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Strategic Rx Stewardship: P is for Purpose

Week 13 – R X S T E W A R D S H I P


Why do we do what we do? Organizations often position themselves as “mission driven.” What does this mean? The implication is that the mission of that particular company is in some way to do good. All organizations are “mission driven.” For some, the mission is increasing shareholder value. For others, the mission may be to cure a particular disease. Some may claim the mission to heal people or build better cars or deliver packages faster or help others solve complex problems.

The reality is that all organizations see “good” in whatever mission they’ve chosen and that “goodness” may or may not have anything to do with social, political, environmental, or spiritual purposes. We all want to attach ourselves to a meaningful purpose that enables us to live well and with a clear sense of doing something constructive in the world…or at least nothing destructive.

The world of health benefits and healthcare delivery is criss-crossed with varying messages of purpose. Most of them claim the high ground of cost-effectiveness, value, patient-centeredness, and overall goodness as it relates to costs and outcomes. We all want “high-value care” for ourselves, our families, and our employees and their families. But what is “high-value”? We all want great health outcomes. But what are great outcomes? We all want to live full, healthy lives but what exactly does that mean?

Herein lies the purpose conundrum: much of what we claim for purpose or desire uses the same vague terminology while we all have a more explicit understanding what we want as our ultimate result. Some of this is deliberate marketing and positioning as we gradate the levels of ultimate value as we work to give our organizations room to maneuver in the shifting sand of competing priorities. As in many definitions of value, it comes down to money and who keeps how much.

In this fuzzy zone of mission, purpose, and value, we tend to get lost in “mine” and “yours” as we arm-wrestle over ultimate results. This is where stewardship becomes a fabulous bridge for our purpose chasm.

How does this relate to health benefits and healthcare delivery? Because, as employers, we want to be good stewards of our financial resources and, as appropriate, the health of our employees. We offer health benefits because we want them to benefit those with whom we work. Stewardship isn’t just about lowering costs or aggregating benefits to the organization. Good stewardship is using our resources wisely and getting the most for the money we spend. Nobody wants to be taken advantage of, restricted unnecessarily, or bullied. Everyone wants positive relationships, continually improving outcomes, the ability to influence costs and outcomes, and a sense of good purpose attached their efforts.

Strategic Rx Stewardship is mission-driven in the sense that its purpose is to help the employer/health benefit provider turn the drug spend into an investment and use that investment to help employees get and stay as healthy as they possibly can. Good stewardship as purpose is good as it aims to aggregate value across its stakeholders by investing resources wisely in extending them as far as possible while improving the result they yield. In this way, “high value” becomes purpose driven, measurable, and accountable to that ultimate good.

The devil is in the details and good stewardship requires its own processes and mechanisms to deliver on its purpose. For the pharmacy benefit and those medications leveraged in an onsite or nearsite health center, Strategic Rx Stewardship is a framework for executing on this purpose. With Insight, we understand challenges and opportunities. With Influence, we provide access and mechanisms for engaging the right employees at the right time. And with Impact measurement, we ensure good stewardship by monitoring and measuring value as reflected in costs and outcomes.

We should all be asking ourselves: how can I be a better steward of the resources entrusted to me? There are many, many, possible answers to that question and just as many options to help us find our way. Perhaps starting with purpose and finding the common ground to agree on what constitutes good stewardship is the way forward. With this in mind, we then ask: are my partners/vendors being good stewards of what I’ve entrusted to them? Here, we may find purpose of a new sort and begin to see a different kind of path to our own mission.

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