Role of Pharmacy Services in Accountable Care Organizations

Abstract

Background The accountable care organization (ACO) model being adopted across the U.S. aims to improve patient care and reduce costs. Little is known about whether commercial ACO contracts include accountability for prescription drug spending or how ACOs are engaging outpatient pharmacies and managing prescription drug use. Objective To explore how ACOs are addressing drug spending and pharmacy services, a potentially important determinant of both quality and total spending. Methods We use data from two waves of the National Survey of ACOs (N=270), a survey completed by ACOs that were established prior to July 2013. ACO executives were asked about ACO engagement of pharmacy services, pharmacy-related health information technology capabilities, and ACO accountability for prescription drug spending. Results Among ACOs with commercial contracts, 77% report being held responsible for prescription spending by their largest contract. Considering all ACOs (Medicare, Medicaid and/or commercial contracts), 45% report at least one contract includes prescription drug spending responsibility. Nearly half of ACOs report a formal relationship with a pharmacy; 26% include a pharmacy within the ACO; and 19% have contracted pharmacy services. On average, compared to those that do not, ACOs engaging pharmacies have a broader range of services and provider types, both commercial and public contracts, and greater experience with payment reform. Conclusion Management of pharmacy services and prescription spending will likely influence commercial ACO contract success. Given the broad potential impact of prescription use on overall spending and quality, payers might encourage integration of pharmacy services in ACOs through prescribing quality and prescription spending performance measures.

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