Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

The Benefits and Challenges to Medication Therapy Management

By Ryan Mcaskill

This is part two of an interview about the impact of medication therapy management on ACOs and coordinated care.

- Yesterday, we posted part one of an interview with Robert Dubois, MD, PhD and National Pharmaceutical Council (NPC) Executive Vice President and Chief Science Officer, and Amanda Brummel, PharmD, BCACP, Director of Clinical Ambulatory Pharmacy Services at Fairview Pharmacy Services. The topic of conversation was a series of new case studies that the NPC and a work group is a part of that focuses on the use of comprehensive medication therapy management within ACOs as a way to save money and improve care.

Previously, Dubois and Brummel spoke about how the case studies came to be and what they hope organizations will get out of it. But what are the major benefits of a medication management solution and why should hospitals and ACOs be paying attention to it?

According to Brummel, there are a lot of different ways to use comprehensive medication therapy management. However, at its core, organizations are doing some version of the same thing.

“It’s really looking at how do pharmacy intersect and play across populations and interact with the care team and provide help to population management,” Brummel said. “If you are applying a comprehensive medication management model you are going to be looking at those high risk patients and and working to improve their quality or lessening readmissions.”

She added that it starts by looking at quality metrics and total cost of care measures. Every ACO is going to be a little bit different and knowing the “sweet spot” is critical to truly take advantage of the savings that are possible.

READ MORE: NAACOS: Mandatory Bundled Payments Impede ACO Financial Success

She did stress that doing this kind of cost analysis can be difficult.

“Cost is always a challenge and a hard analysis to do, I’ll be honest,” Brummel said. “Since we are not our own healthplan, we had the data already to look at and were able to look at a population and see the impact. The challenge is to attribute that to any one specific thing, in this case comprehensive medication therapy management.”

The reality is that setting up a control test is not always easy to determine this because of the number of other variables. Brummel said that at Fairview they look at the patients that have had the intervention and those that haven’t and try to let the rest of the background variables remain the same. Then you factor in clinical and economic outcomes. These will also vary from location to location, depending on if pharmacists are billing directly for services or not.

“In the Medicare ACO space, for a true Comprehensive Medication Therapy Management that would be billed through a part D, and so there could be some dollars there,” Brummel said. “But really what it comes down to is that high risk population looking to decrease hospital visits, decrease emergency department visits, decrease readmissions. That is where the real financial bang is going to come in.”

Why does medication management fit within an ACO?

Some of the main aspects of an ACO is the coordinated care effort and medication management is a tool to help accomplish that. Not every patient is going to require this kind of system, but those that do could experience significant benefits.

“In the triangle, it is looking at your highest risk patients and the benefits that you are providing by having the services is that whole person approach,” Brummel said. “It’s where most of those patients have multiple conditions, multiple providers that are providing the care, multiple medications that they are taking and this is one person looking at all of that and working as part of a team, making sure that patient has a solid plan of care.”

Dubois added that this all goes back to the opening framework that was created.

“What does success look like for an ACO? Well you have a happy bunch of patients, a happy bunch of doctors and you achieve the success factors that those looking at you want to see,” Dubois said.

He added that there are constrained costs, so this system will allow for savings. In the end, Medications are a cost and are highly leveraged in certain circumstances. However, in certain circumstances, they can keep people out of the hospital.

“One of the reasons people end up back in the hospital is their medications are a mess to follow or they are taking two of the same thing or the doses are not right or they do not know how to follow their symptoms to know when to call the doctor,” Dubois said. “A huge part of medicine is medicine, so success financially and keeping people out of the hospital is going to be affected greatly by medication management.”

He also spoke about the 32 quality measures that were used to create the program. Medication can be a big part of improving health. Diabetes, for example, is not going to get better with exercise alone, it requires medication.

Ultimately, the role of the pharmacists is changing from a secondary role to being a key part of the decision making process.

“I think people are realizing that central to success are drugs and central to the success of medications are pharmacists,” Dubois said.

What does the future hold?

This type of thinking has already spread across the healthcare landscape. Brummel mentioned that she speaks around the country upto 10 times a year about medication management, and there is always interest. This shows that there is already high demand for these kinds of systems and integrating pharmacists into the care team.

“I’m hearing more and more about how ACOs are working with the pharmacy and have incorporated pharmacists,” Brummel said. “Some of this is the shift. When you are a hospital organization that has utilized pharmacists for years, now some of those are turning into ACOs and many of them are partnering with primary care. It’s just a new way of thinking about how you use pharmacists. I continue to get questions about this but it is clear that the movement will continue to grow.”

Dubois added that there are three main challenges that need to be handled in order for this strategy to truly take off. The first is changing how pharmacists are thought of and what they are able to do. In some cases this is just old thinking taking hold, in others its regulations that limit what a pharmacist is able to do.

The second issue is cost. Pharmacists and these programs do cost money.However, they can also help boost revenue. In some cases, pharmacists can directly impact revenue by billing for these services. They will also impact them indirectly by lowering readmissions and improving the health of patients.

The final hurdle is IT. While there may be portal forms for doctors, nurses and administration that are coordinated to help with overall health, there are not so many options for pharmacists. This requires ACOs to work closely with an IT company of vendor to create a portal that can will allow pharmacists to do everything they need to do.

“If you could wave a magic wand and pharmacists got paid and everyone was happy to have pharmacists more deeply involved and the IT systems were there, I think it would be much easier to roll out,” Dubois said.

The goal of these case studies is to help enact change when it comes to pharmacists and overall health and helping ACOs understand the importance that this aspect of healthcare plays.

“We wanted to look and say, why have everyone reinvent the wheel, why don’t we look at everyone’s best practices that are already out and be able to put those out there and not just say, here this is it, but put them out there with some practical tools to go with them, so it can be more actionable,” Brummel said.



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