Accountable Care Organizations: Impact on Pharmacy

Abstract

The Patient Protection and Affordable Care Act (PPACA) has considerably transformed the approaches being used to deliver health care in the United States. It was enacted to expand health insurance access, improve funding for health professions education, and reform patient care delivery. The traditional fee-for-service payment system has been criticized for overspending and providing substandard quality of care. The Accountable Care Organization (ACO) was developed as a payment reform mechanism to slow rising health care costs and improve quality. Under this concept, networks of clinicians and hospitals share responsibility for a population of patients and are held accountable for the fi nancial and clinical outcomes. Due to high rates of medication misuse, nonadherence to therapeutic medication regimens, and preventable adverse drug events, pharmacists are in an ideal position to manage drug therapy and reduce health care expenditures; as such, they may be valuable assets to the ACO team. This article discusses the role of the pharmacist in the era of ACOs specifi cally and health care reform globally. It outlines pharmacy-related quality of care measures, medication therapy management (MTM) programs (which may provide the foundation for pharmacist involvement in ACOs), and pharmacist functions in patient-centered medical homes (through which ACO services may be organized). The article concludes with a description of successful ACO models that have incorporated pharmacists into their programs.

Implementation and evaluation of comprehensive medication management in telehealth practices

“…For services delivered within health systems that include acute care hospitals, pharmacists should consider focusing on addressing value‐based purchasing metrics such as reducing readmissions. In the private sector, accountable care organizations (ACOs) have developed similar value‐based payment programs in both acute and ambulatory settings that pharmacists have already linked to their services …”

Pharmacy: An Evolving Profession without the Status

“…ACOs that are able demonstrate the delivery of cost-effective, high-quality care receive incentives based on savings it achieves for the Medicare program [10]. In these models, pharmacists generally work under collaborative practice agreements with physicians to make decisions about medication therapy, and there has been evidence of the pharmacists having an impact on patient outcomes [11].…”

Why do we need pharmacists in pharmacovigilance systems?

“…The role of pharmacists in pharmacovigilance systems is amplified under Affordable Care Act or the current health care reform, because people who otherwise had no insurance, now qualify for insurance; and this could increase the demand for pharmacy services. More pharmacists will be required in delivering health education, including education on drug-drug interaction [ 12 ]. Also, in developing countries, pharmacists have a distinct role in in the health care system since many patients in prefer going to pharmacies for primary care.…”