Impact of Pharmacists in ACOs on Patient Outcomes, Costs

Optimal use of pharmaceuticals is often overlooked for accountable care organizations (ACOs), but ensuring proper medication use, efficacy, and safety is critical to an ACO’s success. A study in the December issue of the Journal of Managed Care & Specialty Pharmacy explores the role pharmacists can play.

The investigators studied Fairview Pharmacy Services’ Medication Therapy Management (MTM) program, which utilizes 23 pharmacists who focus on patients in a comprehensive manner and assess all of their diseases and medications.

“The lessons learned through our medication therapy management program can assist other organizations in improving patient outcomes while reducing costs,” Amanda Brummel, PharmD, BCACP, director of clinical ambulatory pharmacy services at Fairview Pharmacy Services and a study author, said in a statement. “Every ACO is unique, but this case study suggests key components that can be modified and adapted for MTM programs, depending on the needs of an ACO.”

Fairview is a Pioneer ACO and its pharmacists have seen over 670 patients and resolved more than 2780 medication-related problems, according to the study. The data show that the proportion of optimally managed diabetes patients was significantly higher for MTM patients. Furthermore, the Fairview MTM showed a 12 to 1 return on investment when comparing the overall health costs of MTM patients with patients who did not receive MTM services.

“This study reinforces previous findings that optimizing the use of pharmaceuticals in an ACO is critical to its effectiveness in reducing costs and improving the patient’s experience,” NPC Executive Vice President and Chief Science Officer Robert W. Dubois, MD, PhD, who is a study co-author, said.

Although the Fairview MTM program requires a substantial budget—it employs 18 full-time equivalent pharmacists—the investment can be justified since MTM programs reduce hospitalizations by targeting discharged patients, thus avoiding financial penalties associated with 30-day readmissions.

The authors concluded that developing an MTM program will be a foundation for managing the health of a population. However, the ACO needs to correctly identify which patients are candidates for MTM services, as well as provide pharmacists with enough autonomy to ensure timely and effective care is delivered. While the pharmacist is able to modify prescriptions, the referring physician needs to be notified quickly and efficiently of changes.

“In order for an ACO to deliver high quality patient-centered medication services, there must be clear lines of communication between providers, pharmacists, and the other care providers within the organization,” the authors wrote.