Jan 15

Transforming Healthcare One Medicare Patient at a Time

medicareby Wayne Oliver – Healthcare Consultant
Originally published by the Atlanta Journal Constitution on January 4, 2013

As we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.

So what are Accountable Care Organizations (ACOs)?

ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.

HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare services for Medicare patients. ACOs were also created to provide a framework for a patient-centered model of care.
As part of the ACO strategy, Medicare will continue to pay providers under the traditional fee-for-service basis but have added a shared savings programs to encourage providers to improve care delivery. While doctors and hospitals are the driving forces behind the development of ACOs, other providers such as pharmacists are in a unique position to help ACOs achieve the goals of improving patient care.

As America’s most accessible healthcare professional, pharmacists are experts in prescription drug therapy, which is the most utilized of all Medicare healthcare services. Working closely with physicians in an integrated, ACO environment, pharmacists can help better manage chronic conditions like diabetes, asthma, and hypertension.

Proper management of these and other chronic conditions helps to reduce hospitalizations and readmissions to hospitals. Pharmacists’ participation in ACOs help to ensure the achievement of clinical and financial performance targets that demonstrate improved patient outcomes and lower health care costs.

Studies have consistently demonstrated that pharmacists who participate in team-based care models make positive contributions to the safe and appropriate medication use. Pharmacists are distinctively positioned in the health care system to help optimize appropriate medication therapy, improve patient adherence to prescription drug therapy, reduce medication related problems and improve health outcomes.

As the ACO model is adapted for non-Medicare patients, pharmacists will be pivotal in terms of improving care while reducing costs. Whether serving as a clinical pharmacist embedded in a primary care medical practice or community pharmacists working with hospitalized patients at discharge, pharmacists continue to make significant contributions to improved care at lower costs.

So are ACOs going to single handedly solve Medicare’s budgetary woes. Probably not, but they offer the hope of creating a patient centered system that can help patients better navigate a complex system of healthcare providers and professional healthcare services. It is this promise of better coordinated care with an emphasis on prevention, wellness, and patient safety that can help in the transformation of the US health delivery system … one Medicare patient at a time.

ACOs that create a patient centered model where physicians, hospitals, nurses, and pharmacists work collaboratively will be successful. And Medicare patients are the beneficiaries of improved care while taxpayers benefit from lower costs.

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