Improving Patient Safety Using an Electronic Drug Safety Alert Program: Addressing Gaps Identified in AMGA/Premier/NPC’s Initial Readiness Assessment

When the American Medical Group Association, Premier Inc., and NPC fielded a readiness assessment examining accountable care organizations’ (ACO) capabilities to support, monitor and assure appropriate medication use, the three organizations also recognized the importance of sharing real-life examples of how ACOs are tackling these tough issues. In one real-life example published in this month’s edition of the Journal of Managed Care and Specialty Pharmacy, the Marshfield Clinic describes how it manages medication use through an innovative Drug Safety Alert Program (DSAP). 

The study, “Best Practices: An Electronic Drug Alert Program to Improve Patient Safety in an Accountable Care Environment,” was written by the Marshfield Clinic and NPC and outlines what Marshfield learned in creating and managing its DSAP.

Different health care providers within an accountable care organization (ACO) may be responsible for managing the care of the same patients, making the dissemination of safety information a critical concern. Marshfield Clinic addressed this concern through its DSAP, which provides clinicians with up-to-date, clinically meaningful information to prevent drug contraindications, polypharmacy issues, and dosing errors based upon safety information received from the Food and Drug Administration and biopharmaceutical manufacturers.

In the study, Marshfield Clinic described what it learned in creating the DSAP and identified several factors for consideration in the development and ultimate success of an electronic drug safety alert program within an ACO. In particular, it recognized the importance of utilizing the real-time information found in electronic health records, avoiding “alert fatigue” caused by sending an overabundance of alerts and flagging medication issues that are tied to the ACO quality measures the Clinic is required to meet.

Meeting these quality measures is important for an ACO. As ACOs focus on improving quality, reducing costs and promoting population health, appropriately managing medications and preventing potential adverse events are critical to ensuring that high-quality care is delivered efficiently. In addition, payments made to ACOs are at risk and tied to potential shared savings via specific financial and clinical metrics, the latter in which medications often play a key role.

As a participant in the Centers for Medicare and Medicaid Services’ (CMS) Shared Savings Program, Marshfield Clinic is eligible to share in a percentage of their savings if it meets the quality benchmarks set forth by CMS while also reducing costs. The Marshfield Clinic’s DSAP targets some of the quality measures that CMS is highlighting so there is an added benefit for the accountable care population. It also utilized the DSAP model for quality improvement initiatives, a key aspect of CMS’ Medicare Shared Savings Program.

This case study is the second in a series of studies that will address the gaps identified by the ACO Medication Readiness Assessment. NPC and its partners hope that these real-world examples can be helpful to other ACO organizations seeking to leverage pharmacists and pharmacy services to appropriately manage medications in this new payment and delivery model.