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Impact of a centralized population health pharmacy program on value-based Medicare patients.
Journal of the American Pharmacists Association : JAPhA 2023 September 23
BACKGROUND: Memorial Healthcare System (MHS) Participated in the Centers for Medicare and Medicaid Services (CMS) Bundled Payments for Care Improvement Advanced (BPCI-A) value-based program aimed to improve patient care and reduce healthcare costs. Challenges with medication therapy problems (MTPs) led to the development of a centralized tele-health population health pharmacy program. This innovative approach aimed to provide comprehensive post-discharge medication support and resolve MTPs during the 90-day risk period.
OBJECTIVES: The program aimed to provide longitudinal medication support, resolve MTPs, and impact 90-day readmission rates.
PRACTICE DESCRIPTION: MHS established uniform workflows, a pharmacy task force, and a dual pharmacy team approach with Population Health Registered Nurses. The Population Health Pharmacists (PHPs) conducted post-discharge telephonic encounters to resolve MTPs longitudinally throughout the risk period.
PRACTICE INNOVATION: The program used a centralized, tele-health model with Electronic Health Record integrated tools. It targeted readmission rates up to 90 days, beyond the conventional 30-day period.
COLLABORATION: PHPs collaborated with onsite ToC pharmacists, PHRNs, and healthcare professionals for coordinated patient care and MTP resolution.
EVALUATION: Over 7 months, PHPs completed 801 telephonic visits, identifying 433 MTPs with a 94% resolution rate. The program significantly reduced readmission rates.
CONCLUSION: The centralized tele-health population health pharmacy program improved patient outcomes, resolved MTPs and reduced readmission rates. The program serves as a model for integrating pharmacists into value-based care initiatives.
OBJECTIVES: The program aimed to provide longitudinal medication support, resolve MTPs, and impact 90-day readmission rates.
PRACTICE DESCRIPTION: MHS established uniform workflows, a pharmacy task force, and a dual pharmacy team approach with Population Health Registered Nurses. The Population Health Pharmacists (PHPs) conducted post-discharge telephonic encounters to resolve MTPs longitudinally throughout the risk period.
PRACTICE INNOVATION: The program used a centralized, tele-health model with Electronic Health Record integrated tools. It targeted readmission rates up to 90 days, beyond the conventional 30-day period.
COLLABORATION: PHPs collaborated with onsite ToC pharmacists, PHRNs, and healthcare professionals for coordinated patient care and MTP resolution.
EVALUATION: Over 7 months, PHPs completed 801 telephonic visits, identifying 433 MTPs with a 94% resolution rate. The program significantly reduced readmission rates.
CONCLUSION: The centralized tele-health population health pharmacy program improved patient outcomes, resolved MTPs and reduced readmission rates. The program serves as a model for integrating pharmacists into value-based care initiatives.
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