Health System Pharmacy and Population Health Management
By Mike Long |
How health system pharmacy can lead the way to population health management success.
Population health management (PHM) has become a key initiative for hospitals and health systems seeking to lower costs, improve care quality, and increase efficiencies in order to succeed in risk-based contracting. And pharmacy is uniquely positioned to play a central role in an effective PHM strategy. By enhancing existing infrastructure and core assets with emerging technologies, pharmacy can be a driving force in an impactful PHM initiative.
For the health system pharmacy, it’s best to think of PHM in a practical sense: proactively (and sometimes reactively) managing the health of a population through effective medication management. More specifically, it’s about focusing on the small percentage of patients who can generate the greatest impact.
In today’s healthcare environment, smaller populations often consume the majority of resources.1 In fact, 10 percent of patients with a chronic disease drive 75 percent of healthcare costs.2 At the same time, research indicates that nearly 50 percent of patients don't take their medications as prescribed, and that medication-related problems cost $177 million each year, accounting for 700,000 emergency room visits and 120,000 resulting hospital admissions.3
Clearly, these are areas in which pharmacy can make a significant impact. By contributing a proactive and targeted medication management program to a comprehensive PHM initiative, pharmacy can play a pivotal role in overcoming these types of challenges.
Reducing Readmissions through Medication Adherence
Hospital and health system pharmacies are increasingly recognizing this opportunity and, as a result, are implementing ambulatory and concierge (often referred to as “meds-to-beds”) programs to lead interventions, mitigate adherence barriers and minimize readmissions.
Traditionally, hospitals’ clinical staffs have assumed responsibility for reconciling and synchronizing a patient’s medications and providing treatment plan counseling upon discharge. These efforts are now shifting to on-site ambulatory pharmacies. Through concierge medication offerings, pharmacies are making it more convenient for patients to obtain their medications by delivering them directly to their bedside before they leave the hospital. They are also providing stronger educational resources and regular follow-up to optimize adherence and mitigate care gaps.
This approach has not only made it easier for patients to comply with their treatment plan—assuring consistency of care with fewer complications that could potentially bring individuals back to the hospital—it has increased their satisfaction with the overall care experience. From the hospital’s perspective, it helps lower readmission rates and increase compliance with associated regulatory mandates that could result in significant financial penalties.
Taking the Next Step
While ambulatory and concierge pharmacy programs are already generating results,4 some progressive hospitals and health systems have begun to strengthen these initiatives with predictive analytics and stratification technology that facilitates end-to-end clinical integration to unlock the power of data.
Today’s pharmacies have access to more information than ever before. Applying predictive analytics technology to admission and discharge data allows pharmacies to better leverage this intelligence to identify the patients with the greatest impact potential. By analyzing data feeds from electronic medical records and discharge systems and then monitoring prescription activity, adherence patterns and compliance, the pharmacy can identify optimal opportunities, better deploy resources and focus education and engagement where they are most needed.
These new technologies—combined with targeted, pharmacy-driven clinical programs for discharge patients—can generate important results. They enable pinpoint analysis and patient and disease state stratification that allows pharmacies to identify those individuals most at risk for an adverse event (again, often a small group of outliers driving the majority of costs) and develop an appropriate strategy for optimal intervention.
Core Pharmacy Assets + Emerging Technology = PHM Success
Healthcare’s shift from fee-for-service to fee-for-performance has placed an unprecedented emphasis on the quality and value of care. Hospitals and health systems are exploring every opportunity to meet changing mandates while maintaining a competitive advantage in value-based arrangements. PHM is a key component of achieving these goals and capitalizing on the opportunities that ultimately arise in the shifting landscape.
And pharmacy can be the cornerstone of these efforts. Through burgeoning programs and emerging technologies, pharmacy can address one of the biggest cost and risk drivers health systems currently face – patients who are readmitted due to medication non-adherence. Identifying, intervening and appropriately managing these high-risk patients can significantly improve costs, increase efficiencies and, most importantly, optimize outcomes.
As a result, PHM presents a genuine and important opportunity for the pharmacy to take on a strategic leadership role in the overall health system framework and solidify its position in the center of the care continuum. There, the pharmacy can be key a contributor to the health system’s performance and, most importantly, significantly impact its ability to elevate patient care.
1. Agency for Healthcare Research and Quality. The High Concentration of U.S. Health Care Expenditures. June 2006. Accessed 22 March 2017. Available online at https://archive.ahrq.gov/research/findings/factsheets/costs/expriach/expendria.pdf
2. Centers for Disease Control and Prevention. Chronic Disease Prevention and Health Promotion. 14 November 2016. Accessed 6 May 2017. Available online at https://www.cdc.gov/chronicdisease/
3. Advisory Board. Six Ways Your Pharmacist Can Save the Day. 6 July 2016. Accessed 22 March 2017. Available online at https://www.advisory.com/-/media/Advisory-com/Research/PEF/Multimedia/2016/32793_PEF_Pharmacist_Role_IG_Web.pdf
4. MedCity News. “Meds-to-Beds” programs aim to improve patient engagement, tackle readmission problem. May 2017. Accessed 1 September 2017. Available online at: http://medcitynews.com/2017/05/meds-beds-programs-aim-improve-patient-engagement-tackle-