Many accountable care organizations have overlooked the role of pharmacists, but they could benefit from chronic disease medication management and better coordination of prescriptions as patients move from home to hospital to nursing home, according to a new essay in Health Affairs.
“Pharmacists can help meet the demand for some aspects of primary care and can contribute to the efficient and effective delivery of care,” said Dr. Thomas Bodenheimer, Dr. David Bates and Marie Smith, dean of the University of Connecticut's pharmacy school. “A pharmacist's expertise in medication reconciliation, pharmacotherapy management and monitoring and care coordination across multiple prescribers and care settings is complementary to the skills of other healthcare professionals.”
Their current exclusion from teams may be a result of payment policies that fail to directly pay pharmacists to manage medication. It may also be complacence, the authors said. They called it “the toleration of the status quo, including the acceptance of preventable medication errors as mere accidents.”
Pharmacists working within a team could concentrate on medications. One survey found doctors spend less than a minute during patient visits discussing new prescriptions. The authors also called for quality measures that would identify and track gaps in medication use and safety.
The authors also urged ACOs and other alternative payment and delivery models to include medication management and to pay pharmacists from global budgets.
“Medical homes, ACOs and integrated networks should be motivated to refer patients with complex drug regimens, high-cost healthcare, failure to achieve desired clinical outcomes, high risk of adverse events, poor adherence, or drug-related health literacy issues to a pharmacist for comprehensive medication management services. The pharmacist would be compensated from the practice's per member, per month payments.”
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