ACOs, Pharmacists, and Transitional Care: A Winning Strategy

Among all the elements of health care reform, perhaps none has created as much debate in the halls of health plans and hospitals as Accountable Care Organizations (ACOs), which can be loosely defined as integrated and coordinated systems with financial incentives to reduce the cost of care within quality standards.    Norton Healthcare was selected by the Brookings/Dartmouth University initiative as one of the nation’s first pilot sites to develop an ACO.   Exciting for the pharmacist community is that Norton also happens to be one of a minority of hospitals where pharmacists are actively engaged in transitional care services.  Transitional care focuses on the coordination and continuity of health care as patients transition between different locations or levels of care.  While it can apply to various types of transition, patient transition from the hospital setting to home has been an area of particular interest because patients are vulnerable to gaps in care and adverse medication events, as evidenced by high rates of readmission.  Nearly two-thirds of adverse events following discharge from the hospital are related to medications.

Based on well-done randomized controlled trials, transitional care has repeatedly been shown to improve quality, reduce readmissions, and in many cases, save money—a rare find in health care.  Unfortunately, its commercial adoption has been limited until now due to a lack of financial incentives.   However, organizations such as Norton will now have just such incentives under health reform, and pharmacists are at the forefront of Norton’s efforts to reduce readmissions through transitional care services.  Norton staff pharmacists were trained in the provision of transitional care services, and a pilot project was implemented that allowed for pharmaceutical care provision by Norton pharmacists both during the admission and at discharge.  Norton reported better adherence to physicians’ orders at discharge and fewer medication errors at admission and at discharge.   An evaluation of readmissions apparently was not part of the initial pilot, but prior research bodes well for the savings potential of this initiative.  As a next step, Norton is placing pharmacists on a team with nurse navigators, who will follow up with heart failure patients after hospital release and will reach out to pharmacists to address medication issues.

The financial incentives that promote transitional care under health reform are a win for patients, and the early recognition of the value of pharmacists in transitional care at one of the first ACOs is a win for both the profession of pharmacy and for Norton.