Drs Weaver and Chitre discuss aligning key considerations for payers and goals of therapy for patients in the treatment of MDD.
Jay Weaver, PharmD, MPH: I think about our goals of therapy in several domains. First is the clinical domain. Our goal is to reach the most rapid remission and potentially cure the condition. Some people receiving medications that are effective quickly and behavioral cognitive services can find themselves without symptoms, and they eventually may be able to discontinue therapy. There’s a set of clinical goals.
We also know that with depression and other chronic disease, management—such as diabetes management—often goes hand in hand. As people do more poorly with their diabetes, their depression gets worse. Or when they’re depressed and have trouble committing to and engaging in therapy, they do more poorly with their diabetes. That’s our clinical sphere of things. Second is some financially oriented goals around reducing cost of care. We think of ourselves as a fiduciary working on behalf of employer groups, hopefully reducing the number of admissions for major depressive disorder [MDD] in patient stays and reducing the number of other services needed because of poor outcomes. Those are goals.
The third set of goals are employer focused. Many people are buying group benefits on behalf of their employees. Think about the workforce shortage we have at the moment coming out of COVID-19 and the great resignation. Many of my employers say, “We don’t have enough staff to do all the work. We have disability. We have people missing work or at work but not working very well because they’re ill.” They call that presenteeism. Absenteeism and presenteeism have a real impact, especially today. For many years in benefits, we’ve talked about this as a consideration. It has only recently become super important because this is having a financial impact on the businesses buying these benefits.
Lastly, I think about the patient-oriented goals, which could be their quality of life, as Dr Chitre pointed out. It could be the ability to engage in family activities or other things that they want to do. Their depression has kept them withdrawn from things that they love. We’re bringing that holistic set of goals together—many times those things are aligned—and hopefully align the plan, the member, and the provider to achieve good things.
Mona Chitre, PharmD, CGP: Our goals with MDD therapy are similar to the goals I previously commented on: to provide access to high-quality, affordable care. This includes working through the care continuum and ensuring patients find the right provider, have access to the therapies that are right for them, and have the tools they need to be adherent. One other thing we focus on is the stigma, ensuring that mental health is as focused on physical health, and that our members have tools and are having these conversations with their peers, their support group, and their family members.
Whether it’s MDD or a different disease state, we want to encompass a member from the global population perspective all the way to what their questions may be to support them through their care journey of access to affordable, high-quality care so they can stay on therapy, follow up with their physician, get their questions answered, and have a good quality of life.
Transcript edited for clarity.