19 Jun Optimization of Medication Use Critical to Success of ACOs
MedicalResearch.com Interview with:
Kimberly Westrich, MA
Vice President, Health Services Research, National Pharmaceutical Council, and
Kristina Lunner
Principal, Leavitt Partners
MedicalResearch.com: What is the background for this study?
Response: With the advent of accountable care organizations (ACOs) following passage of the Affordable Care Act in 2010, it became important to understand how success in an ACO world is different from success in a capitated environment, where the focus is only on managing costs. In an ACO, providers are responsible for the quality of care they provide for a defined population in addition to having at least some financial responsibility. We wanted to explore how an ACO can succeed in this environment of dual responsibility for costs and quality, and more specifically, how pharmaceuticals fit into this success.
To address these questions, the National Pharmaceutical Council worked with the American Medical Group Association (AMGA), Premier, Inc., and a group of seven leading ACOs to develop a conceptual framework for considering the role of pharmaceuticals in ACOs. This framework shows how optimizing medication use in a value-based healthcare environment, such as an ACO, can help the organization achieve its cost and quality benchmarks.
We evaluated ACO readiness to optimize medication use in 2014 and again with our most recent study, published in June 2017 online ahead of print in the Journal of Managed Care & Specialty Pharmacy. For our 2017 study, we worked with Leavitt Partners to survey and interview ACOs to understand how they optimize medication use, determine if there is an association between efforts to optimize medication use and achievement on financial and quality metrics, ascertain organizational factors that correlate with optimized medication use, and identify barriers to optimized medication use.
MedicalResearch.com: What are the main findings?
Response: Forty-nine ACOs participated in the study. Of these ACOs, 64 percent indicated they were prepared to manage the quality aspects of optimizing medication use, and 31 percent were prepared to manage the cost aspects. In terms of specific tasks related to optimized medication use, ACOs ranked themselves highest on their ability to transmit prescriptions electronically for non-controlled substances and notify providers of known drug allergies. ACOs ranked themselves lowest on their ability to notify pharmacies when a prescription is cancelled and notify care providers when a prescription is discontinued.
Compared to a similar study completed in 2014, this study found evidence that more ACOs are working to optimize certain areas of medication use. Specifically, more ACOs are:
- educating patients about medication alternatives,
- involving pharmacists in direct patient care,
- focusing increasingly on appropriate generic use,
- notifying care providers of potential adverse events,
- alerting providers to gaps in preventive care, and
- electronically transmitting prescriptions for non-controlled substances.
Although ACOs continue to build effective strategies to optimize medication use, the research revealed several barriers to implementing more comprehensive medication strategies at ACOs, including:
- lack of reimbursement for pharmacists’ services,
- poor technology interoperability, and
- difficulty isolating and evaluating the cost savings associated with better medication use practices.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: It’s clear that success in a value-based environment will depend on understanding the unique contribution of medications and utilizing them optimally across conditions and populations. Our research indicates medication use practices may be easier to implement if ACOs:
- provide access to data to both pharmacists and physicians,
- focus on removing technological barriers,
- gather buy-in from frontline physicians, and
- integrate pharmacists into care teams.
In addition, medications cannot be viewed as a siloed expense item in a value-based environment. Policies that remove barriers to or incentivize integration of practices to optimize medication use—and integrate pharmacists into care delivery—are likely to improve medication use in ACOs, which should enhance achieving the “Triple Aim” of improving the individual experience of care, improving the health of the population, and reducing per capita costs for care.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: To highlight leading ACOs’ best practices in optimizing medication use, we worked with those ACOs to publish their approaches as peer-reviewed case studies in the Journal of Managed Care & Specialty Pharmacy. For example, these case studies examined topics such as improving provider productivity through electronic prescription refills and the use of an electronic drug alert program to improve safety. Future research should focus on measuring the impact of effective medication use practices on cost and quality outcomes for patients in ACOs.
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Citation: Optimization of Medication Use at Accountable Care Organizations
Chrisanne Wilks, PhD1*, Erik Krisle, MA1, Kimberly Westrich, MA2, Kristina Lunner, BA1, David Muhlestein, PhD, JD1, Robert Dubois, MD, PhD2
1Leavitt Partners, Salt Lake City, Utah.
2National Pharmaceutical Council, Washington, DC
Journal of Managed Care & Specialty Pharmacy
Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
Last Updated on June 19, 2017 by Marie Benz MD FAAD