NPS MedicineWise responds to the Review of NPS MedicineWise Quality Use of Medicines Funding Decision

This statement relates to the independent review of the 2022-23 Budget Measure Guaranteeing Medicare and Access to Medicines – Improving Access to Medical Equipment, Treatment and Diagnostic undertaken by Dr Pradeep Philip at Deloitte Access Economics and the subsequent report (the Report). This Report was published on September 15, 2022.

NPS MedicineWise response:

NPS MedicineWise accepts the decision of the Minister in response to the Report and will make every effort to ensure a positive transition of activities for the benefit of the Australian people. The company is very proud of its work and will ensure that an accurate record is provided to support future QUM initiatives. This response provides further information to correct and explain some parts of the Report.

While the analysis and recommendations in the Report are largely sound, it has been selective in its use of facts and the conclusion is largely unsubstantiated. The conclusion has had a catastrophic impact on NPS MedicineWise (see this media release).

NPS MedicineWise does not agree with a number of the observations of the Report and had requested that inaccuracies/misrepresentations be corrected prior to publication. This request was declined.  

 

Report inaccuracies

The Report contains several inaccuracies and/or misrepresentations. Specifically:

MBS Savings.

The Report questions the MBS savings figure reported by NPS MedicineWise for the period FY17-FY21 and says that the team have been unable to verify the source and contribution of these savings. This information is available and could easily have been provided if it had been requested, with reference to individual evaluation reports for the input figures as well as the calculation methodology itself. It is correct that NPS MedicineWise did not meet its annual MBS savings target in the most recent year; QUM programs have exceeded the MBS target in previous years meaning that QUM programs have averaged an annual saving of $11.8 million towards the MBS over the whole Grant Agreement, which is just short of the $13 million/annum target.

Effectiveness and Reach of Program Delivery Model.

Key finding 2 refers to a program delivery model which only reaches 27-33% coverage of GPs. This is misleading as currently presented: 

  • Educational visiting programs achieve 27-33% coverage per program and 50-60% coverage per year across 2-3 programs – noting coverage is a function of the funding available.
  • Educational visiting is not delivered in isolation but as part of a multifaceted set of interventions in line with the evidence for best practice for behaviour change activities.
  • These multifaceted programs frequently reach 100% of relevant GP prescribers through the use of Practice Reviews, which are part of our program delivery model, and go out to all GPs.
  • NPS MedicineWise has shown that 27-33% visiting program coverage per program, as part of a multifaceted program, consistently achieves 5-15% prescribing rate changes for target medicines across the whole GP prescriber population. This outcome is better than results reported elsewhere (including internationally) and is as good or better than what is demonstrated in clinical trials for multifaceted programs (which only measure for exposed population). 

Use of Technology / Innovative Delivery Models.

The report says “there is no mention of utilising video conference technologies as an alternative to in-person program delivery”. While this is technically correct in relation to the reports provided, Deloitte did not check with NPS MedicineWise whether these technologies had been used. Video conference technologies have been a service offering for NPS MedicineWise for many years and were a core component or our program delivery in response to COVID-19 restrictions. There are several key areas where NPS MedicineWise has undertaken innovative programs to support new models of program delivery. This information was ignored in the analysis. The suggestions that there has been a lack of innovation or adaptation by NPS MedicineWise are misleading and incorrect.

Other feedback:

  • The report claims but does not substantiate duplication between NPS MedicineWise and the Australian Commission on Safety and Quality in Healthcare (the Commission).
  • The report did not consult and does not reflect the voices of health professionals or consumers.
  • The Report fails to consider the implications of the Budget decision on the many other parts of Department and wider Government that NPS MedicineWise works with, including the Therapeutic Good Administration, and consultation does not appear to have extended beyond the Quality Use of Medicines (QUM) Branch of the Department.
  • We welcome the consideration of the broader ramifications of dismantling the collective QUM assets of NPS MedicineWise, and the importance of ensuring that key personnel and expertise are not lost to the sector during a transition. However, the report recommendations fail to adequately consider and manage the risks associated with this decision.
  • Some of the high risks are identified in the Report and require active mitigation:
    • There is a greater risk of fragmentation through redesign, with the move away from an integrated QUM delivery model.
    • The extensive network of health professionals and consumers, and the associated level of trust and credibility that has been built up by NPS MedicineWise over many years, cannot simply be replicated by transitioning key personnel from NPS MedicineWise to a government agency.
    • The Report highlights the relatively limited expertise within the Commission in primary care. It will take considerable time and resources for the Commission to establish the necessary reach and trust in primary care and aged care, even with the transfer of NPS MedicineWise personnel. In the meantime, the levers needed to address QUM in this part of the health system, and the ability to have impact, will be significantly reduced at a time of critical reforms in mental health, aged care and primary care more broadly.