Introducing next generation ambulatory pharmacy to health systems

When patients transition from the hospital to an outpatient setting, medication discrepancies can occur.

In fact, research conducted by the Mayo Clinic indicates that 50% of patients nationwide don’t take medications as prescribed, and it’s estimated that non-adherence is responsible for 11% of hospital readmissions across the country. Further, medication mismanagement creates an estimated 1.5 million adverse events each year and $177 billion in avoidable costs. With specialty drug spending rising nearly 60% over the past five years – and reimbursement being more closely tied to outcomes versus a fee for service model – it’s increasingly important for health systems to address the critical role ambulatory pharmacies can play in supporting transitional care and improving the patient journey.

Historically, when a patient was discharged from the hospital, he or she would have received a prescription along with guidance from a physician or nurse who would have explained the overall treatment plan and the role that medication played within it. Often, the patient would then visit a retail pharmacy to pick up the prescription or wait for it to arrive at home via a mail order pharmacy. In either case, the patient experienced a delay in starting treatment, creating a disconnect between the health system, physician and patient and resulting in the potential for poor medication compliance and outcomes. Questions would arise, such as: Did the patient get the script filled and begin treatment? Was the medication prescribed covered by the patient’s insurance? Can the patient recall the instructions he/she received prior to discharge? Did the patient receive counseling along with the dispense, and was this consistent with the guidance he/she received before discharge?

Today, most health systems recognize the positive role that ambulatory pharmacists can play in supporting patient care, particularly during the critical transition from inpatient to home. By more seamlessly integrating the pharmacy team earlier into the therapeutic journey, while the patient is cared for within the health system, hospitals can improve the patient experience and – ultimately – clinical outcomes. They’ve created smoother transitions back to the home environment, resulting in improved patient satisfaction and patients who are confident and comfortable managing their treatment regimens. Concierge medication (or, “meds to beds”) programs are an example of how health systems have increased patient engagement. By bringing the pharmacist to the bedside to provide counseling, along with the patient’s first dispense prior to discharge, the health system can reduce time to treatment and increase patient engagement. This approach has resulted in documented reductions in readmissions and improvements in patient satisfaction scores associated with the care provided by the health system.

Ambulatory pharmacists have long recognized their role in patient care as more than dispensing medication; at health systems, they close the gap between a prescriber and a patient by providing education and medication therapy management (MTM) post-discharge. Ambulatory pharmacists pride themselves in building long-term relationships with patients. They answer patient questions about treatment, recommend over-the-counter medications when necessary and can act as a liaison between the patient and their insurance company. As specialty pharmaceuticals have become a common part of so many treatment regimens, ambulatory pharmacy has become even more important for health systems who do not have their own specialty pharmacy. Patients have more opportunities than ever to receive highly effective, innovative treatments, but the regimens associated with specialty pharmaceuticals require patients to manage more complexity once they’ve left a health system. This complexity increases the risk of non-adherence and possible readmission and these negatively influence both patient outcomes and a health system’s financial performance.

For example, we worked with a health system to develop its ambulatory pharmacy, later creating a pharmacy-driven MTM program that focused heavily on community outreach. The benefits of this program for the hospital and its patients included: a $5,000 cost avoidance per patient; improved medication adherence and patient outcomes; substantially lowered hospital readmissions and ER visits; enhanced patient satisfaction and deepened community engagement.

How can health systems ensure they have an effective strategy in place, with ambulatory pharmacy as the foundation to effective transitional care?

Start by:
Creating a hub of transitional care: by focusing on continuity of care as patients transition from hospital to another care setting, the aim is to “close the gaps” in transitions of care.
Focusing on concierge medications: concierge medication programs improve adherence by making it convenient for patients to obtain their discharge medications and receive proper counseling at their bedside, before leaving the hospital.
Using data-driven analytics: robust data analytics are at the forefront of patient care today, ensuing the right care is delivered to the right patient, in the right setting, at the right time. Clinical and socioeconomic markers can also be used to identify high-risk patients and introduce risk stratification analytics. The resulting targeting allows pharmacists to identify and pay the most attention to high-risk patients.
Engaging a consulting partner: consultants can not only help a health system implement the above but also navigate myriad factors that will ultimately influence success, including (but not limited to): geography, demographics, financial health and regulatory decisions.

In this future state, ambulatory pharmacists within health systems can operate close to the patient and care team, allowing for better communication, better coordinated care and error mitigation. Their increased attention to transitions of care and adherence promotes positive patient outcomes and ultimately, hospital success.

Patient outcomes are optimized when care is kept as close to the clinical team as possible. Additionally, the data sharing generated from care delivered closest to a patient’s medical record is beneficial for all stakeholders, not least of which is the health system. These programs are increasingly becoming the rule rather than the exception, and partners can help health systems create them. To tailor the program for each hospital, teams first meet with the gamut of hospital stakeholders including medical staff, finance, HR, quality, marketing, and IT. The combined teams work to maximize success based on identifying a pilot unit or patient population that has clinician champions—nurses, case management, physicians, and inpatient pharmacists willing to work collaboratively to make the pilot succeed, so expansion throughout the facility can be executed quickly and with a high degree of success.

Over the past ten years, health systems have faced new challenges to providing lifesaving care at a lower cost, as reimbursement models shift, pressure to consolidate mounts and the government landscape continues to be ever-changing. As a result, innovative health systems are taking these challenges head on by leveraging the skills and expertise of their existing pharmacy staff and combining that with the repeatable and results-driven outcomes that can be found by partnering with a consultant. Health systems are more actively managing the full patient journey, and they are succeeding both clinically and economically by leveraging next generation ambulatory pharmacy.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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