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    Minn. ACO uses MTM to reduce hospital readmissions

    The Hennepin County Medical Center (HCMC), based in Minneapolis, Minn., significantly reduced hospital readmissions and emergency room visits by forming an accountable care organization (ACO) team.

    Bruce Thompson
    Under the ACO model, healthcare providers are accountable for care, quality, and cost of the Medicaid beneficiaries' services, explained Bruce Thompson, RPh, MS, director of pharmacy services for HCMC, at the McKesson ideaShare program held this summer in Las Vegas, Nev. The ideaShare continuing education program was developed and sponsored by The Institute of Wellness and Education.

    The Minnesota Department of Human Services provided a $32 million grant to HCMC and three other hospitals for late 2010 through 2011 to take care of patients in an ACO program after the Minnesota General Assistance program was discontinued in April 2010. HCMC is a 454-bed hospital with 60 clinics and 16 ambulatory pharmacists that provide medication therapy management (MTM) services.

    HCMC staff carefully tracked the progress and costs associated with approximately 8,000 patients after segmenting them into three groups based on past hospitalizations and expenses accrued. Patients who had not been hospitalized in the past year were in tier 1, those who were hospitalized once were in the tier 2 group, and those hospitalized more than once were in tier 3. Tier 3 patients were assigned a multidisciplinary team that included a pharmacist, physicians, a social worker, nurse practitioners, and other health professionals, depending on the patient.

    Nearly half of all the patients were on 10 or more different medications, which is why pharmacist involvement and intervention was necessary, according to Thompson. All patients' medications were reconciled upon both admission and discharge, and patients in the tier 3 group received a follow-up MTM visit with one of HCMC's pharmacists within five days of discharge. "We look at patients who have the highest pharmacy spend, find out why that is, and determine how we can help reduce those costs," Thompson said.

    When Medicaid patients visited any of the health system's clinics, pharmacists provided MTM services there. "Clinics would notify our MTM group if the patient did not pick up a prescription, for example," Thompson said.

    The 2011 ACO project was extremely successful. After a year, HCMC reduced hospital admissions by 42%, reduced ER visits by 37%, and reduced the cost of care by an average of $2,500 per patient. "We had 8,000 patients, so we reduced costs by $24 million," Thompson said.

    As a result, the Minnesota Department of Human Services, which operates Medicaid, funded HCMC for a second ACO project starting in January 2012. In the current project, HCMC is working with pharmacy benefit managers (PBMs), a challenging process, said Thompson, as their business model differs from the typical ACO model. "The PBM industry has looked at the cost of drug, regardless of cost of care. If the PBM industry doesn't change, they could be our next dinosaur."

    The ACO model teaches pharmacists and other healthcare providers how to provide quality care while reducing costs, Thompson said. In this year's ACO project, HCMC's pharmacy budget is $140 per patient per month.

    Clinical pharmacists are key

    Because clinical pharmacists are essential to the success of ACOs, HCMC has increased the number of clinical pharmacists from four in 2008 to around 20 currently. Because of the positive results realized at certain HCMC clinics, "more and more of our pharmacists are going into our clinics. We have about 55 clinics, and have pharmacists — some full-time and some part-time — in about 20 of them," Thompson said.

    Christine Blank is a freelance writer based in Lake Mary, Fla.