Specialty Pharmacy and Accountable Care Organizations

These buzzwords—“accountable care organization”—actually say it all. By using the word “accountable,” one is implying that someone is actually accountable or being called to task for “care”—in our world, this means the health care of patients. Once you throw in “organization,” you could get the impression that there is some semblance of order and, in fact, a model or a clear outline to follow. So, we surmise that accountable care organizations (ACOs) are under control and have become part of mainstream health care. Not so fast.

Since the passing of the Affordable Care Act (ACA) in March 2010, it is true that ACOs have become a big part of our vocabulary. The Centers for Medicare & Medicaid Services started to contract with ACOs to provide health care to Medicare beneficiaries under a shared savings program that began in January 2012. This means that there are already data being collected with the goal to ensure that costs were controlled and patient care was advanced.

But ACOs are still evolving, especially with regard to the role pharmacy plays, and it is with some anxiety that we are watching this happen—it’s very important to “get it right.” The premise of these organizations, along with patient-centered medical homes, is to reduce costs and provide substantial improvements in terms of patient adherence. If the individual organizations don’t clearly delineate the pharmacist’s role and empower pharmacists with access to data, such as patient records, the value that the pharmacist brings to the table may well be lost. Without current, detailed information about patient medications, lab results, history, and more, the pharmacist is handicapped while working on patients’ medication management and, ultimately, their success in managing their conditions.

No doubt, specialty pharmacists will claim a special place within the developing ACO models because they deal with patients who present with some of life’s most difficult diseases—cancer, hepatitis C, HIV, multiple sclerosis, hemophilia, and rheumatoid arthritis, to name just a few. Specialty pharmacists are working with “high-touch” cases where every patient needs specialized care and management.

No health care professional can work in these environments alone, so perhaps specialty pharmacists are 1 step ahead since they already work closely with manufacturers and payers. Take a look at Nick Calla’s Viewpoints on ACOs in this issue, which argues that moving patients from “uncoordinated care” to “coordinated care” will definitely reduce health care costs. In fact, successful patient programs already exist in the specialty space and they can show us how to proceed as the nuances of ACOs continue to be worked out in the coming months and years. SPT

Thank you for reading!

Mike Hennessy

Chairman/Chief Executive Officer