Zellmer Lecturer Provides Insights Into Future of Healthcare, Opportunities for Pharmacists
Pharmacists are poised to make strong contributions in the areas of postacute care, behavioral health, and population health, says Mark L. Hayes, 2017 recipient of the William A. Zellmer Lecture Award.
The award recognizes leadership in advancing public policy that improves medication use through the efforts of pharmacists.
Hayes, senior vice president for federal policy and advocacy for Ascension, the nation’s largest nonprofit health system, is the eighth recipient of the award. Hayes delivered his lecture on September 26 in Bethesda, Maryland, as part of ASHP’s annual Policy Week activities.
The annual lecture takes place the day before Policy Week participants meet with their representatives on Capitol Hill to discuss issues important to the pharmacy profession.
Hayes said professional opportunities for pharmacists are related to the national shift from fee-for-service to value-based models of healthcare delivery that attempt to control rising healthcare costs.
“The payment model is what drives the delivery of healthcare. The fee-for-service model says, ‘Do more services, and you get paid more,’” Hayes said, citing lessons he learned as a Senate healthcare staffer and as chief health counsel for the Senate Finance Committee’s Republican staff.
He said movement away from fee-for-service payments started decades ago, when policymakers first began bundling Medicare-covered inpatient services into diagnosis-related groups, or DRGs, with the government setting fixed rates for reimbursement.
“This is the first time we went from a cost-based payment in hospitals to a bundled payment. It turns everything in the hospital from a revenue center to a cost center,” Hayes said. As a result, he said, hospitals began to deliver care in ways that better manage costs.
And by later bundling Medicare reimbursement in outpatient settings and introducing penalties for early readmissions, he said, policymakers have created new incentives for hospitals to be accountable for what happens to patients after they leave the hospital.
“That’s going to really transform how postacute care happens. And I want to ensure that’s on [pharmacists’] radar screen,” Hayes said.
Behavioral health is another area that pharmacists should pay attention to, he said.
The Substance Abuse and Mental Health Services Administration estimates that the United States will spend $238 billion for prescription medications to treat behavioral health problems in 2020, up from $179 billion in 2014.
To reduce costs and provide better care for people with behavioral health conditions, Hayes said, it’s important to tackle the stigma of mental illness and treat it as just another medical condition.
And Hayes said healthcare providers “are just now beginning to talk about social determinants of health,” such as income, education, and housing, that affect day-to-day health status outside of healthcare settings.
Hayes referred the audience to AJHP’s September 15, 2017, special issue on population health for specific examples of how pharmacists are “doing amazing things and changing the delivery of healthcare.”
But he cautioned that pharmacists still need to document and track the return on investment for pharmacy services in order to convince healthcare administrators to support expansion of the profession’s efforts.
Hayes described himself as a “policy pharmacist” but said he didn’t know in advance that he would follow that professional path.
He said that while serving as ASHP executive resident in association management in 1988, he learned about the role played by Capitol Hill staff in shaping healthcare policy and delivery. After completing his residency at ASHP, Hayes served for 5 years as a legislative assistant for Christopher Bond, of Missouri, his state’s U.S. senator.
Hayes later served as a policy adviser for the Senate Committee on Health, Education, Labor, and Pensions and for Senator Olympia Snowe of Maine. In late 2002, he became the health policy director and chief health counsel for the Senate Committee on Finance. He served for 8 years and was involved in the drafting of major federal health legislation, including portions of the 2003 Medicare Modernization Act, which created the Part D prescription drug benefit and the Medicare Advantage program.
He called the awarding of the William A. Zellmer Lecture Award an “unexpected honor.”
“I am really humbled to be a part of this,” Hayes said.
[This news story appears in the November 15, 2017, issue of AJHP.]