Are ACOs Optimizing Medication Use?

Journal of Managed Care & Specialty Pharmacy (JMCP)

This past year, the global COVID-19 pandemic inflicted an unprecedented strain on the U.S. health system’s clinical and financial resources. As a result, it’s now more important than ever to use care delivery and payment structures that maximize the value of each health care dollar spent. Value-based payment models, such as Accountable Care Organizations (ACOs), offer an opportunity to improve patient care while containing costs.

However, an essential factor in achieving improvements in patient outcomes and reducing unnecessary spending is optimizing medication use among ACO enrollees. Medications play a vital role in helping patients manage their health, particularly for those with chronic illnesses; ensuring patients get the medicines they need can help ACOs achieve improved patient outcomes and meet the cost and quality benchmarks for which they are accountable. 

In a recent Contemporary Reflection article published in the November issue of the Journal of Managed Care & Specialty Pharmacy (JMCP), National Pharmaceutical Council (NPC) Vice President of Health Services Research Kimberly Westrich and Consultant and former Research Manager Lisabeth Buelt revisit a 2014 NPC study published in JMCP that surveyed ACO readiness to optimize medication use. The Reflection article summarizes changes to the ACO policy landscape, evaluates the progress made in three areas of limited readiness found in the 2014 survey, and identifies opportunities for future medication optimization in ACOs. 

According to a follow-up survey published in 2017, ACOs have made substantial progress in communicating and managing adverse events as well as in engaging patients when creating a medication care plan since 2014. That survey also noted some improvement in capturing patient-reported outcomes (PROs); subsequent NPC research identified that additional research in this area is needed. 

NPC’s 2014 readiness survey also identified the need for more sophisticated quality measures to evaluate the effect of appropriate medication use. As ACOs gain traction with public and private payers, this need becomes even more pressing. To help identify and address gaps in accountable care measures, NPC has partnered with Discern Health and other organizations on several research projects that advance the field of quality measurement and improve capabilities for medication optimization in accountable care. 

Looking ahead, there are several opportunities to improve medication use in accountable care. Earlier this year, NPC sponsored the Accountable Care Learning Collaborative’s Committee on Medication Optimization. The Committee developed helpful new resources, including a Case Study Brief and a Competency Orientation Guide, which summarize key strategies successful ACOs have employed to optimize medication use and improve care delivery.
As we navigate a changing health care environment, it’s critical that we maximize efficiency in both care delivery and health care spending. Because medications are a substantial source of value generation for the U.S. health system, optimizing medication use in ACOs can promote success in maximizing efficiency in both of these critical areas.