 1.1 million people are infected in the US and 20% don’t know it. The CDC announced this week a $1.2 million dollar grant program that will offer the free rapid HIV tests at pharmacies and in-store clinics in 24 cities and rural communities. The tests have already been piloted in seven locations including Washington, D.C., Oakland, Calif., and an Indian health service clinic in Montana.(1)
In this pilot, a simple oral swab saliva test yields a result with 99% accuracy within 20 minutes. Participating pharmacies have instituted systems to assure privacy. Pharmacy workers have been trained to administer the tests and deliver the results. If positive, patients are referred to health professionals for counseling and follow-up care.(1)
Will issues arise with this approach. Almost certainly. But that’s the reason for pilot testing. The point is that in an age of expanded health consumer responsibility, with a growing focus on access, cost efficiency, and population health, cost-effective care available where people live delivered by trained (not over trained) caring individuals will become increasingly common – quite independent of the pronouncements of hyper-ventilating voices filling the airwaves this week.