Currently Viewing:
The American Journal of Accountable Care June 2018
Amazing Grace: A Free Clinic's Transformation to the Patient-Centered Medical Home Model
Jason Alexander, BS, PCMH CCE; Jordon Schagrin, MHCI, PCMH CCE; Scott Langdon, BA; Meghan Hufstader Gabriel, PhD; Kendall Cortelyou-Ward, PhD; Kourtney Nieves, PhD; Lauren Thawley, MSHSA; and Vincent Pereira, MHA, PCMH CCE
Lessons Learned in Implementing Behavioral Screening and Intervention
Richard L. Brown, MD, MPH
The Intersection of Health and Social Services: How to Leverage Community Partnerships to Deliver Whole-Person Care
Taylor Justice, MBA, President of Unite Us
Case Study: Encouraging Patients to Schedule Annual Physicals
Nicholas Ma
Currently Reading
Effects of an Integrated Medication Therapy Management Program in a Pioneer ACO
William R. Doucette, PhD; Yiran Zhang, PhD, BSPharm; Jane F. Pendergast, PhD; and John Witt, BS
Utilizing Community Resources, New Payment Models, Technology to Deliver Accountable Care
Laura Joszt, MA
Cost-Effectiveness of Pharmacist Postdischarge Follow-Up to Prevent Medication-Related Admissions
Brennan Spiegel, MD, MSHS; Rita Shane, PharmD; Katherine Palmer, PharmD; and Duong Donna Luong, PharmD

Effects of an Integrated Medication Therapy Management Program in a Pioneer ACO

William R. Doucette, PhD; Yiran Zhang, PhD, BSPharm; Jane F. Pendergast, PhD; and John Witt, BS
This article reports that an integrated medication management program in a Pioneer Accountable Care Organization was associated with decreases in all-cause hospitalization and Medicare costs.
ABSTRACT

Objectives: The objectives of this study were to: (1) assess the effects of an integrated medication therapy management (MTM) program for accountable care organization (ACO) patients on all-cause hospitalization rates, (2) evaluate the impact on 30-day hospital readmission rates for the ACO patients, and (3) assess the effect of an integrated MTM program on per capita Medicare parts A, B, and D costs for ACO patients.

Study Design: A quasi-experimental nonequivalent design compared utilization and costs for ACO patients in an MTM program with those of patients in a Medicare Shared Savings Program (MSSP) but not an MTM program.

Methods: The integrated medication management program linked a network of community pharmacies with ACO practitioners. Analyses included Medicare parts A and B claims data from January 1, 2013, through December 31, 2014, with a 9.5-month baseline period and a 14.5-month intervention period. The outcome variables were all-cause hospitalization rate (per 30 days), 30-day hospital readmission rate (per 100 discharges), and average monthly per capita costs for Medicare parts A and B. Longitudinal analyses (generalized estimating equations) were used to compare across groups and over time, controlling for age, gender, and race.

Results: Data comparing 885 ACO patients with 642 MSSP patients showed significant decreases in hospitalization rates and Medicare costs over time, but no significant differences across the groups. No significant decreases were found in 30-day readmission rates.

Conclusions: An integrated medication management program was associated with lower hospitalization rates and costs of care over time, although these reductions were not significantly different from decreases found in a comparison MSSP group.

The American Journal of Accountable Care. 2018;6(2):20-25
Accountable care organizations (ACOs) have been stimulated by the Affordable Care Act, which prompted CMS to utilize ACOs to reform Medicare payments.1-3 Although ACO performance measures include quality and cost indicators, another important area that can affect the performance of an ACO is medication therapy, which is commonly used to manage chronic conditions. Whereas safe and effective medication therapy can keep patients out of the hospital and help control total healthcare costs,4 unsafe medication use, medication nonadherence, and drug-related problems can lead to adverse drug events and associated increased healthcare utilization, such as emergency department and other hospital use.5 Many of the ACO performance metrics used by CMS directly involve specific medication therapy or the control of conditions through the use of medications.6

Some ACOs are employing pharmacists on care teams to address various medication-related issues, including reconciling medications at the time of hospital admission and discharge, helping to manage patients on high-risk medications, and serving on advanced care teams.7-9 Similarly, Medicare Part D plans provide required medication therapy management (MTM) programs to eligible beneficiaries, with such services often being delivered by community pharmacists.10 Community pharmacists are well positioned to deliver these services to help ACOs extend access to care for their patients. However, little has been published about engaging a network of community pharmacies in this manner and how such a network may contribute to the performance of an ACO. The purpose of this study was to implement and evaluate an integrated MTM program in a Pioneer ACO.

Specific objectives of this study were to: (1) assess the effects of an integrated MTM program for ACO patients on all-cause hospitalization rates, (2) evaluate the impact on 30-day hospital readmission rates for the ACO patients, and (3) assess the effect of an integrated MTM program on per capita Medicare parts A, B, and D costs for ACO patients.

METHODS

Trinity Pioneer ACO, part of UnityPoint Health, is centered in Fort Dodge, Iowa, and serves about 10,000 rural patients primarily through Trinity Regional Medical Center and UnityPoint Clinics. Trinity Pioneer ACO provides numerous services to coordinate care and improve its patients’ health outcomes, including a high-risk medical care team, integrated chronic care disease management, care at home following hospital discharge, and wound care and palliative care coordinated with long-term care facilities. In addition, a network of community pharmacies and an MTM program coordinator, OutcomesMTM, participated in the intervention arm of the study.

The service area of Trinity Pioneer ACO consists of 8 rural counties served by 32 community pharmacies. At the start of the study, 25 of these pharmacies agreed to participate in the MTM program and completed training in delivering and documenting MTM services on the OutcomesMTM platform. OutcomesMTM has extensive experience with coordinating community pharmacy networks to deliver MTM services, especially for Medicare Part D beneficiaries. Their online MTM platform was used to coordinate the MTM process among the ACO and the community pharmacy providers. The Human Subjects Office of the University of Iowa approved this study.

Randomization of patients, providers, or pharmacists to intervention and control groups was not feasible in this setting because providers and pharmacists were likely to provide services to many ACO members in their geographic region. If the intervention appeared to be useful to some, the risk of contamination, or “bleeding,” of the intervention into a randomized control group was substantial. Thus, a comparison group was chosen to be very similar on key factors but in a nonoverlapping geographic region (ie, in a quasi-experimental nonequivalent groups design).

The comparison group was a rural Medicare Shared Savings Program (MSSP), also part of UnityPoint Health. Although the MSSP group did not have a specific MTM program, its coordinated care programs included patient-centered medical home models, an advanced medical care team, a long-term care team to improve transitions between hospitals and long-term care facilities, and the use of pharmacists to conduct medication reconciliation with patients prior to hospital discharge. The Trinity Pioneer ACO began its care coordination programs about a year ahead of the MSSP group, which may have given the groups different baseline levels on some of the outcome variables. We attempted to adjust for such differences with our use of longitudinal analyses by comparing the magnitudes of change between the study groups.


 
Copyright AJMC 2006-2019 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up