Accountable Care Organizations: The Future Is Here!

What role will accountable care organizations (ACOs) play in the evolution of health care in this country and even in the practice of pharmacy? It’s a question I have been asking myself since the presidential election. For the last few years, there has been a lot of press concerning the Medicare Shared Savings Program and the resulting ACOs. Recently, Health and Human Services Secretary Kathleen Sebelius announced 106 new ACOs, which included a diverse cross-section of physician-led organizations. Many of these new ACOs serve fewer than 10,000 beneficiaries. Additionally, about 20% include community health centers, rural health centers, and critical access hospitals.

I share these facts to help you realize that these new organizations will become part of the health care system in many communities—and can offer opportunities for many pharmacists who know what types of drug-related services these group need, and know how to market to these new entities. ACOs are being promoted to assure care coordination across the health care continuum as well as to save health care costs. Pharmacy has been suggesting that poor drug therapy management is a problem and pharmacists can play a vital role in improving care and reducing costs. Although pharmacists are not mandated to be part of an ACO, they are widely recognized as important players because drug nonadherence and drug therapy misadventures are expensive. When drug therapy is managed well, savings occur. Therefore, most ACOs will be looking to pharmacists to help them. If you are not learning about ACOs and what is happening in your marketplace, you may wake up one morning and wonder what happened to your pharmacy’s business.

What should you focus on if you want to get involved with an ACO? Since the ACO is an integrated patient care model based on a pay-for-performance reimbursement model, quality of care becomes more important than quantity of care. It is not how many prescriptions you fill that matters, but how well the patient does on the medicine dispensed. For many pharmacists this will be a paradigm shift. How would your role as a pharmacist change if you were paid on patient outcomes? That’s how you will need to think if you want to get involved with an ACO.

It probably means that you will spend more time talking to the patient and less time on handling the prescription drug. It will probably mean that you will have to be linked better electronically to the other providers who are also taking care of the patient. Today, all health professionals can survive practicing in a silo and too many still do. But that approach will not work in a successful ACO. True interdisciplinary practice will be required. Pharmacists will also have to learn to collaborate with pharmacists in other practice settings to make the patient’s care transition seamless.

Some of these new approaches will happen easily, but some many require major effort on your part to get ready. Pharmacy school curriculums are being reworked to prepare students to practice effectively as members of a health team. Interdisciplinary education is now being stressed in all health profession schools. To stay competitive with these new graduates, you will also need these skills.

Pharmacy organizations will be affected as this new model grows. Many organizations were started to help pharmacists practice in unique settings. Now that collaboration across settings is required, these organizations will also have to learn to collaborate. That should be good for the profession.

The profession is changing and ACOs may be a big driver of that change. But whether ACOs grow, as I expect they will, or not—health care reform is happening. Pharmacy Times plans to help keep you aware of these important changes and how you can be a player in them with this special series (please see page 8). Welcome to the future!

Mr. Eckel is a professor emeritus at the Eshelman School of Pharmacy, University of North Carolina at Chapel Hill. He is past executive director of the North Carolina Association of Pharmacists.