Jennifer Zilka

Reduced readmission rates are what all hospitals and health systems are striving for today. These rates are extremely important as health systems aim for better patient outcomes and look to improve performance in today’s value-based care environment.

Part of the Affordable Care Act requires CMS to reduce payments to hospitals with excessive readmission rates, but achieving lower readmission rates isn’t always easy.

There are many reasons why a patient may return for additional care, and sometimes these visits are not preventable, but it’s critical that hospitals start by evaluating and eliminating avoidable adverse events. This process starts with addressing non-adherence among patients. A recent 

 found that between 33 and 69 percent of all medication related admissions could be attributed to non-adherence. As hospital teams look for new solutions for this persistent issue, they must engage with one of the most effective and efficient options: partnering with independent community pharmacies.

Independent pharmacies are established sources of care in their communities and uniquely positioned to prevent medication non-adherence. Unlike clinicians who may only see their patients three or four times per year, community pharmacists often see patients 35 per year. These pharmacists are known for having strong relationships with those they serve, along with the capability to offer personalized care and intervene when patients become non-adherent. At the same time, health systems can support the growth of a pharmacy’s business through increased access to patients and their associated prescription counts.

To leverage these mutual benefits and maximize outcomes for patients, both pharmacies and health systems can easily collaborate. Through our work with independent pharmacies across the country, we have identified three ways in which pharmacists and hospitals can create and sustain long-lasting partnerships that ultimately improve patient care.

Medication Therapy Management (MTM) refers to an array of services that pharmacies can provide, including establishing medication treatment plans, monitoring medication treatment performance, patient education, adherence programs, and more. The most successful partnerships we have seen utilized an independent pharmacist’s MTM program onsite at the health system. In these cases, the independent pharmacy visits patients receiving inpatient care at the hospital and coordinates the activities within the MTM program.

MTM programs are successful in alleviating adherence issues because they help patients understand their therapy regimen and why it’s important as they transition their care, along with proactively identifying any side effects or challenges the patient could have. Pharmacists should work directly with the health systems’ discharge nurses when conducting MTMs to build collaboration and ensure coordinated care across the patient’s care team.

Independent community pharmacies can be nimble, responsive, and innovative in the programs they implement. Their flexibility and ability to tailor programs to meet patients when, where, and how they need them is unique. For example, an independent pharmacy can work with a health system to determine the best medication delivery program for its community of patients, whether it’s a “meds-to-beds” program or a “hand delivery” program outside of the hospital.

In operating a meds-to-beds program, independent pharmacists work onsite at the hospital and proactively meet with patients most at-risk for non-adherence and possible readmission, even before they are released from the hospital. Through this program, they deliver discharge medications to these patients’ bedside and thoroughly counsel them on their treatment regimen before they leave the hospital. This is both a huge benefit to hospitals and independent pharmacies.

In executing a hand-delivery program-which differs from “home-delivery” in that the pharmacist will not leave the medication at the address unless the patient is there-pharmacists interact with the patient in their home and can serve as a valuable touchpoint on behalf of a health system or hospital. It is an opportunity for the pharmacist to address patient questions and concerns about side effects and treatment regimens once the patients are home.

Communication is critical in ensuring both parties feel the value of working together and maximizing service for patients. When pharmacies and health systems team up to rely on each other in caring for patients, it is easier to coordinate care and improve outcomes.

Pharmacists can support this continued communication by holding monthly meetings with key stakeholders within the hospital or health system. During these meetings, the team can review current processes to address any issues or opportunities to improve. Teams should thoughtfully consider the stakeholders. For example, the health system’s director of pharmacy should certainly be included, but it may also be beneficial for the chief nursing officer, who is often focused on clinical outcomes and tasked with adherence, to be involved as well.

From there, reaffirming the results through quarterly and annual reporting will help support the long-term growth and sustainability of a partnership. Reporting should include data that demonstrates how the partnership is improving care while driving readmission rates down.

Non-adherence is one of the most preventable issues affecting healthcare today. By taking steps today to create a partnership, independent pharmacies and health systems can work together to provide tailored and coordinated solutions that address adherence challenges and help patients get the care they need to live healthier lives. Through this type of partnership, patients experience better health outcomes, hospital systems maintain strong reimbursement under new value-based care models with reduced readmissions, and independent pharmacies can grow their business and improve patient care.

Jennifer Zilka is the group vice president of Good Neighbor Pharmacy field programs & services, a part of AmerisourceBergen.

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By working together, health systems and independent pharmacists can create and sustain long-lasting relationships to benefit patients.

Author | Jennifer Zilka

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3 ways hospitals and community pharmacies can address adherence