Placing the Patient at the Center of Healthcare

The buzz words, wherever you turn to in healthcare today, are “value,” “patient-centered,” “quality.” The question remains, how are these elements being incorporated in practice by the healthcare industry, and is the patient engaged in these discussions?

The Patient-Centered Medical Home (PCMH) is a perfect example of the shift in healthcare today. PCMH, developed by the Agency for Healthcare Research and Quality (AHRQ) is a model for delivering primary care that is patient-centered, coordinated, integrated, accessible, and improved through quality and safety feedback that is in-built. To actively involve the patient in this new model of care, AHRQ encourages primary care practices to improve communication with the patient and their family, encourage self-care, and engage the patient in quality improvement practices at the clinic.

And, PCMH is cost-effective. A study published in The American Journal of Managed Care in 2014 evaluated the medical cost and healthcare utilization of high-risk patients who were enrolled in PCMH and non-PCMH practices—a significant reduction in costs and utilization were noted in the PCMH practices for this high-cost group of patients.

How about clinical trials that bring the drug to the patient? While trials are adopting to the changing healthcare environment, they are still a long and laborious process with little consideration for the patients’ viewpoint. Paul Wicks, Vice President of Innovation and PatientsLikeMe, said in a recent interview that patients should be involved in phase 0 of a clinical trial, a step before a trial is actually launched. This will help answer questions of unmet need and avoid “me-too” drugs, he said. He also suggested continuous patient feedback during ongoing trials to improve trial design and outcomes.

The FDA, on its part, has opened up the floor so better drugs reach the right patients faster. The Accelerated Drug Approval Program, for instance, allows for earlier approval of drugs that treat serious conditions and that fill an unmet need based on surrogate endpoints. The drug manufacturer, meanwhile, is required to conduct phase 4 confirmatory trials to confirm the drug’s clinical benefit. Additionally, to better engage the patient in the drug and device approval process, the FDA launched the Patient Network Website in 2012, with the hope that in addition to providing much needed, and valued, information to the patient community, it could serve as a platform to gather the patient perspective.