Pharmacists Optimize MTM Outcomes in ACOs

Pharmacists play an important role in ensuring optimal patient outcomes within accountable care organizations (ACOs), according to findings published in the Journal of Managed Care & Specialty Pharmacy in December 2014.

A team of researchers analyzed current literature and practices in order to identify areas where pharmacists can improve ACOs using their skill sets and clinical experience. The authors described best practices for medication therapy management (MTM) programs within ACOs and offered additional thoughts and considerations.

“Many of the ACOs have similar models in how they deploy pharmacists in their care models,” lead study author Amanda Brummel, PharmD, BCACP, of Fairview Pharmacy Services, LLC, told Pharmacy Times. “I believe we focus them on different segments of the patient population. For example, comprehensive MTM is likely best deployed in your higher risk/chronic condition patient population.”

The study authors noted that a successful MTM program within an ACO addresses several key factors, including:

- Protocols for pharmacists to change prescriptions. While collaborative approaches are the most effective, they vary based on state laws. By keeping each member of the health care team on the same page, however, pharmacists can initiate, modify, and discontinue prescriptions and keep the referring physician informed of changes in the medication regimen.

- Communication from pharmacist to physician. Electronic communication channels are widely used to improve collaboration between pharmacists and physicians. Direct communication also occurs if the physician and pharmacist work in the same clinic.

- Costs. Even though each ACO has its own characteristics and requirements, all require financial considerations to function effectively. Some patient centered medical homes (PCMHs) receive per member/per month fees to provide population-level and individual patient management. Other MTM programs provide some of the PCMH costs and services, but per member/per month revenue could make up some of the cost difference, the authors suggested.

- Identifying patients. Physician referrals and patient data analysis are the 2 main systems in which MTM patients are recruited. As ACOs grow by taking on more financial and clinical responsibility, they need to coordinate the expansion of their recruitment systems and analytics.

- Direct interaction with patients. The researchers believed that a multifaceted approach to patient interaction is best. While telephone calls and Internet interactions are viable options, face-to-face meetings in person or via webcam are generally the most prevalent methods for MTM patients.

“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,” Dr. Brummel told Pharmacy Times. “…Working in a team-based model also impacts patients by knowing they have a team working together to provide care for them and that communication is enhanced when people work as a team.”