From Theory to Practice: Addressing the Gaps of the ACO Medication Readiness Assessment

When the American Medical Group Association, Premier Inc., the Dartmouth Institute and NPC fielded a readiness assessment examining accountable care organizations’ (ACO) capabilities to support, monitor and assure appropriate medication use, it was the authors’ intention to develop a series of real-life examples of how ACOs are tackling these tough issues.

When the American Medical Group Association, Premier Inc., the Dartmouth Institute and NPC fielded a readiness assessment examining accountable care organizations’ (ACO) capabilities to support, monitor and assure appropriate medication use, it was the authors’ intention to develop a series of real-life examples of how ACOs are tackling these tough issues. Published in the December edition of the Journal of Managed Care & Specialty Pharmacy, this article, "Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management," is the first in the series, developed with Fairview Health’s Director of Clinical Ambulatory Pharmacy Services Amanda Brummel, PharmD, BCACP.

Medication therapy management (MTM) is defined by the American Pharmacists Association as a service or group of services that optimize therapeutic outcomes for individual patients and may include medication therapy reviews, pharmacotherapy consults, anticoagulation management and many other clinical services. Previous research has shown that MTM programs can reduce costs, improve patient care and reduce physician burden. This case study highlights the effectiveness of Fairview Health’s MTM program in identifying patients’ drug related needs, assessing and confirming patients’ drug therapy, documenting outcomes, and collaborating with all members of a patient’s care team.

Fairview Health, which has been continually recognized as providing high-quality health care services to the Minneapolis-St. Paul metropolitan area, has operated a successful MTM program since 1998. The program, which utilizes 23 MTM pharmacists working in 30 different clinical sites, has cared for over 20,000 patients and resolved more than 107,000 medication-related issues to date.

In 2012, the Centers for Medicare & Medicaid Services’ (CMS) Center for Medicare & Medicaid Innovation selected 32 organizations to test the impact of different payment arrangements to achieve the goals of providing improved care while reducing costs. Known as the Pioneer ACO model, organizations participating in this model are measured on both quality and financial benchmarks. If organizations are able to meet the quality benchmarks set forth by CMS while also reducing costs, they are able to share in a percentage of their savings with CMS. However, organizations participating in the Pioneer ACO model are also at risk of having to pay back CMS if they are unable to meet these benchmarks.

As one of the 32 initial Pioneer ACOs, Fairview’s MTM program has greatly aided the organization in meeting the financial and quality benchmarks set forth in the rigorous Pioneer ACO model. Previous research conducted by Fairview has shown a 12:1 return on investment when comparing overall health care costs of patients receiving MTM services when matched to patients who did not while also ensuring patients are receiving appropriate drug therapy.

This case study is the first of a series of articles 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 ACOs seeking to leverage pharmacists and pharmacy services in this new payment and delivery model.