Next-Generation ACOs and the Future of Health-System Pharmacy

With accountable care organizations now covering more than 23.5 million patients across the United States, it is becoming increasingly important for pharmacists to understand their role in enhancing quality of care through the entire continuum.

This year, the US Department of Health and Human Services launched a new accountable care organization (ACO) initiative from the Centers for Medicare & Medicaid Services’ Innovation Center, coined the “Next-Generation ACO Model.” This model builds upon the experience gathered from the Pioneer ACO Model and the Medicare Shared Savings Program. It affords health care professionals the tools needed to better coordinate care, including predictable financial targets.

With added opportunity comes added responsibility. ACOs will soon be required to share not only cost savings, but also risks of cost overages. In addition, health-system providers could be faced with reduced Medicare revenue if they exceed their projected budgets. To successfully traverse the savings programs, ACOs will need to properly manage the care of patients across the entire continuum.

ACOs place a premium on reducing overall health care utilization, and poor medication management is generally understood to be a large contributor to hospital readmissions and added health costs for patients. As medication experts, pharmacists are well placed to play an integral role in helping to mitigate this issue.

In the May 2015 issue of Directions in Pharmacy, Troy Hilsenroth, RPh, MHA, MBA, EMT-P, discussed the importance of adherence and good medication management: “With more than 80% of health care dollars spent on chronic conditions and more than 70% of office visits resulting in a prescription, possessing a well-developed adherence platform is a necessity,” he wrote. “…If you can’t manage medications, you can’t manage financial risk in a post health care—reform world.” Although not mandated to be part of an ACO, pharmacists are widely recognized as important players because nonadherence and other therapy-related errors are expensive.

“Applying a consistent practice model to provide comprehensive medication management is effective—that has been shown to improve clinical outcomes and reduce total cost of care by reducing hospitalization and emergency department visits,” Amanda Brummel, PharmD, BCACP, told Pharmacy Times previously. For many pharmacists currently practicing, this constitutes a paradigm shift. Student pharmacists, however, have the opportunity to begin their careers with this mindset.

This way of thinking may not always be presented in current pharmacy school curriculum, though, said Stephen Eckel, PharmD, MHA, BCPS, FASHP, FAPhA, Pharmacy Times Health-System Edition editor. “Most student pharmacists are not well-prepared for working within an ACO model,” Dr. Eckel told Pharmacy Careers. “The majority of the educational model is teaching them pharmacotherapy knowledge—not so much practiced-related skills.

“There are some skills-based activities that occur in the curriculum, but most of those are inadequate or more academic in nature, whereby the practice site has to retrain or orient the student pharmacist on how to do it in practice.”

Although Dr. Eckel predicted the educational model for pharmacy will shift over time to better prepare students for the evolving workplace, he asserted that, presently, rotations, jobs, and student internships are the ideal time for student pharmacists to develop skills. Additionally, he noted that student pharmacists who are best trained with the skills needed to reduce readmissions and improve medication management “will always be in high demand” and those “willing to learn new skills and try new activities will be more valued than those who expect to do 1 thing only and are uninterested in evolving their skills to match up with the current needs.”