With an effort to access and improve the healthcare industry in USA; along with managing the costs which have been the primary issue since years; the introduction of ACO (Accountable Care Organization) whereby the providers have created a comprehensive network that works for the betterment of the patients, and it is appreciated as an achievement in the health care reform legislation.
ACOs also widely known as Accountable Care Organization comprises groups of doctors and/or hospitals that voluntarily assume responsibility for the quality and the cost of health care for a defined population of beneficiaries. The payers establish a framework whereby provider groups agree to care for a population of patients with the goal of reaching or surpassing predetermined cost and quality benchmarks. If the ACO happens to meet all the quality benchmarks and the population’s cost of care is below the established threshold, the ACO is able to share in all or part of the savings. Some contracts add additional incentives for reaching even higher quality goals.
ACOs struggling with health information technology challenges
Accountable care organization is struggling to overcome the challenges associated with health information technology integration, patient management and drug selection to improve care outcomes, according to a new study from the Pharmacy Benefit Management Institute
A recent survey conveyed that Accountable care organizations, who cover over 40 million patients, specifically to analyze current practices in pharmacy management, the use of pharmacists in ACOs, the state of care management and patient engagement, clinical integration and future goals.
It suggested that ACOs needed tech-intelligent pharmacists to help improve value, quality, and care in our nation’s healthcare and pharmacy plays an important role in achieving those goals.
Why partnering with tech-intelligent pharmacist will be good for ACOs
Partnerships between pharmacies and ACOs could have a significant move in key areas, such as hospital readmissions and patient care and satisfaction. Pharmacists provide medication therapy management (MTM) programs which include conducting comprehensive medication reviews and medication reconciliation. These programs ensure patients take all the correct medications for their conditions, adhere to their regimens and avoid drug interactions.
When patients are safely taking the right medications and adhering to their regimens, their conditions are less likely to escalate, keeping them out of the hospital. Less error means healthier patients, more savings for the health care system and a bigger payoff for the ACO.
Additionally, pharmacists can assist in providing patients with smooth transitions of care from the hospital to their homes. Transitions of care affect a patient’s overall health care experience and perception of care, which is another area of financial incentive for ACOs.
Integrating Pharmacists with ACOs
Incorporating pharmacists into patient care teams could provide value to accountable care organizations as their network of providers seek to improve the quality of health care services and reduce costs.
Optimized medication use, often involving the use of medication management services, is essential for positive health outcomes, especially among high-risk patients with chronic ailments. Utilizing pharmacists’ medication use expertise within coordinated care management strategies, accountable care organizations may be better situated which not only improve quality and lower costs, but also promote positive patient health outcomes.
Some ACO-like organizations are already implementing pharmacist patient care services, such as medication therapy management (MTM) services, into their health care models. A recent brief profiles a variety of roles pharmacists serve within population health management and patient care strategies, and also provides examples of organizations that include pharmacists as essential components of their health care delivery system.
Here are 4 significant role played factors to which pharmacist engagement have successfully helped health care organizations manage costs and promote better patient outcomes.
- Drug Therapy Clinics
These clinics, often directed by pharmacists, work to ensure that patients are correctly adhering to medication regimens, and that drug-related problems are identified and managed. Such clinics include anticoagulation clinics, transplant programs, and HIV, hepatitis C, psychiatric and lipid management clinics.
- Comprehensive Medication Reconciliation
These services, often provided and/or directed by pharmacists, include reviewing a patient’s entire regimen of prescribed and over-the-counter medications and herbal supplements to ensure that the patient is on the correct medication and to minimize drug-to-drug interactions. Increasingly, these services are provided post-hospital discharge to reconcile the medications a patient may receive in the hospital with any medications they may have been taking prior to hospital admittance.
- Drug Utilization Review and Identification of Gaps in Care
These services, often provided by pharmacists, involve assessment of medication appropriateness and identification of possible patient safety issues. Pharmacists may also identify gaps in care, such as heart attack patients who are not prescribed a daily aspirin.
- Prescription Drug Adherence
These services, which often involve pharmacists, comprise efforts to identify patients which are not adherent to their medication regimen and working with those patients to identify ways to improve their adherence. Positive adherence rates are often tied to improved outcomes.
As more organizations realize benefits from more robust integration of pharmacists into patient care, programs involving pharmacists will become an increasingly common approach to improving outcomes and reducing the total cost of care.