Optimization of Medication Use at Accountable Care Organizations

Abstract

This research was sponsored and funded by the National Pharmaceutical Council (NPC), an industry funded health policy research group that is not involved in lobbying or advocacy. Employees of the sponsor contributed to the research questions, determination of the relevance of the research questions, and the research design. Specifically, there was involvement in the survey and interview instruments. They also contributed to some data interpretation and revision of the manuscript. Leavitt Partners was hired by NPC to conduct research for this study and also serves a number of health care clients, including life sciences companies, provider organizations, accountable care organizations, and payers. Westrich and Dubois are employed by the NPC. Wilks, Krisle, Lunner, and Muhlestein are employed by Leavitt Partners and did not receive separate compensation. Study concept and design were contributed by Krisle, Dubois, and Muhlestein, along with Lunner and Westrich. Krisle and Muhlestein collected the data, and data interpretation was performed by Wilks, Krisle, and Muhlestein, along with Dubois and Westrich. The manuscript was written primarily by Wilks, along with Krisle and Muhlestein, and revised by Wilks, Westrich, Lunner, and Krisle. Preliminary versions of this work were presented at the following: National Council for Prescription Drug Programs Educational Summit, November 1, 2016; Academy Health 2016 Annual Research Meeting, June 27, 2016; Accountable Care Learning Collaborative Webinar, June 16, 2016; the 21st Annual PBMI Drug Benefit Conference, February 29, 2016; National Value-Based Payment and Pay for Performance Summit, February 17, 2016; National Accountable Care Congress, November 17, 2015; and American Journal of Managed Care's ACO Emerging Healthcare Delivery Coalition, Fall 2015 Live Meeting, October 15, 2015.

Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions

“…When considering health IT use with regard to patient engagement efforts, over half of ACOs use telehealth and are able to send notifications to patients electronically, just under half (48 percent) provide patients with access to medical records, and an additional 24 percent provide patients with access to medical records and clinical notes [24]. However, aside from a few exceptions such as drug-drug/drug-allergy interaction checks, telehealth, and electronic notification sending, each of these studies found that fewer than 50 percent of ACOs reported participating in a variety of health IT activities [202224253536].…”

“…One study identified no relationship between EHR functionality and care management activities [40], but another found that using Certified EHRs and participating in either an ACO or patient-centered medical home (PCMH) was associated with the highest odds of performing population management, care coordination, quality measurement, and communication compared to physicians using a Certified EHR but not participating in an ACO or PCMH [8]. Six qualitative ACO-level studies found that ACO leaders emphasized the importance of health IT capabilities in achieving their quality, population health, or financial goals [162125354142]. Additionally, one study found that ACOs performing highly on quality and financial metrics reported extensive and sophisticated use of EHRs in their organizations as a factor for success [43].…”

“…In particular, few studies have explored the implications prerequisite barriers have for the achievement of reform goals. In addition, lack of interoperability has been cited as a barrier to delivery reform efforts like ACOs [35], motivating studies to examine the effect of interoperability on ACO goals [13].…”

Optimizing the Role of Community Pharmacists in Managing the Health of Populations: Barriers, Facilitators, and Policy Recommendations

“…Existing evidence has shown that expanded clinical roles of pharmacists have had a positive effect on total cost reduction and quality within ACOs, 38,39 and ACOs have recognized the importance of appropriate medication use in achievement of quality and cost benchmarks. 40 In fact, studies indicate that while 70% of ACOs poorly rate their preparedness to manage medication costs, 40 half of ACOs have established formal relationships with community pharmacies, 38 and over the last 5 years, ACOs have progressively increased pharmacist involvement in their models. 39,40 For example, community pharmacies that provide MTM services in an integrated setting have demonstrated improved medication management and collaboration with physicians to enhance care for shared populations.…”

“…40 In fact, studies indicate that while 70% of ACOs poorly rate their preparedness to manage medication costs, 40 half of ACOs have established formal relationships with community pharmacies, 38 and over the last 5 years, ACOs have progressively increased pharmacist involvement in their models. 39,40 For example, community pharmacies that provide MTM services in an integrated setting have demonstrated improved medication management and collaboration with physicians to enhance care for shared populations. 41,42 While evidence is mounting on how ACOs can effectively integrate community pharmacists, there is opportunity to learn from established integrated care networks that include pharmacist-led medication services.…”