‘Building the ACO’ revisited

DSN Oct. 15, 2012

The ink was barely dry when we received this response to our Oct. 15, 2012, cover story, “Building the ACO.”

Dear Editor,

Thank you for your excellent article, “Building the ACO.” It is clear that U.S. healthcare policy is moving in the direction of accountability and performance. The objective is to spread primary care responsibility across an integrated healthcare team. As you note, ACOs address the goals of improving healthcare access and outcomes while decreasing cost. I fully agree that this approach is in the best interest of individuals and the healthcare system. It is an example of a policy gone right! 

We now have a significant body of research — both government and commercial — demonstrating the value and [return on investment] of integrating community pharmacists into key roles on ACO teams. In my view, the role of the pharmacist in the ACO paradigm is pivotal. As the medical professionals with the broadest knowledge of medicines, and often the most accessible, pharmacists are in a unique position to help impact medication adherence. There is widespread agreement that medication adherence is one of the greatest contributing factors to overall healthcare costs in the United States, ... ultimately costing more than $290 billion annually — and growing. 

The cost story is clear. The Boehringer Ingelheim data that you cite demonstrate that it is one-third less expensive to visit a retail clinic versus a physician’s office and five times as expensive to go to an emergency room versus a retail clinic. According to the [Centers for Disease Control and Prevention], when pharmacists take a central role in helping to manage medication therapy, the ROI ranges between 3:1 and 5:1, and can be as high as 12:1, based on reduced hospital admissions, use of unnecessary or inappropriate medications, emergency room admissions and overall physicians visits. Other data have supported the role of pharmacists in helping to manage other routine services, such as vaccinations, blood pressure monitoring, and risk factor and lifestyle modification counseling. 

Despite the well-documented opportunity at hand with community pharmacies, legislation and private-payer reimbursement models are still lagging in fully recognizing and enabling community pharmacists to fulfill their potential on ACO teams. As a pharmacist and the founder and CEO of RxAlly, I am proud that members of our industry are not waiting for policy and reimbursement models, but have been at the front line advancing the practice of pharmacy forward through innovative research and partnerships. It is this model of pharmacists playing a central role in an ACO on which RxAlly was conceived. With more than 22,000 member pharmacies nationwide, RxAlly has brought together the largest national network of pharmacies to improve health and lower costs. The RxAlly Performance Network of community pharmacies aims to improve health through personalized pharmacist care; reliable, evidence-based clinical practices; proprietary research; and an interoperable technology platform, which many — including you — have identified as central to the success of any ACO. 

... I appreciate the role of DSN in tracking and reporting on critical trends and hope you and your readers will continue to focus, in particular, on advocating for legislation and reimbursement policies that further our evolution toward effective ACO models that take full advantage of all that pharmacists and community pharmacies have to offer.


Bruce T. Roberts, R.Ph.

Chairman and CEO, RxAlly

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