A mid-sized Midwest health plan partnered with ActualMeds to tackle one of the most persistent and challenging problems in care management: avoidable hospital readmissions for the high-risk patient populations.
The results were compelling:
- Members belonging to Heart Failure, Diabetes and COPD cohorts, who received a pharmacist-completed Medication Reconciliation Post-Discharge (MRP) within 30 days of discharge that included follow-up with both the patient and their provider, had a 12% readmission rate.
- Members who did not receive an MRP, had a 20% readmission rate- a 40% relative reduction.
- Over 12 months, the program avoided an estimated 418 readmissions as compared with national risk data for those same chronic disease conditions, and equivalent to $4.1 million in gross savings based on the average cost of an associated readmission. Using the plan ‘s own historical averages, an estimated 786 hospital readmissions were avoided, projecting $7.8 million in potential savings.
Using an AI-enabled platform, these outcomes are not only possible, but scalable as pharmacist -led medication reconciliation can provide care teams with medication intelligence when and where it is needed.
The Problem Is Well-Documented. The Solutions Are Not.
Medication discrepancies occur in a significant percentage of hospital admissions and discharges. They are a leading cause of adverse drug events that result in emergency department visits, and preventable readmissions. For members with Heart Failure, Diabetes, and COPD, the stakes are especially high. They are the most complex, highest-utilizing members, as nearly half presented with chronic co-morbidities in this program
The period immediately after discharge is the most dangerous time for these members. Yet most health plans lack access to data, technology and service infrastructure to close the gap at scale, and to prevent unnecessary and costly readmissions.
A Pharmacist-Led Solution Built for Scale
ActualMeds deployed its Pharmacist On DemandÔ solution across approximately 22,000 discharge events representing nearly 14,000 unique members over a 12-month period. The member population spanned all lines of business, with the majority representing a Managed Medicaid Population.
Here is how the solution works:
- Notice of Admission/Discharge/ Transfer of members is received by system daily. The system pulls medication data from EHR aggregators, claims and health plans to assemble the most current and best possible medication history for the member at the time of discharge from an acute care episode.
- The system’s evidence-based risk framework identifies potential adverse drug events and other gaps in care and presents them for review by experienced clinical pharmacists.
- Pharmacists adjudicate the system results and designate recommendations to be included in a system generated Medication Reconciliation Post Discharge (MRP) report for the provider and a corresponding Medication Action Plan for the member.
- Value-based care alignment: A proven, scalable model for transitions of care supports broader VBC strategies with quantifiable cost savings and favorable ROI.
- Utilization management: Fewer readmissions mean lower inpatient costs and better resource allocation across the plan.
- HEDIS performance: Completing MRPs consistent with HEDIS requirements improves quality scores and Star Ratings performance.
Data handling, risk identification and workflow is directed by the system allowing pharmacists to focus on clinical decision-making and follow-up with provider and member if needed.
Successful Care Transitions Lead to Improved Outcomes for High-Risk Members and Better Performance for the Plan
The program exceeded its stated readmission reduction goal of 17% by more than double. Results were consistent across disease cohorts and most pronounced among members with multiple co-morbidities.
Health plans that invest in structured, pharmacist-led transitions of care programs are not just improving their bottom line. They are providing members with a more seamless experience that results in better on-going management of their chronic conditions.
If your plan is ready to reduce readmissions and build an effective and scalable model for improving transitions of care, contact ActualMeds today.
