News & Commentary

ACOs' pharm management not up to snuff

Not everybody believes that accountable care organizations (ACOs), a bulwark of the Affordable Care Act, will ride to medicine’s rescue. In fact, in these pages, well-known policy experts such as Regina Herzlinger, PhD, of Harvard Business School, and David J. Brailer, MD, PhD, the health technology czar under President George W. Bush, have been downright dismissive ( and, respectively). In fact, Brailer told us, “Accountable care organizations are a publicity stunt created by Congress and the administration to make people feel like they were reforming care delivery when everyone knew they weren’t.”

So, pressure’s on for those trying to make ACOs function. A study in the January issue of the Journal of Managed Care Pharmacy looks at how 46 ACOs handle pharmacy. They do a few things well, but some areas need improvement. For instance, only 9% are good at notifying a doctor when a prescription has been filled.

“Developing the capabilities to support, monitor, and ensure appropriate medication use will be critical to optimal patient outcomes and ACO success,” the authors say.

What are ACOs doing?
Percentage of 175 members of the American Medical Group Association that consider themselves highly ready to undertake each operation
Transmit prescriptions electronically70%
View prescription and medical data in single system54%
Encourage appropriate generic use with formularies50%
Identify potential drug-drug, drug-disease, and/or polypharmacy concerns43%
Use visit summaries to list all Rx, potential adverse reactions, and clear directions for use41%
Synchronize formularies across different care sites35%
Alert providers of preventive care gaps28%
Involve pharmacist in direct patient care22%
Balance financial incentives with quality metrics for a diversity of conditions22%
Notify care providers when Rx is prescribed20%
Implement protocols to avoid duplicate medications/polypharmacy17%
Capture patient-reported outcomes electronically15%
Share potential drug-drug/drug-disease/polypharmacy concerns with care team13%
Educate patients about alternatives/implications when determining the recommended medication care team11%
Notify care providers when Rx is filled9%
Quantify medication cost offsets7%
Source: “Are ACOs Ready to be Accountable for Medication Use?” Journal of Managed Care Pharmacy, January 2014