Richard Resnick is the chief executive officer (CEO) of Cureatr, a medication management optimization technology and services company. In a December Q&A, he looked back on 2020 and shared his thoughts on key takeaways for the year, how the year affected him personally and Cureatr as a company, the evolving and expanding role of pharmacists, and the top lesson he learned.
In this Q&A, Resnick shares his expectations, predictions, and hopes for 2021.
Q: What issues and trends are you watching closely this year?
Richard Resnick: I have a vested interest in the loosening of regulations around telehealth, which I think have been critical to helping provide access to care during the pandemic. I worry that those regulations will be tightened. I think there's tremendous amounts of data supporting telehealth's value. I expect the incoming administration will use evidence to make decisions around telehealth, which should bode well for its future.
The public health and vaccination matter are above my paygrade. I anticipate that there will be a weird transition because of those who get vaccinated and those who do not. How will society reopen fully? Will there be a vaccine passport? All of these issues are worrisome but transient. Ultimately, I expect that enough people will get the vaccine to achieve herd immunity, which will do a favor for those who, for one reason or another, choose not to get vaccinated.
I expect the Biden administration will be pretty keen on Medicare for All, with it probably taking the form of more Medicare Advantage plans. I don't believe the Biden administration will be interested in destroying private payers, nor would it be successful even if it were. Rather, I think we will see continuing support of the massive growth of Medicare Advantage plans, which are essentially commercial offerings from a health plan that the government helps fund and direct. I would support that because the regulations imposed upon health plans by the government to cover their members help drive the quality improvements that Cureatr can offer.
One other major trend to watch for this year and into 2022 is the continued loosening of restrictions on health data and how patients will become more empowered with their own medical information. This is due to a few regulations taking effect now that will essentially force EMRs to give data up in ways that they haven't been forced to do before.
That will start slow, it won't start automated, and it won't be pretty. However, over the course of 2021 and 2022, it will be easier for healthcare technology vendors to access all of this clinical data without needing to go through hoops. I think that will normalize a competitive playing field which will only benefit patients.
Q: What does 2021 look like for Cureatr?
RR: What we see is an opportunity. All of the people who have died from COVID-19 until now is close to the number of people who die every year from suboptimal medication regimens. Roughly 275,000 people every year die from their medications, and that figure is growing. Medications will either cure you or kill you. The difference between the two is good management.
At Cureatr, we've fought our way through building out all of the pieces of the puzzle that we need to address that problem. We're capturing the data that allows us to essentially know anything about a consenting patient's medical and prescription-fill background. We have numerous pharmacists on our team. Now we can start to focus on those places where we can really provide help.
What's interesting is that where we think we can make the most difference is not where one might assume. Provider organizations are busy because of COVID-19 and will be dealing with it for a while. Then they'll be busy with adapting to the post-COVID-19 era. Even when they weren't this busy, providers were busy with trying to adapt to the inertia in healthcare, which makes it hard for them to integrate new practices, technologies, and people.
As we get into 2021, the health plans are showing themselves to be the place where innovation can happen. There are a series of additional restrictions and measurements that Medicare and Medicaid impose on the plans if they want to create Medicare Advantage plans and access the government funding for them.
One such restriction states that when a member goes to a hospital and is discharged, that member is expected to have the benefit of somebody reviewing all of their medications when they arrive home. This is to make sure the member has all of their expected medications. This service, known as medication reconciliation post-discharge (MRP), is vital because the discharge from the hospital to the home is one of the most dangerous care transitions for all patients, but particularly for those with complex medication regimens. CMS sets the target for completed MRPs at 80%, but it really ought to happen 100% of the time since over 50% of discharges have at least one medication error. A plan is financially dinged when they miss that mark, and yet the plan doesn't have total control over whether it happens. It's the provider who is supposed to perform the reconciliation.
Unfortunately, providers are doing it about half of the time. Even though the plans are pushing providers to perform the MRP and giving them incentives to do so, it's still not occurring regularly. Providers are too busy, there's too much workload challenge, there's not enough data — these and other reasons are why MRPs are not happening consistently for each and every patient.
The plans are beginning to move forward with taking on this responsibility themselves. They are choosing to hire their own telehealth team to make sure medications are safe when patients go home. But the plans lack all of the data – particularly real-time data which is so vital in a care transition – required to perform complete and proper reconciliation and they don't have a team of the scale necessary.
This is an opportunity for companies like Cureatr to go in and offer end-to-end solutions to the plans. That's what we've begun to do, and we have some exciting news about major opportunities forthcoming concerning the ability to improve care for patients who are discharging from the hospital and doing the transition back to home and then keeping them out of the hospital.
These are opportunities that will be paid for by the plans. They're interested in paying because such solutions lower readmissions, which they also need to pay for, that happen when reconciliation does not occur or occurs improperly.
Those are the sorts of developments we're expecting and looking forward to in 2021. It's the ability to use the combination of our software and data along with our clinical pharmacy team to address these significant and obvious places where people get sick and die when they don't need to, largely funded by health plans that are acting benevolently because they care about their patients and their bottom lines.
Q: Besides improving medication management, what is another top issue that you believe must be a focus for the healthcare industry in 2021?
RR: If we don't solve the problem of the lack of equity in healthcare, then we are not doing our jobs. There's plenty of understanding that there's bias in healthcare. There's bias in the data that's collected — even Cureatr's data. We are beginning some projects to try to quantify what that looks like. We have access to pharmacy data from all of the big box stores, but we don't have it for many of the mom-and-pop pharmacies yet. I wonder — and we will measure — whether there is bias around social demographics. We know there's bias in the experimental datasets we use. Now there are recent reports that in all of these COVID-19 vaccine studies, there are not enough people of color included.
There's also a well-documented mistrust of the health system by people of color. This is, in part, because when you go to hospitals in neighborhoods largely populated by people of color, they often have cops in them, just like there are often cops in the schools these people grow up in. It's no wonder that people of color are hesitant to go to a hospital when it feels like jail.
We've done a lot of work at Cureatr to try to understand how this all factors into healthcare and our services. I believe that addressing inequality is the cause of our time. It is far more important than recovering from COVID-19. We have a chance to finally get equality right in our country after 250-plus years.
Cureatr is going to throw all of its small amount of weight behind that. We'll be working to hold the healthcare industry to do the same.