Transitions of care: Taking action under ACA

Pharmacists in Ohio get ready for value-based purchasing; Virginia pharmacists seek grant from Innovation Center.

Transitions of care projects in Ohio and Virginia are examples of health-system pharmacists partnering with colleagues in the community to improve patient care in alignment with financial incentives in the Affordable Care Act (ACA). In these two projects, medication therapy management (MTM) plays a key role—a way of practicing pharmacy that is very much in line with the pharmacists’ visions for the profession.

In Circleville, OH, Berger Health System expanded pharmacy staff in early 2010 to provide a clinical support pharmacist who now does discharge medication reconciliation and outgoing patient counseling. Berger, which is eligible for the 340B Drug Pricing Program, began discussions last spring to develop a partnership with two community pharmacies to offer continuity of care. The community pharmacists will follow the discharged patients via MTM visits and have conference calls with the hospital pharmacists.

“The dedication of these resources is in direct response to government programs such as [ACA], specifically value-based purchasing, as well as the focus on improving readmission rates,” said Joseph Dula, PharmD, Regional Director of Clinical Services at Pharmacy Systems, Inc., a hospital pharmacy management and clinical consulting company that partners with hospitals, including Berger Health System.

CMS implemented a value-based purchasing program for hospitals in a  (section 3001). The program ties bonus payments for hospitals to their performance on quality measures or on their improvement in performance on quality measures; the bonus payments will be distributed in fiscal year 2013, and the measures for that round of payments are being taken from July 1, 2011, to March 31, 2012.

According to Dula, the project will improve patient safety by verifying a complete and accurate medication history on discharge (and any subsequent admissions); decrease medication errors when the pharmacist identifies potential issues during the discharge review process; improve medication adherence through face-to-face teaching and direct involvement in the education process; increase patient satisfaction scores specifically related to medications on patient surveys; and decrease readmission rates because patients will receive more frequent counseling on their medications once discharged.

“We are very fortunate to have a visionary and supportive hospital administration,” Dula told Berger’s executive team believes “pharmacists are integral to the patient care process and are very visible throughout the implementation and design of these services.”

Pharmacists in Virginia are working on a grant proposal for the CMS Center for Medicare and Medicaid Innovation for a transitions-of-care project in collaboration with an area agency on aging. The  in section 3021 and established by CMS on November 16, 2010; funded with more than $10 billion, its mandate is to test programs with new ways of paying providers and providing care, and then to expand the successful ones.

The Carilion project includes pharmacist-provided medication reconciliation, with a special emphasis on creating actionable recommendations for the physicians at discharge, using the electronic medical record and a virtual consult; the identification of and focus on high-risk patients with chronic diseases; and a direct handoff of pharmacy information, such as changes and significant issues, to community pharmacies and home health and care coordinators in patient-centered medical homes or primary care physician practices. Carilion seeks partnerships with area chain and independent pharmacies.

“It is a transitions-of-care proposal from the CMS perspective, but it also begins to demonstrate what may become best practice for integrated health systems to address readmission prevention from a pharmacy perspective,” said L. David Harlow III, BSPharm, Director of Pharmacy Operations at Carilion’s New River Valley Medical Center in Christiansburg, VA, and Tazewell Community Hospital in Tazewell, VA.

New River Valley Medical Center is the pilot site for the project, which—if successful—would roll out to the other regional hospitals and then a larger medical center in the system.

According to Harlow, the project’s goals are to demonstrate decreased pharmacy-related issues and improved transitions of care, including readmissions, fewer medication duplications, and a more streamlined process; develop a vetted best practice model that can be duplicated or embraced by other health systems; quantify a monetary value for such services; tease out a specific pharmacy model with extensive use of pharmacy technicians as well as refocused pharmacist talent; evaluate the impact that coordinated MTM has on outcomes; and begin to elucidate the value and mechanism of virtual pharmacy consults, which could help prevent admissions, not just readmissions.

“This is … about sharing what consequential clinical pharmacy transformation is and that it can in fact be done in rural settings and in small and medium scales,” Harlow told “We are after paradigm shift—and not just inside the hospital.”