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 electronically 70%
View prescription and medical data in single system 54%
Encourage appropriate generic use with formularies 50%
Identify potential drug-drug, drug-disease, and/or polypharmacy concerns 43%
Use visit summaries to list all Rx, potential adverse reactions, and clear directions for use 41%
Synchronize formularies across different care sites 35%
Alert providers of preventive care gaps 28%
Involve pharmacist in direct patient care 22%
Balance financial incentives with quality metrics for a diversity of conditions 22%
Notify care providers when Rx is prescribed 20%
Implement protocols to avoid duplicate medications/polypharmacy 17%
Capture patient-reported outcomes electronically 15%
Share potential drug-drug/drug-disease/polypharmacy concerns with care team 13%
Educate patients about alternatives/implications when determining the recommended medication care team 11%
Notify care providers when Rx is filled 9%
Quantify medication cost offsets 7%
Source: “Are ACOs Ready to be Accountable for Medication Use?” Journal of Managed Care Pharmacy, January 2014