November 15, 2016
Has your pharmacy considered partnering with an Accountable Care Organization (ACO)?
The Centers for Medicare & Medicaid Services (CMS) defines ACOs as “groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients.”
The formation of ACOs under Medicare was a provision of the Affordable Care Act (ACA). The ideas behind ACOs was to reduce health care costs and focus payments on quality. ACOs strive to improve care and control costs based on financial incentives.
An ACO’s payment depends on whether it achieves health care quality goals and outcomes, and if those outcomes result in cost savings. Essentially, providers will make more money if they keep their patients healthy and out of the hospital.
Many ACOs are comprised of health systems, hospitals and physician groups, but they’re increasingly contracting with complementary providers to help them achieve comprehensive coordinated care.
Pharmacies are an ideal partner for these organizations. They are valuable assets in crucial areas, such as medication adherence, preventative care and other clinical services that affect quality of care and patient outcomes.
Here’s a look at how pharmacists can partner with—and provide value to—ACOs.
Partnerships between pharmacies and ACOs could have a significant affect in key areas, such as hospital readmissions and patient care and satisfaction.
Many independent community pharmacies provide medication therapy management (MTM) programs that include conducting comprehensive medication reviews and medication reconciliation. These programs ensure patients take all the correct medications for their conditions, adhere to their regimens and avoid drug interactions.
When patients are safely taking the right medications and adhering to their regimens, their conditions are less likely to escalate, keeping them out of the hospital. Less readmissions means healthier patients, more savings for the health care system and a bigger payoff for the ACO.
Additionally, pharmacists can assist in providing patients with smooth transitions of care from the hospital to their homes. Transitions of care affect a patient’s overall health care experience and perception of care, which is another area of financial incentive for ACOs.
Not only can independent pharmacies offer transitional patients MTM programs, they can also provide additional education and a personal touch that patients can’t get anywhere else. The relationships independent pharmacists form with their patients play a significant role in improving quality of care and the patient experience.
For example, an independent pharmacist can provide a transitional patient and his caregiver with in-depth information, product recommendations and other resources specific to his condition—in addition to his prescription medications. And, they can counsel patients on how to better live with their conditions at home.
So, what are ACOs looking for in a pharmacy partner?
Leavitt Partners, a firm that provides health care consulting services, released a brief Oct. 11 that provides guidance for leaders on what they should consider when assessing a potential pharmacy partner.
According to the brief, ACOs need to “determine what combination of retail versus clinical pharmacy resources will have the greatest impact on their population.” It also notes that local pharmacies may be especially attractive partners due to the flexibility in their operating strategy.
The report lists various characteristics ACOs should look for in a pharmacy partner, along with corresponding questions for them to consider.
A few characteristics listed in the report include:
Before contracting with an ACO, independent pharmacies need to focus on a few areas.
It may seem obvious, but you need to have expertise in MTM and other clinical services. An ACO needs to view your pharmacy as a community-based clinical resource, and one that can provide services other members of the organization can’t. If you can’t successfully provide these services, you won’t be a valuable partner to an ACO.
It’s important that ACOs view you as a partner, and that you’re able to work efficiently with them. These organizations are taking on the medical and financial responsibilities of providing care to a patient population, so they need to see the value proposition in adding you to their team.
You also need to show your willingness to coordinate with ACOs in order to achieve goals. This may mean integrating technologies to allow for information sharing, adding new services and capabilities, and being comfortable forming new relationships.
Considering partnering with an ACO? Make sure your pharmacy is offering the most in-demand patient care services.