Congress adopted Accountable Care Organizations (ACO) into the Medicare program as part of an effort to optimize health care delivery by incentivizing Medicare providers to furnish more integrated, better quality, and cost-effective care. Part of ACOs stated purpose is to “encourage investment in infrastructure and redesigned care processes for high quality and efficient service delivery.” So why are ACOs underutilizing pharmacists?
Recently, the Pharmacy Benefit Management Institute (PBMI) released the industry’s first report examining pharmacy trends in ACOs. More than one hundred providers representing 6.5 million enrollees were surveyed.
Pharmacists are critical to the pillars of health care transformation, and are playing an increasingly broader role in health care delivery. They serve as a vital health care delivery channel for services like immunizations and screenings, for information and patient engagement, care coordination, and medication management therapy. Pharmacists can help solve the patchwork of problems and gaps in health care because they are highly trained professionals where patients are – in local communities. There are 67,000 pharmacies in the U.S. and with nearly 90 percent of the population living within five miles of a pharmacy.
A patient with diabetes generally sees her primary care provider three to four times a year and takes only about half of her medications as prescribed. Physicians rarely know whether their patients adhere to their recommendations between visits and have infrequent interactions with even their sickest patients. The same diabetic patient visits her local pharmacy approximately nine times a month. These moments are opportunities to connect with patients and are invaluable in helping with medication adherence, monitoring of progress, and managing of health. ACOs need to capture these moments to achieve the goals of better outcomes and reduced utilization of health care services.
As trusted and accessible community resources, pharmacists are uniquely positioned to drive positive behavioral changes and favorable patient outcomes. A study by University of Iowa researchers found that among minority patients, a collaborative model that included a pharmacist along with a primary care physician led to better blood pressure control when compared with a control group. CVS Health has partnerships with ACOs to identify patients who could benefit from interventions designed to improve medication adherence, reduce gaps in care and help reduce overall pharmacy spend. This enables our ACO partners improve key quality measures for their patients and improve health outcomes.
Without pharmacists as an integrated part of the ACO clinical team, we are missing major opportunities to continue to transform health care for patients.
Langowski is executive vice president for Strategy, Corporate Development, Government Affairs at CVS Health.