Pharmacists can help accountable care organizations (ACOs) both in population health and in direct patient care services, said Susan C. Winckler, BSPharm, JD, Senior Advisor at Leavitt Partners, in a March 12 webinar for APhA members.
In direct patient care services, ACOs may use pharmacists and their medication expertise in care transitions because ACOs are especially focused on quality measures for hospital readmissions, she continued. Other areas of opportunity for pharmacists in ACOs include medication adherence, medication management, and disease state management.
The conventional wisdom on ACOs was that medications wouldn’t have a significant role in ACOs because Medicare ACOs don’t include the Part D drug spend in their financial calculations. But in some Medicaid ACOs and private sector plans, drug spend is included, according to Winckler. And even in ACOs where the drug spend is not included, the conversation is transitioning to “what can we do to improve the outcomes that come from that medication use,” she added.
“We’re now getting to the point where ACOs are paying attention to medication use,” Winckler said. “But know that every ACO is different, and they’re all at some level of maturity in being ready to approach medication use.”
The nation is now at 621 ACOs, including 344 Medicare Shared Savings Program ACOs, 23 Pioneer ACOs, and 34 Medicaid ACOs, according to Winckler. An ACO is a common way to help implement the transition from fee for service to value-based purchasing—in other words, from volume-based to value-based payment. “This is an emerging reality,” she said. “It’s by no means greatly influencing care delivery today. But it certainly is something that will influence [the future].”
Key differences between accountable care and managed care include a more robust health information technology (HIT) environment for better collaboration across the health care continuum, a better understanding of the need for preventive efforts, the use of quality metrics, and the fact that Medicare is a driver in promoting ACOs.
“Pharmacists have an opportunity to own medication use,” Winckler said. “In an environment where everyone wants to practice at the top of their license, that means physicians recognize they can’t do everything but rather what they’re ideally positioned to do—so they will collaborate with other health care providers.”
Pharmacists who want to work with an ACO should learn about the ACO market in their local area and how it is structured (e.g., hospital led, physician led, insurer led). Pharmacists should open the conversation with ACO leaders not with how pharmacists can save money on the drug spend, but rather with how pharmacists can help the ACO to “get the most of that investment made in medications” through improvements in outcomes, quality metrics, readmission rates, and medication use.
Currently, most ACOs are engaging pharmacists by hiring them into their system, although it is anticipated that, in the future, ACOs will contract with pharmacists in the community, perhaps as part of a pharmacy network.
One audience question was: “How do I find out more about if there’s an ACO in my community, and where do I go for this information?” Winckler responded that Medicare and Medicaid ACO locations were publicly available. Some ACOs are on the ACA health insurance marketplaces. “So check out the insurance exchange sites,” she said. “If there are three big health care players in your town, go to their websites and check for ‘ACO.’ Those doing it are promoting it.”
Much of the content from Winckler’s presentation can be read in a series of eight ACO briefs being published on pharmacist.com (see page 62 for more information). The first ACO brief is open access. The rest are for APhA members only. In related news, this month Leavitt Partners released a white paper, Optimized Medication Use: A Growing Priority for ACOs. The white paper, targeted to ACO decision makers, provides insights into the state of medication use strategies among early ACO adopters. On March 10, APhA collaborated with the National Alliance of State Pharmacy Associations to host a webinar for state pharmacy association executives on Medicaid ACOs and the role of pharmacists.