Promoting generic prescribing habits and improving patient medication adherence can lead to lower costs and improved patient outcomes in ACOs. Here's how some ACOs are incorporating pharmacists into their organizations to help meet those goals.
Since the start of the accountable care movement, hospitals, health systems and physician groups have been looking for ways to improve care quality and patient experience while lowering costs. One aspect of patient care that is relatively untapped by accountable care organizations but has a major impact on cost and quality outcomes is medication management.
For instance, major cost savings can be achieved by prescribing generic drugs instead of brand-names: on average, the price of a generic drug is 75 percent lower than the cost of a brand-name drug at retail, according to a 2012 report by the U.S. Government Accountability Office.
Additionally, medication non-adherence costs the nation's healthcare system nearly $300 billion annually, according to a 2009 study by the New England Healthcare Institute, because of increased risks of hospitalization and other medical risks.
By increasing generic prescriptions and improving medication adherence, ACOs can achieve major cost savings and can improve patient outcomes at the same time. One of the more efficient ways to do so is by incorporating pharmacists in to ACOs.
"Because of the role that medications play in improving quality and reducing overall costs, it behooves ACOs to take a close look at medication use in a new way and to consider the role that pharmacies and pharmacists, who are the medication experts, can play in that space," says Kristina Lunner, senior advisor with Leavitt Partners.
Rich Cassidy, MD, chief accountable care officer for Walgreens, agrees. "I think we're going to see increasingly coordinated collaborative care partnerships that leverage pharmacists."
What ACOs are doing now
There are several ways ACOs are currently working with pharmacists to improve medication adherence, better manage chronic diseases and reduce overall medication spend.
Care teams. Several ACOs employ clinical pharmacists and incorporate them into their clinical care teams. Minneapolis-based Allina Health, a Pioneer ACO, developed advanced care teams that include pharmacists as well a social workers, care managers and health coaches. The pharmacists, who are embedded in clinics, conduct comprehensive medication reviews for high-risk patients, according to Lee Mork, director of ambulatory pharmacy services at Allina.
The program at Allina has caught several drug therapy issues with patients, Mr. Mork says. "The dose might be too high or low, or there may be adverse effects or even unnecessary drug therapy," he says. Though it is too early to see concrete results, early trends show this program has had positive effects on emergency room visits and admissions from drug therapy issues, according to Mr. Mork.
Similarly, Phoenix-based Banner Health's ACO has also incorporated pharmacists into care teams. "Pharmacists are definitely part of the team," says Pamela Nenaber, CEO of pharmacy services at Banner.
Research, done by Walgreens, shows that patients who receive face-to-face counseling with a pharmacist had a 7.2 percent higher medication adherence rate than patients who did not receive counseling.
Prescription guidance. Another way pharmacists can use their skills to drive ACO success is by helping control how much is spent on medications. At Hunterdon Healthcare Partners, a physician-hospital organization affiliated with Hunterdon Healthcare in Flemington, N.J., that has three commercial ACO contracts, pharmacists help educate physicians on generic vs. brand name prescribing from an academic point of view. They also communicate directly with physicians about their generic prescribing rates, according to Jeff Weinstein, the CEO.
Pioneer ACO Atrius Health, an alliance of six community-based medical groups and a home healthcare and hospice agency in Newton, Mass., employs clinical pharmacists who create a formulary for the group. The formulary is a set of recommendations for physicians for what they believe are the best drugs in class to use, Rick Lopez, MD, CMO of Atrius Health, explains. These pharmacists also meet individually with primary care physicians once a quarter "to review the physicians' individual prescribing practices," Dr. Lopez says. "We also don't allow pharmacy reps on our sites to talk to physicians, so that physicians do not receive conflicting messages to the quality [and] cost prescribing practices promoted by the clinical pharmacy program."
Encouraging physicians to prescribe generic medication when appropriate helps lower the overall cost of care and it positively impacts patient medication adherence. "It doesn't do any good to prescribe something that [patients] can't afford," says Mr. Weinstein.
Possible roadblock
While incorporating pharmacists into accountable care efforts seems makes sense, it may not be feasible for all developing ACOs. "We're not receiving any reimbursement — Medicare doesn't cover in-office pharmacy visits," Mr. Mork says of the situation at Allina.
"There's a lack of reimbursement for pharmacist services," Ms. Lunner agrees. However, she notes that the cost savings achieved by the pharmacist services often outweigh the cost of paying the pharmacists. "While lack of payment may dissuade some, more and more, ACOs are moving in that direction because of the overall savings gained," she adds.
Looking ahead
The role of pharmacy in accountable care doesn't have to stop at care team inclusion and encouraging generic drug prescription. There are other ways to incorporate pharmacists and pharmacies into ACO activities.
For instance, incorporating pharmacists more in the retail space — instead of the office-based care team work — is a possibility for the future, especially because patients with chronic diseases tend to visit their local pharmacy to refill medication much more often than they visit their primary care physicians. "Pharmacists are likely to see them 20 times a year," says Dr. Cassidy. "Each visit is an opportunity to reinforce what the primary care or leading physician wants the patient to do." Walgreens is the only national pharmacy chain directly involved in three Medicare Shared Savings ACOs in this way.
As more hard data becomes available on how relationships with pharmacists affect medication adherence, readmission rates and medication spend, the trend of incorporating pharmacists into ACOs is likely to grow and evolve.