An unsigned but thoughtful article on AJMC.com, sponsored by the American Journal of Managed Care, appeared on Oct. 20 under the headline, “The Interface Between Accountable Care and Managed Care Real World Insights and Innovations.” In the article, which reports on a panel discussion held at AMCP Fall 2013 Nexus—the Academy of Managed Pharmacy’s annual conference, held in San Antonio Oct. 15-18—the author notes the following: “Since 2010, the growth and proliferation of accountable care organizations (ACOs) has increased, and the rise of this collaborative care model is not without reason. Lack of consumer engagement, lack of competition, and misaligned incentives have made care less affordable. Underdeveloped quality measures, unusable information, and misaligned incentives have stagnated quality.” But the potential for truly integrated care through ACO-provided care management, the article noted, holds the potential for fundamental change.
The article cites Robert Schoenhaus, PharmD, director of pharmacy benefits administration at Sharp Rees Staley Medical Group (part of the San Diego-based Sharp Healthcare), as noting that it is very important to ensure that pharmacy services under ACO care be as robust as possible. The article notes that “To maximize pharmacy resources to support patients, physicians and staff, professionals should look ‘Path to Primary Pharmaceutical Care.’ The steps for the path,” Schoenhaus indicated, “include: know the model and adapt, build the team plan for savings, build the systems, find the targets, and monitor and report your progress. Through commitment to this process, pharmaceutical stakeholders can leverage medical systems and position themselves for ACO quality improvement and shared savings.” Further, Dr. Schoenhaus told the audience, Pharmacists need to become embedded in the care team.
The AJMC article further goes on to report the comments of Dr. Laura Happe, PharmD, MPH, associate professor of pharmacy at the Presbyterian College School of Pharmacy, who noted that the Danville, Pa.-based Geisinger Health System “utilized case managers to follow up with high-risk patients and phone calls. To reduce their workload,” the article noted, “they implemented an interactive phone system.”
Further, Dr. Happe is quoted as noting that “This interactive voice response system basically replaced the case manager’s time calling the high-risk patients. It would ask the patients certain questions, and if they responded in certain ways, then it would flag them as being at a potential high risk for readmission, and then they would move forward with an intervention. They were able to reach a lot more patients because it reduced the case manager’s time, and so they had a very sustainable reduction of 44 percent in readmissions in 30 days.”
Both of these highlights, from Dr. Schoenhaus and Dr. Happe, speak to an element in accountable care that will be essential for the success of accountable care and population health management, and that is fully integrating pharmacy utilization and medication management into the care management piece of population health management, on a regular, sustained, routine basis, linking patients/plan members with case managers, and further, connecting the case managers with physicians in private practice, and with all other appropriate caregivers, care managers, and with data analysts and senior ACO leaders, across the enterprise.
And of course, that implies a very strong level of interoperability and systems integration—of the electronic health record (EHR), call-center software, interactive voice response (IVR) technology, and ultimately, patient monitoring devices, on one end of the spectrum, and data warehouses and data analytics programs, on the other end. Talk about a heavy lift for CIOs, CMIOs, and all the other healthcare IT leaders in these enterprises!
Furthermore, this discussion that took place at the Academy of Managed Care Pharmacy meeting, reminds me that, truly, every “stakeholder” group will continue to have to be at the table as accountable care organizations are built, as patient-centered medical homes are constructed, as population health management regimens are developed, and as data analytics programs are evolved forward. And that includes pharmacists, case managers, utilization managers, medical informaticists, and that rarest of stakeholder groups—pharmacist informaticists—along with all the other, better-known stakeholders (physicians, nurses, physician and nurse informaticists, medical and nursing senior leaders, IT leaders and programmers, non-clinician administrators, etc., etc.).
Clearly, as the pioneers of the new healthcare are already learning, accountable care and population is not for the weak-willed! I look forward to more insights being brought forward from pharmacist leaders and others, as the new healthcare evolves forward and becomes more and more sophisticated and present across patient care organizations nationwide.