Authors: Schoenhaus, R; Lustig, A; Rivas, S; Monrreal, V; Westrich, KD; Dubois, RW.
Publication: Journal of Managed Care & Specialty Pharmacy. March 2016
Accountable care organizations (ACOs) will increasingly be reimbursed for achieving clinical and financial benchmarks. Accordingly, refining processes in order to improve quality and reduce costs is key. An important factor in meeting these benchmarks is an ACO’s ability to optimize medication use.
This case study highlights the critical components of Sharp Rees-Stealy Medical Group's electronic medication refill system that allows for a centralized team to manage all incoming prescription requests. The case study demonstrates how pharmacists can help offset primary care providers' (PCPs) workload, as PCPs take on additional population health management tasks in ACOs.
Even within fully integrated health care systems, PCPs often lack support for medication management. Because challenges with conducting medication reconciliation, improving adherence, and achieving optimal patient outcomes continue to be prevalent, Sharp Rees-Stealy Medical Group provided PCPs with the resources and support they need to provide high-quality, patient-centered care in an accountable care environment.
Over time, 16 disease-specific protocols were created that allowed the pharmacy team to absorb approximately 80 percent of incoming refill requests for all enrolled PCPs. The refill clinic assessed all clinic information that a PCP would normally review in order to approve a refill. In 2014, PCPs estimated that this service provides between 20 and 30 minutes of time savings per day.
This study is part of a broader project supported by the National Pharmaceutical Council, the American Medical Group Association and Premier, Inc. to understand the role of biopharmaceuticals 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 for various conditions. The partners also are exploring other best practices, such as medication therapy management, an electronic drug alert system, physician leadership in a team-based care environment, and collaborative opportunities between the biopharmaceutical industry and ACOs.