Survey: ACOs Fall Short When Managing Medication Use

A survey of 46 representatives from accountable care organizations (ACOs) indicates that critical gaps remain in the organizations’ ability to support, manage, and ensure appropriate medication use. The research was conducted by the American Medical Group Association, the National Pharmaceutical Council, and Premier, Inc., and published in the Journal of Managed Care Pharmacy. Participating ACOs represented a wide variety of configurations—group practices, independent practice associations, academic health systems, and integrated delivery systems.

The 28-question survey was designed to evaluate whether ACOs are prepared to maximize the value of medications to achieve quality benchmarks and cost offsets. Results show that these ACOs have an electronic infrastructure set up, with 70% able to transmit prescriptions electronically, 54% able to integrate medical and pharmacy data into a single database, and 50% able to encourage appropriate generic usage with formularies (Figure).

There were critical shortcomings identified in the survey, however. Respondents report that only 28% of ACOs have the ability to alert physicians of gaps in preventive care. Only 20% of ACOs have the ability to notify a physician when a medication is prescribed by someone else on a patient’s care team and only 9% can alert a physician when a prescription is filled. There was also a significant lack of protocols to communicate (13%) and manage (17%) adverse events with providers.

Although the survey did not address costs, a previous articlein Oncology Business Management did highlight the financial benefits observed in the first oncology-specific accountable care organization, with a reported 2% savings in its first year of existence.

The survey indicated room for improvement with respect to patient engagement efforts. Only 22% used patient registries, 15% were able to integrate patient outcomes into electronic medical records, and even fewer (11%) could provide patients with education about therapeutic alternatives.

Figure. What Percentage of ACOs Are Ready to...

Respondents responded on a scale of 1 through 9, with 1 to 3 representing a low level of readiness, 4 to 6 a moderate level of readiness, and 7 to 9 a high level of readiness. Source: DuBois WR, Feldman M, Lustig A, et al. Are ACOs ready to be accountable for medication use? JMCP 2014; 20(1):17—21.