Partnering up

A new program by retail pharmacy giant Walgreen Co. could help hospitals avoid new penalties for 30-day readmissions while getting more prescriptions filled and improving patient outcomes in the process.

The company's offer may be an early one among many pitched to hospitals confounded by the new Medicare policy, which many argue holds hospitals responsible for things they can't control.

Walgreen's WellTransitions program will review patients' prescriptions upon admission and discharge, offer hospital-bedside delivery of medications to patients guaranteeing their prescriptions are filled before discharge, provide medication counseling to patients and their caregivers, make regularly scheduled follow-up calls to discuss patient progress and medication-regimen adherence, and be available to answer questions online or by telephone 24 hours a day.

Joel Wright, Walgreen's vice president of health systems operations, said his company will work with hospitals to target patients with complex conditions and chronic diseases who are particularly at risk for readmission within 30 days. Wright said contracts have been signed with a dozen hospitals, and discussions are in progress with others. Existing agreements offer fee-for-service contracts, but Wright said Walgreen is exploring shared savings arrangements in which the company would get some of the money a hospital saves by avoiding the readmission penalties included in rules that went in effect Oct. 1.

An early adopter of WellTransitions was Washington Adventist Hospital in Takoma Park, Md., where Walgreen reports that, of the first 48 high-risk patients enrolled in the program, only three were readmitted within 30 days of leaving the hospital.

In a news release, Walgreen cited studies that found preventable hospital readmissions cost the healthcare system about $25 billion a year and that one in five Medicare patients are re-hospitalized within 30 days.

The Pharmaceutical Research and Manufacturers of America, the industry's largest trade group, declined to comment on the program but provided statistics noting that as many as 75% of patients—and 50% of those characterized as chronically ill—do not comply with their physician's prescribed treatment regimens.

A report last month in the Annals of Internal Medicine cited earlier studies that estimated between 20% and 30% of prescriptions are never filled, and this lack of adherence results annually in 125,000 deaths and 10% of hospitalizations. The authors, from RTI International in Durham, N.C., concluded that interventions such as reduced patient out-of-pocket expenses, case management and patient education with behavior support particularly improved adherence for patients with asthma, depression, heart failure and hypertension.

“It's hard to say anything bad about the extra help,” said Dr. Bruce Bagley, the American Academy of Family Physicians medical director for quality improvement. “If they can do what they say they'll do, it's a good thing, but it has to be about the patient's total care and not just the medicine list.”

Bagley noted that nonadherence is often “a problem in both directions” that reflects a lack of listening by the patient and the doctor. Physicians have to be aware if patients can afford the drugs they prescribe as well as complaints about side effects, he said. And unless the program is fully integrated into a patient's total care, he's concerned it could foster further fragmentation of the healthcare system because it's “a hospital solution with a hospital focus that doesn't solve the full problem.”

While appreciative of the program's offering of community-level patient support, Bagley said what's needed is “to pull the primary-care physician into the loop” so there is an effective handoff ensuring that someone “accepts that hard transfer of responsibility once the patient walks out the hospital door.”

—with Melanie Evans