Magazine article Drug Topics

Pharmacist-Driven MTM Could Save ACOs a Bundle

Magazine article Drug Topics

Pharmacist-Driven MTM Could Save ACOs a Bundle

Article excerpt

Atypical accountable care organization (ACO) with 10,000 Medicare beneficiaries might save up to $1.1 million annually in emergency room and hospitalization costs by improving medication adherence for patients with diabetes, according to Health Affairs. The shift toward accountable care is opening the door to greater reference to pharmacist expertise.

More than 250 organizations have contracted with the Centers for Medicare and Medicaid Services (CMS) under an ACO model for Medicare beneficiaries, and the private market is keeping up a similar pace in accountable care contracts.

With their unique roles, pharmacists are moving away from being only drug dispensers to becoming consultants and medication managers in the coordinated care environment of ACOs. The role is already accepted in the Medicare space under the Medication Therapy Management (MTM) program.

Emerging role

Edith Rosato, RPh CEO of the Academy of Managed Care Pharmacy, said that pharmacists can document improvements in care and costs information, which benefits ACOs by contributing to measures that earn shared savings. Their emerging role encompasses:

* Fine-tuning risk stratification criteria

* Prioritizing pharmacy services to identify and manage high-risk patients

* Making sure that electronic health records include pharmacist interventions, such as MTM

* Broadening current performance metrics and cost data

AMCP is actively defining quality metrics to be used by MTM programs.

"Managed care pharmacists and insurers will need to reassess their programs and make sure their workforces can be nimble in addressing the planning and coordination that are needed to help ACOs reach their targets," Rosato said.

Although pharmacists by themselves are not designated as eligible ACO participants, the Department of Health and Human Services allows the contracted ACO organizations to use their discretion in including pharmacists as participants in the big picture.

Specifically, only providers billing under Medicare Part A and Part ? can participate direcdy in shared savings; however, the ACOs themselves can choose to award pharmacists a portion of the additional payments received from Medicare.

Integrated models

Transition to an ACO is proving to be less complicated than might be expected for organizations that previously embraced an integrated care model.

Joseph Manganelli, PharmD, MPA, director of pharmacy, Montefiore Care Management Organization in Yonkers, N.Y., the only Pioneer ACO in the state, said that his organization is "fully in the door" of involvement with pharmacists in coordinated care.

Member stratification, Manganelli said, makes it possible for care managers to turn to pharmacists for drug utilization review and for recommendations on optimizing drug therapy. Pharmacy partners have access to data from Montefiore programs that identify high-risk patients and enroll them in intensive care management programs.

In the general risk population for Montefiore's ACO, pharmacists work closely with nurses and other healthcare providers to enroll patients in case- and disease-management programs, conduct drug use evaluation to identify duplications in pharmacotherapy, make recommendations about treatments, and counsel members about proper medication use. The result is fewer admissions and readmissions, Manganelli said.

The organization relies on pharmacists' expertise in the hospital and the discharge environments, Manganelli continued, especially for medication reconciliation and depends as well as on their ability to promote discussion with patients.

Manganelli's primary concern has to do with patient use of outside providers. Medicare beneficiaries assigned to an ACO - assignment is made retrospectively - can choose their providers without regard to either a network or differential cost. Outside physicians probably will not have access to an ACO's electronic health records and can miss historical patient data. …

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