The Issues of the US Healthcare System and Solutions to the Problems

The US healthcare system is sick. According to a recent Commonwealth Fund report on the performance of select healthcare systems around the world, the US is “in a class by itself in the underperformance of its healthcare sector.” The report, which seeks to understand how advances in care worldwide might inspire improvements in the US, ranked the US last among the ten countries it assessed in terms of “access to care” and “health outcomes.” It ranked the US ninth out of ten on “administrative efficiency” and “equity.”

The Commonwealth report’s findings did not surprise those who use the US healthcare system. According to a Gallup poll rating Americans’ views on healthcare, less than half — 48 percent — describe the system as “excellent/good.” The report found that 21 percent of Americans consider US healthcare to be “poor,” marking the highest response rate in that category in the ongoing poll’s two-decade history.

The state of the US healthcare has far-reaching implications for the American people. High costs and limited access have caused many to contract preventable illnesses, and medical debt has become a damaging side effect for many seeking treatment. A solution that can open the doors to better care is desperately needed.

The fallout for US pharmacies

The US pharmacy system is one sector that has been hit hard by the underperformance of US healthcare. Recent news reports describe the pharmacy industry as “crumbling” under the weight of issues that include declining revenues, a labor shortage, and competition with online retailers. Additionally, customers say they are increasingly frustrated with long wait times, difficulty ordering prescriptions, and other customer service issues.

The widespread consolidation in the pharmacy benefit management and digital health space is a key contributor to these problems. Although presented as a cost-saving ecosystem, consolidations often inflate drug prices, limit patient access, and create fragmentation in patient care. Pharmacies that work with these systems are forced to deal with high costs, administrative inefficiencies, and lack of primary care access.

How pharmacies can drive improvements

Pharmacy-first healthcare solutions leverage the strengths of pharmacists to improve patient outcomes by providing a readily available source of expertise on medical issues who can play an active role in patient care. When effectively resourced, pharmacy-first solutions can be pillars for preventive, cost-effective, and accessible care in the local community.

One of the critical deficiencies cited by the Commonwealth Fund report was a lack of investment in primary care. This neglect, the report says, has resulted in “nationwide shortages of the clinicians who play a vital role in managing chronic illnesses.” Without the help those clinicians have traditionally provided, chronic illnesses can lead to costly and often unnecessary emergency and specialty care services.

Pharmacy-first solutions can address the problems that have surfaced in the US primary care system. A pharmacist’s scope is complementary to that of their physician and RN counterparts, providing the capability to support chronic illness management, and the medications pharmacists administer continue to be the most cost-effective treatment option for chronic conditions.

Telepharmacy services can further improve outcomes by making it even easier for patients to access medical support. Studies have shown that telepharmacy services allow those in rural communities to gain access to healthcare expertise while providing the same quality of care experienced via traditional pharmacies.

Long-term care at home pharmacy, which helps high-risk individuals manage their chronic conditions via effective medication management in their homes, can be especially helpful for addressing healthcare’s current shortcomings. The innovative pharmacy model reduces the need for patients to seek skilled nursing or hospital care by providing support for complex patient needs at a fraction of the cost associated with facility-based care.

The steps needed to empower pharmacies

Pharmacies are fixtures in local communities that have a deep understanding of proper drug administration and develop strong, lasting relationships with patients. Although these characteristics make them ideally positioned to provide preventive, mediation-focused care that can manage chronic conditions effectively and affordably, the current system makes it challenging for pharmacies to serve patients this way, primarily due to financial challenges.

Recognizing and adequately reimbursing pharmacies for the critical services they provide would enable their greater role in the healthcare ecosystem. If pharmacy-based services were more fully integrated into healthcare, pharmacists could consistently be used as the healthcare providers they are. Such a shift has the potential to save billions in preventable expenses while improving the quality of life for millions of Americans.

“Unsustainable” is one term that has been used to describe the current state of the US healthcare system. Pharmacies and pharmacists are uniquely positioned to create a more sustainable healthcare ecosystem through preventive care, chronic disease management, and medication optimization. Expanding the scope of pharmacist services and supporting fair reimbursement for these interventions would enable a cost-effective, patient-centered approach that improves outcomes and reduces system-wide healthcare costs.