Many accountable care organizations (ACOs) are wrestling with challenges related to health information technology integration and the effectiveness of health IT support tools, according to a study by the Pharmacy Benefit Management Institute.
The survey found that clinical integration varies as less than a third of ACO providers use a single electronic health record (EHR) system, while 59 percent use multiple EHR systems. In fact, 23 percent of ACO providers are still using paper charts. The study found that 26 percent of ACO providers are connected through an internal health information exchange (HIE) and 28 percent use a population health management system on the same platform as their EMR.
PBMI surveyed 101 ACO providers, who cover over 6.5 million patients, specifically to analyze current practices in pharmacy management, the use of pharmacists in ACOs, the state of care management and patient engagement, clinical integration and future goals. Of the respondents, 88 percent are Medicare ACO models, 17 percent are Medicaid and half are commercial ACO models.
“Moving toward a population health mindset while still individualizing care for each patient creates challenges for providers. Prescription drug therapy is an important tool in this quest and the role of pharmacy management is likely to only increase in importance as the ACO model evolves,” the report authors wrote.
According to the report, pharmacy management and the ways that providers have implemented pharmacy management into patient care in an ACO setting have been understudied.
The study found that most ACO providers use support tools with 90 percent utilizing quality reporting tools and 60 percent using point of care decision tools, however, only 34 percent find the support tools easy to use. And, 44 percent of respondents reported that point of care decision tools were only “somewhat effective” and only 60 percent reported that quality reporting tools were “effective” or “very effective.”
“ACOs represent a critical and growing part of the solution to help improve value, quality, and care in our nation’s health care and pharmacy plays an important role in achieving those goals,” Jane Lutz, executive director of PBMI, said. “Our new ACO report looks specifically at valuable information regarding contract and financial incentive structures, current practices in pharmacy management, and plans for the future.”
Almost all ACOs, 93 percent, said managing population is “very or extremely important” and 98 percent believe their focus on population health will increase in the next three to five years.
However, only 57 percent of respondents currently employ or contract with clinical pharmacists.
“Pharmacists are underutilized as trusted advisors to both patients and physicians and other providers. Their patient-facing role can be very powerful in education and motivation, providing a potential solution to the lack of patient engagement and commitment to self-care,” the report authors stated. “Providers who directly employ clinical pharmacists are much more likely to have them engaged in educating patients on the proper use of medication, providing transition of care from hospital to community, and providing medication adherence and reminder programs than providers who contract with clinical pharmacists.
Looking ahead, 56 percent of respondents say ACOs will decrease cost of prescription drug therapy, while 69 percent see them increasing quality of prescription drug therapy. And, two-thirds of ACO respondents believe the use of biologics/specialty products and genomic testing will increase over the next three to five years.
“The availability of actionable information in the clinical and financial domains is helping to create an environment that may lead to achieving the goals of ACOs. Meaningful clinical integration and effective and easy to use clinical support and reporting tools are a necessary part of the solution,” the report authors stated.