Accountable Care Organizations: Role of Pharmacists

San Antonio—Since 2010, the number of Accountable Care Organizations (ACOs) has grown in the United States, with many states now moving toward adopting this new model of healthcare delivery. Currently, most of the ACOs involve public programs with Medicare Shared Savings Program as the dominant type of program represented, followed by ACOs with private contracts. Physician groups and hospitals are seeing the most rapid rise in the number of ACOs created.

These were some of the data presented by Thomas Merrill, senior analyst and lead researcher at the Center for Accountable Care Intelligence, a practice within Leavitt Partners. Mr. Merrill opened an AMCP meeting session titled The Interface Between Accountable Care and Managed Care: Real World Insights and Innovations. Among the issues presented during the session were the proven and likely impact of ACOs on healthcare quality and cost, and specific roles for pharmacists in the ACO model.

Laura Happe, PharmD, MPH, the associate professor of pharmacy administration at the Presbyterian College School of Pharmacy, provided information on some of the benefits of ACOs. Dr. Happe presented responses from 24 ACOs—16 commercial and 6 Medicare—surveyed on which interventions the ACOs are using to improve outcomes and reduce costs. Respondents from these organizations were evenly split between pharmacy directors and medical directors, she said.

All of the respondents (100%) reported that improved care coordination between physician offices and specialties, as well as discharge planning and follow-up for hospitalized patients were interventions the ACOs were using to improve outcomes and reduce costs. The survey also showed that pharmacy-related interventions were second to readmission interventions as being the most successful intervention. “ACOs are relying heavily on pharmacists and pharmacy-related interventions to reduce costs and improve care,” said Dr. Happe. She said that pharmacist-driven initiatives that are proving to be key strategies for ACOs include medication therapy management (MTM), discharge medication reconciliation, improved medication adherence, and formulary management. For example, she said that changing to a less expensive tumor necrosis factor product has led to $5000/year in savings per patient.

Along with pharmacists, case managers are also playing a critical role, as all of the survey respondents said they use case managers to, for example, identify high use/high cost patients. Results from a study from Mount Sinai, she said, showed that the use of case managers to identify high risk patients and then refer them to social workers to try to prevent readmissions resulted in a 43% reduction in admissions, 54% reduction in emergency room visits, and $1.6 million savings in medical costs. 

Rebecca Cupp, RPh, vice president of pharmacy at Ralphs Grocery Company, a subsidiary of The Kroger Co., said that community pharmacies are untapped resources for improving patient outcomes and talked about ways these pharmacies can help reduce readmissions, reduce the cost of drugs, promote treatment adherence, provide pharmacy specific data, and help with disease management. Of these, she emphasized the importance of MTM and disease management and described a pilot MTM program at Ralphs Pharmacy that uses an appointment based model (ABM) to coordinate a partnership among homes, social workers, nurses, pharmacists, and physicians.

The ABM allows for more efficient coordination of care by setting up a once monthly pre-appointment call from pharmacy to the patient prior to the patient’s appointment date, thus streamlining and synchronizing the process. Results of the pilot program at 12 months showed greater patient adherence to treatment in a number of drug classes.