PHARMACIST’S ROLE IN ACCOUNTABLE CARE ORGANIZATIONS

To recognize that pharmacist participation in collaborative health care teams improves outcomes from medication use and lowers costs; further,

To advocate to health policymakers, payers, and other stakeholders for the inclusion of pharmacists as health care providers within accountable care organizations (ACOs) and other models of integrated health care delivery; further,

To advocate that pharmacist-provided care (including care coordination services) be appropriately recognized in reimbursement models for ACOs; further,

To advocate that pharmacists be included as health care providers in demonstration projects for ACOs; further,

To encourage comparative effectiveness research and measurement of key outcomes (e.g., clinical, economic, quality, access) for pharmacist services in ACOs; further,

To encourage pharmacy leaders to develop strategic plans for positioning pharmacists in key roles within ACOs.

Rationale

The Affordable Care Act of 2009 encourages the formation of accountable care organizations (ACOs). Similar in concept to health maintenance organizations, these entities consist of alliances between physicians, other health care providers, and hospitals that provide comprehensive and coordinated health care to a population of patients. ACOs emphasize primary and preventive care, are provider-led, and receive reimbursement linked to increasing health care quality and lowering per capita costs. The ACO model is based on the premise that care coordinated in this manner and incentivized by a shared-risk reimbursement model will improve health care quality and slow the growth of health care spending. One significant deterrent to pharmacist participation in the fee-for-service care model, lack of provider status, is less of a barrier in the ACO model because reimbursement is tied to quality and reduced costs rather than specific services.

Integrated systems present an important opportunity for pharmacists to demonstrate their value to the quality of care. Pharmacists could contribute to the success of ACOs by providing the following patient care services:

• Developing, implementing, and monitoring patient-specific, evidence-based drug therapy as an active participant in team-based care.
• Improving transitions in care with coordinated MTM services for patients in the hospital as well as post-discharge in ambulatory clinics and physician practices.
• Monitoring the therapy of patients with multiple chronic conditions or complex medication regimens.
• Preventing and managing adverse drug events.

Although a number of ACOs have already evolved from existing disease management and medical home programs, not much is known about the elements of success for ACOs, and implementation is likely to be challenging. To establish these elements of success, pharmacists will need to be included in ACO demonstration projects and pharmacist services will need to be the subject of research on ACO effectiveness. 

As pharmacists assume the expanded roles outlined in the PPMI recommendations, pharmacy leaders should use their expertise to explore innovative strategies to meet the broader goals of ACOs. This payment model is an opportunity to demonstrate how pharmacists can help these organizations reach clinical and financial performance targets set by the Centers for Medicare & Medicaid Services (CMS), i.e., improved patient results and lower health care costs. Pharmacy managers and other pharmacy leaders should prepare now to participate in emerging ACOs by developing strategic plans for positioning pharmacists in roles where their expertise can be best applied to these goals. 

This policy was reviewed in 2017 by the Council on Pharmacy Practice and by the Board of Directors and was found to still be appropriate.