Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management

Authors: Brummel, A; Lustig, A; Westrich, K; Evans, MA; Plank, GS; Penso, J; Dubois, RW. Publication: Journal of Managed Care & Specialty Pharmacy. December 2014.

This case study explores the important role that pharmacists can play in ensuring the optimal use of pharmaceuticals and improving patient outcomes in an accountable care organization (ACO). It describes Fairview Pharmacy Services’ successful medication therapy management (MTM) program that utilizes pharmacists’ skillsets and leverages their full clinical expertise in comprehensive patient care. The study, “Best Practices: Improving Patient Outcomes and Costs in an ACO Through Comprehensive Medication Therapy Management,” was published in the December 2014 issue of the Journal of Managed Care & Specialty Pharmacy. 

The lessons learned through the MTM program can assist other organizations in improving patient outcomes while reducing costs. Every ACO is unique, but this case study suggests key components that can be modified and adapted for MTM programs, depending on the needs of an ACO.

The study, written in partnership with the National Pharmaceutical Council (NPC), identified several factors for consideration in the development of a successful MTM program within an ACO:

• Costs. Start-up costs and ongoing financial considerations are critical issues, and these will likely depend on the characteristics of each organization.
• Identifying Patients. An ACO may want to target high-risk patients, such as those who are not meeting health goals, those missing key drug therapies, or those who are utilizing the emergency services or inpatient setting frequently. The Fairview MTM program uses both physician referrals and data analysis to identify patients who might benefit from MTM services.
• Direct Interaction With Patients. There are various delivery methods to provide direct patient care. Although Fairview MTM pharmacists are embedded in primary care sites, they also utilize telephone appointments or Internet-based options to interact with patients.  
• Role of Protocols for Pharmacists to Change Prescriptions. The approach to collaborative practice may vary and some are dependent on whether a state has legislation that allows this practice. Fairview MTM pharmacists can initiate, modify and discontinue prescriptions based upon approved protocols, and the referring physician is subsequently informed of the changes in therapy.
• Communication from Pharmacist to Physician. Once changes are made to a prescription, it is critical that those changes be communicated quickly and efficiently to providers involved in that patient’s care. Fairview uses electronic medical records to communicate with physicians when medication regimens have changed and to discuss the patient’s care plan.
• Importance of a Visionary Leader. Organizations need to identify individuals who can carry out the vision and promise of MTM programs.

This study is part of a broader project supported by NPC, the American Medical Group Association and Premier, Inc. to understand the role of pharmaceuticals in helping ACOs achieve their financial and quality goals. In the project’s foundational stage, the partners, working in conjunction with a group of ACOs, developed a framework for considering the costs and benefits of medications in various conditions. The partners also are exploring other best practices, such as integrated database analytics, physician leadership in a team-based care environment, the role of the pharmacist in an ACO, and medication disease therapy management for biologics.