Creating Value in Accountable Care Organizations

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Optimizing medicines use is obviously among the most important responsibilities for pharmacists. There is much discussion and even policy initiatives around optimizing medication use, but doing so still represents a vastly unmet need for millions of Americans. Optimizing medication use is not under the sole auspices of the pharmacist. It is a problem being confronted by a large number of health professionals and by government and private health plan sponsors. Previous Tips have described the concept of patient-centered medical homes. While some might argue there are subtle differences, accountable care organizations (ACOs) represent a similar concept regarding the integration of multiple providers to take accountability and get reimbursed on a capitated basis and/or be incentivized through various pay-for-performance initiatives.

Wilks et al examined medication optimization in ACOs.1 They also identified any association between efforts to do so with various financial and quality metrics, along with organizational factors and barriers to optimized medication use. They employed a survey composed of 38 capabilities across 6 functional domains related to optimizing medication use. Data acquired from 49 ACOs suggested relatively good and relatively low ability to manage quality and costs, respectively. Three ACOs achieved a medication purchases inventory (MPI) score of 8 or higher on a 10-point scale, 45 scored between 4 and 7.9, and 1 scored between 0 and 3.9. The study did not identify a relationship between MPI scores and achievement on financial or quality benchmarks, ACO provider type, member volume, or date of ACO creation. Barriers to optimizing medication use were related to lack of reimbursement for pharmacist integration, lack of health information technology interoperability, lack of data, feasibility issues, and physician buy-in. The data were compared with a prior study and showed that more ACOs are involving pharmacists directly in care, expanding the use of generics, electronically transmitting prescriptions, identifying gaps in care and potential adverse events, and educating patients on therapeutic alternatives. ACO-level policies that facilitate practices to optimize medication use are needed. Integrating pharmacists into care may improve these practices.

Pharmacists are gaining increasing recognition for their ability to help control drug spend while still upholding quality in medication use. ACOs and other emerging practice paradigms might be the perfect venue for pharmacists to continue demonstrating their value. Pharmacy managers should consider clinical and financial arrangements to participate in ventures that could bear some risk but also provide substantial opportunity for monetary reward, career development, and advancing the profession.

Additional information about Creating and Managing Value and Ensuring Quality in Pharmacy Operations can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Wilks C, Crisle E, Westrich K, et al. Optimizing of medication use at accountable care organizations. J Manag Care Spec Pharm. 2017;23:1054-1064.

Go to the profile of Shane Desselle

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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