The establishment of accountable care organizations (ACOs) under the Affordable Care Act is seen by many health policy professionals as one of the marquee components of the law. Certainly it is one of the few aspects of the ACA that has bipartisan political support and widespread enthusiasm among multiple stakeholders who are vested in the success of ACOs as a care delivery model for years to come.


Dan Leonard, National Pharmaceutical Council, NPC, accountable care organizations, ACOs, Affordable Care Act, ACA, pharmacy retailer, chain pharmcy, pharmacist, American Medical Group Association, AMGA, Premier Inc.


































































































































































































































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Inside This Issue - Opinion

Challenges for ACOs mean opportunities for pharmacies

April 28th, 2014
by Dan Leonard

The establishment of accountable care organizations (ACOs) under the Affordable Care Act is seen by many health policy professionals as one of the marquee components of the law. Certainly it is one of the few aspects of the ACA that has bipartisan political support and widespread enthusiasm among multiple stakeholders who are vested in the success of ACOs as a care delivery model for years to come.

Hundreds of ACOs of all sizes have been launched in the private sector market. Within the Medicare program, more than 360 ACOs have been established, serving more than 5 million beneficiaries. It is the dual aim of quality improvement and gains in efficiency that is driving the government, as well as the private sector, toward this rapid embrace of ACOs.

While the growth in the number of ACOs in this country has been brisk and impressive, has the performance of these early adopters kept up with the expectations? There are numerous factors that all need to come together in the construction of a successful ACO — from information technology issues to building physician networks, risk evaluation, and how to share in savings and meet quality benchmarks, to name a few.

Recently, the National Pharmaceutical Council (NPC) and its partners, the American Medical Group Association (AMGA) and Premier Inc., joined forces to examine how ACOs are meeting their marks when it comes to their management of pharmaceuticals — a critical component of total care delivery and a central piece in a successful ACO.

Specifically, our three organizations asked 46 ACOs to conduct a self-assessment to better understand how they are doing with regard to the fundamental questions around whether they are maximizing the value of pharmaceuticals in patient care.

The survey results, which were published in the peer-reviewed Journal of Managed Care Pharmacy in January 2014, were mixed. We found that ACOs are doing pretty well in some activities, but in other areas there is significant room for ­improvement.

At the top of the list was the ACOs’ ability to transmit prescription data electronically to pharmacies, which 70% of the survey respondents said they are well prepared to do. Next, but well down the list, was the ability to view pharmaceutical and medical data in one system. Fewer than half of the ACOs reported the capability to identify potential drug interactions or to provide visit summaries listing all medications, potential adverse reactions and clear directions for medication use. What do all of these functions have in common? They are all best practices of pharmacy-provider interactions enabled by robust IT platforms that in many instances have been developed or enabled through partnerships originating within the pharmacy environment.

The gaps in readiness to provide ideal pharmacy care are even more pronounced in other areas. For example, only 9% of ACOs surveyed said they can notify doctors when a prescription has been picked up at the pharmacy. Eleven percent of ACOs fully educate patients about therapeutic alternatives during development of a care plan. Only 13% of ACOs have protocols to facilitate sharing of potential drug-drug interaction or polypharmacy issues across a patient’s care team. Just 17% have complete protocols in place to avoid duplicate medications. Less than a quarter have clinical pharmacists directly involved in patient care, and only 20% can notify doctors on a patient’s care team when a new prescription has been written.

Again, the common denominator to most of these metrics is engagement between the clinical practitioners within the ACO and the pharmacy and pharmacist on a patient’s care team. Is there a silver lining for the pharmacy sector in these low readiness numbers? The answer is yes — particularly for innovative pharmacy retailers, IT solutions providers and pharmacists.

Our coalition of NPC, AMGA and Premier has been looking at the issues surrounding pharmacy care in the ACO environment for the past three years. However, we have primarily been looking from the ACOs’ perspective. If we turn the microscope around and look at it from the perspective of the pharmacy, a number of these shortcomings begin to look like ­opportunities.

A separate 2012 survey sponsored by AMGA found that 59% of its members in the ACO business indicated that they would participate in an accountable care business venture. Typically those ventures cited partnerships with health plans, hospitals, group practices or “others.” Innovative pharmacy retailers and IT solutions providers should look at statistics like this and see the handwriting on the wall.

ACOs are looking for partners to help them develop end-to-end solutions that more closely integrate clinical and pharmacy care as well as tracking and alert notifications, streamline communications between care teams, and increase patient medication adherence, which all lead to increased quality of patient care.

Technology is the key driver and “one of the most important components of what we do,” Charles Kennedy, chief executive officer of Aetna’s Accountable Care Solutions, explained in an interview with FierceHealthPayer. It is a “foundational requirement for ACOs, because providers need to be able to exchange, analyze and act on patients’ clinical and claims information.” In many cases, the chain pharmacy retailer can be the key driver enabling the IT solutions to the ACO.

Getting to the place where the technical reality can meet the vision of the ACO ideal may come down to some fundamental technology infrastructure changes. As Tom Menighan, executive vice president and CEO of the American Pharmacists Association, explained, “It is absolutely critical for managed care organizations to extend data and incentives to pharmacists who see patients every day.”

One key component that needs to be addressed, he said, is that most electronic health record systems and pharmacy management systems are built on two different platforms. “Typically, these two platforms do not communicate easily, so pharmacists delivering patient care in the community setting do not have access to complete patient information.

This lack of information hampers effective comprehensive medication reviews, transitions-of-care medication reconciliation and medication therapy management as tools for optimizing medication use on an ongoing basis by pharmacists who maintain relationships with patients who trust them.”

Pharmacists also can play a key role in an ACO’s success through an expanded role in advising prescribers of the relative effectiveness and value of drug treatment options. They can take on greater responsibility for the ongoing management of medication therapy and outcomes measurement. And pharmacists can play a central role in care connectivity by ensuring efficient and consistent pharmacotherapy as patients move through the health care system — in turn helping ACOs achieve better-quality benchmarks and financial targets.

The findings of our ACO readiness assessment bring to life a well-known adage, “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” The relatively low marks that most ACOs are hitting for performance in the medication management arena shouldn’t appear as a wall to our progress, but an opportunity for pharmacy retailers and pharmacy IT solutions providers to step in and play a key role. This is clearly a case where good business and innovative thinking can lead to increased performance by ACOs and, ultimately, better patient care.

DAN LEONARD is president of the National Pharmaceutical Council.

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