Accountable Care Organization Review Recognizes the Value of Pharmacists

The rise of value-based care has led to a greater discussion on the importance of pharmacists in the health system. Recently, a new review by an accountable care organization (ACO) known as Partners for Kids (PFK) has detailed how the inclusion of pharmacists in the development and execution of various quality improvements within the organization has positively affected outcomes for patients while also lowering overall costs. It also highlights how pharmacists are critical for the delivery of high-value health care, including medication training, resources, and guidance, which can improve quality of care at lower costs.

According to the review, more than half of ACOs currently employ or contract pharmacists to support their mission to provide an improved patient care experience, better population health, and reduced per capita healthcare costs. Pharmacists in these organizations, including the two in PFK, focus on improving medication adherence, optimizing drug selection while reducing inappropriate utilization, minimizing variations in prescribing patterns, and improving patient satisfaction.

In an annual survey of community providers associated with PFK that assesses the impact of quality improvement projects on practice operation and patient-related health outcomes, 80% of participants responded positively.

The report detailed how pharmacists assist in the following areas:

Prescribing Resources

The report detailed how the PFK pharmacists are invaluable in prescribing guidelines using evidence-informed clinical guidelines and expert opinion for common conditions in pediatric patients, including acne, acute otitis externa and otitis media, behavioral health, head lice, asthma, gastroesophageal reflux, and outpatient antimicrobials. They also work with Medicaid Managed Care Plans to ensure that recommended medications are covered on their preferred drug lists or formularies, ensuring less administrative burden for providers and less disruption for patients.

Education

PFK pharmacists educate community providers by disseminating prescribing resources and academic detailing through the PFK website, as well as distributing newsletters, webinars, and a free provider mobile app. They conduct academic detailing at community pediatricians’ offices or during department section meetings. They also use and distribute practice- or provider-specific data reports to support academic detailing efforts.

Clinical Decision Support

The pharmacists work with information technology specialists to develop clinical decision support, or more specifically, they work with preferred medication options within their practice-specific electronic medical record. This includes creating or modifying alerts, favorites, and orders sets. This clinical decision support provides timely information, at the point-of-care, to help inform decisions about a patient’s care and therapy options.

Medication Management

Pharmacists at PFK provide disease-specific medication management recommendations by collaborating with community pediatricians using patient-level data reports provided by the ACO. The pharmacists identify increased medication costs or changes in insurance formulation and then, with a clinical pharmacy team from Nationwide Children’s Hospital (NCH), devise and recommend alternative cost-effective and clinically-appropriate therapies when possible.

Additionally, PFK pharmacists, NCH staff pharmacists at outpatient pharmacies, and NCH clinical pharmacists integrated into ambulatory clinics collaborate to form both comprehensive medication management as part of the medication reconciliation process. Common interventions include compliance assessments, medication reconciliation completions, medication education for providers and patients, and recommendations on therapeutic adjustment, alternative therapy, and immunization.

Behavioral Health: Attention-Deficit/Hyperactivity Disorder

Pharmacists, in collaboration with pediatric psychiatrists, have updated and published Prescribing Guidelines for Behavioral Health, using evidence-informed clinical guidelines, cost information, and expert consultation to assist providers with timely and effective treatment for children with attention-deficit/hyperactivity disorder (ADHD). They also led efforts to increase the prescribing rate of preferred ADHD medications by implementing interventions, sharing prescriber-specific data and feedback, presenting guidelines and data at meetings, and developing ADHD-specific medications to review patient medications for appropriateness, efficacy, and safety.

PFK recently launched the first pediatric behavioral health Project Extension of Community Health Outcomes (ECHO) in the states of Ohio in collaboration with NCH in 2019. As part of the hub team, the pharmacist played an integral role as a content expert for psychopharmacology and related topics in the context of treatment of psychiatric disorders in the primary care settings.

Asthma

A Q1 project through PFK focused on the optimization of asthma management, with the aim to reduce asthma-related emergency department and inpatient visits. They plan to do this by ensuring that patients with asthma are appropriately diagnosed, evaluated, and managed by pediatricians. Key interventions include:

• The use of asthma control tests to accurately assess a patient’s disease control and guide the need for changes in medication management.
• Distribution of asthma action plans to help patients appropriately self-manage symptoms.
• Workflow changes to support routine 6-month follow-up visits.
• Strategies to improve asthma medication ratios for patients with more severe asthma.

PFK pharmacists have been a valuable resource in helping practices successfully adopt many of these interventions, according to a press release. 

PFK has a governing board that includes representatives from NCH and from primary and specialty practice groups throughout Ohio that participate in its network. Since it was established in 1994, PFK has grown to assume full medical and financial responsibility for approximately 330,000 low-income children enrolled in a Medicaid managed care plan in its 34-county region in central and southeastern Ohio.

The ACO is looking into integrating pharmacy services apart from asthma and ADHD medication management programs, including areas such as antimicrobial stewardship, reproductive health, and high cost or specialty medications.

Reference

1. Kuhn C, Groves BK, Kaczor C, et al; Pharmacist involvement in population health management for a pediatric managed medicaid accountable care organizations. National Pediatric Pharmacotherapy Collaborative Practice Network. 2019;6(7), 82. https://doi.org/10.3390/children6070082. Published July 4, 2019. A