ACOs receive mixed grades in self-assessment study

One out of 10 patients in the United States receives care through an accountable care organization (ACO), which some people credit with lowering healthcare costs and improving quality. But while ACOs are performing well in some areas they fall woefully short in many others, according to a self-assessment study recently published in the January issue of the Journal of Managed Care Pharmacy.

“[ACOs] have the potential to lower costs and improve quality through coordinated care, with incentives based upon shared savings and achieving specified clinical benchmarks,” the report said. “However, the design brings with it many new challenges. One such challenge is the optimal use of pharmaceuticals.”

The study sought to determine whether ACOs are prepared to maximize the value of medications for achieving quality benchmarks and cost offsets. Self-assessments were sent to 175 members of the American Medical Group Association, Brookings-Dartmouth ACO Learning Network, and the Premier Healthcare Alliance. Forty-six people completed the surveys.

ACO members gave themselves high marks in some areas involving readiness to manage medications. Seventy percent reported that they were transmitting prescriptions electronically; 54% said they were able to integrate medical and pharmacy data into a single database; and 50% reported having a formulary in place to encourage generic use when appropriate.

However, the ACO members admitted the need for substantial improvements in many areas. A mere 7% of respondents reported being able to quantify the cost offsets and demonstrate the value of appropriate medication use; and only 9% said they notified physicians after a prescription is filled.

Seventeen percent said they had protocols in place to avoid medication duplication and polypharmacy; and 22% reported having quality metrics in place for a broad diversity of conditions.

“Developing the capabilities to support, monitor, and ensure appropriate medication use will be critical to achieve optimal patient outcomes and ACO success,” the report concluded. “The ACOs surveyed have embarked upon an important journey towards this goal, but critical gaps remain before they can become fully accountable.”

The report continued: “The authors hope that these case studies will help ACOs optimize the value of pharmaceuticals and achieve the triple aim of improving care, health, and cost.”