As Accountable Care Organizations (ACOs) gain traction among both private and public payers, so do expectations that these networks of health care providers will improve the quality of patient care and reduce overall costs. However, new research shows that ACOs have not yet developed the capabilities they need to leverage optimal medication use to achieve those goals.
The research, conducted in partnership among the American Medical Group Association (AMGA), the National Pharmaceutical Council (NPC), and Premier, Inc. (NASDAQ: PINC), appears in the January 2014 issue of the Journal of Managed Care Pharmacy.
"We've long known that optimal use of medications can be an effective tool in meeting the goals of managing costs and improving quality. We set out to determine whether ACOs are poised to maximize the value of medications to achieve those goals," said NPC Chief Science Officer Robert W. Dubois, MD, PhD, one of the article's authors. "What we found was that ACOs have not yet achieved this integral and critical component of care."
The research team developed an assessment tool, using the National Survey of Accountable Care Organizations as a basis, and received survey responses from 46 ACOs representing a variety of physicians, hospitals, providers and health plans.
Study authors found that ACOs reported high readiness in some areas, but have room for improvement in others. Research showed that the most positive indicators included the ability of ACOs to:
• Transmit prescriptions electronically (70 percent have high readiness in this area) • Integrate medical and pharmacy data into a single database (54 percent) • Offer formularies that encourage generic use when appropriate (50 percent)
However, survey responses show ACOs are just beginning to address several key capabilities, including the ability to: • Notify a physician when a prescription has been filled (9 percent) • Have protocols in place to avoid medication duplication and polypharmacy (17 percent) • Have quality metrics in place for a broad diversity of conditions (22 percent) • Quantify the cost offsets of medication use and demonstrate the value of appropriate medication use (7 percent have high readiness in this area)
"Just as physicians need to consider when medications are appropriate for individual patients, ACOs are under the same imperative to put processes into place that will allow them to use medications to maximize the benefit for all of their patients," said Donald W. Fisher, PhD, CAE, AMGA president and CEO.
The study is part of a broader project supported by NPC, AMGA and Premier to understand the role of pharmaceuticals in helping ACOs achieve their financial and quality goals. In the project's foundational stage, the partners, working in conjunction with a group of ACOs, developed a framework for considering the costs and benefits of medications in various conditions. The results of that effort were published as a web exclusive in the July 2012 issue of the American Journal of Managed Care. Following the readiness assessment and gap identification captured in this current study, additional phases will include the development of practical tools that will help ACOs fill those gaps. To advance the discussion, NPC, AMGA, Premier and the ACO group have begun documenting case studies that will provide ACOs with examples of how certain medication issues have been successfully addressed by ACOs or relevant organizations.
"In general, ACOs have made great strides as models to deliver high-quality, cost-effective care and improve population health. For ACOs to realize their full potential, the various moving parts of healthcare delivery -- primary care, hospital care, home care, chronic condition management and medication use -- will have to be used in concert," said Marv Feldman, RPh, MS, Premier managing principal of pharmacy consulting and senior director of medication management and a contributing author. "This collaboration is making important progress in understanding the unmet needs and resources needed for ACOs to achieve their goals."
- Robert W. Dubois, Marv Feldman, Adam Lustig, Greg Kotzbauer, Jerry Penso, Scott D. Pope, Kimberly D. Westrich. Are ACOs Ready to be Accountable for Medication Use? Journal of Managed Care Pharmacy, January 2014
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