WHAT IT MEANS AND WHY IT'S IMPORTANT — WellTransitions could be couched as another way in which Walgreens is striving to create solutions that lower the cost of overall health care outside of the physical retail pharmacy space, because it is. WellTransitions also could be characterized as a program that will routinely chip away at the $25 billion associated with hospital re-admissions by having more prescriptions filled at the pharmacy counter, because it does. But the real impact of this news? The real clincher? Hospitals need retail pharmacy if they're going to focus on reducing re-admissions, eliminating unnecessary healthcare costs and avoiding those penalties.
(THE NEWS: Walgreens introduces WellTransitions, a coordinated care model that works in tandem with hospitals. For the full story, click here.)
And that's the direction Walgreens is headed. Most recently, the company added managed care vet Brad Fluegel as chief strategy officer, adding another talented expert to Walgreens chief Greg Wasson’s dream team, which he has described as the “perfect blend of internal, long-term talent” and “external expertise and talents” that is helping to accelerate a massive transformation in its business. (For exclusive coverage of all Walgreens' efforts, click here for the Sept. 24 DSN special report.)
For the first year, hospitals are only being measured on 30-day re-admissions across three medical conditions: heart attacks, heart failure and pneumonia. Taking re-admission rates around heart attacks as an example, heart attacks are among the top 10 reasons for hospitalization among adults ages 45 years and older, according to a statistical brief recently issued by the Healthcare Cost and Utilization Project — a family of healthcare databases and related software tools and products developed through a federal/state/industry partnership and sponsored by the Agency for Healthcare Research and Quality. In 2009, there were 633,000 patients admitted for acute myocardial infarction. Close to 1-in-5 of those patients, or 17.1%, were re-admitted to the hospital within 30 days.
Medication therapy management isn't a magic wand, mind you. But it can be a hefty tool that if employed properly can take a significant swipe at reducing that readmission statistic. And a lot of hospitals aren't focused effectively on medication therapy management.
According to a study published in the August 2012 issue of the Journal of the American College of Cardiology, a significant number of hospitals failed to employ medication therapy management as a tool to help boost medicine adherence and consequently reduce re-admission rates. In about 14% of hospitals, responsibility for medication reconciliation was never formally assigned. "For nearly one-half of the hospitals, a pharmacist or pharmacy technician was never involved with obtaining the medication history, and a small proportion of hospitals reported always making contact with an outside pharmacy or with the primary physician as part of the medication reconciliation process (in 3.2% and 13.9% of hospitals, respectively)," the report read. "Although patient education about medications was apparently robust, with 70% of hospitals reporting the use of 'teach-back' techniques and 77% reporting that all medication details were given to patients at discharge, lack of standard processes for both the reconciliation and patient education regarding medications is potentially problematic."
But why might these practices be lacking in so many hospitals? "One reason might be because they require added resources," the authors concluded. "Particularly in the case of producing timely discharge summaries and ensuring adequate patient and caregiver education about complex medication and other issues, it is possible that constraints on staff time is a major rate-limiting step to implementing some of these potentially best practices."
A pharmacy can help solve that problem.
According to a study published in Circulation, the journal of the American Heart Association, nonadherence to medications is common for patients with cardiovascular diseases. Almost 1-in-4 never filled their prescriptions. Among patients discharged with prescriptions for aspirin, statin and beta blockers, almost 34% of patients stopped taking at least one of those medicines within a month after discharge, and 12% had stopped taking all three.
And the fact that a pharmacist intervention can produce the desired results has been long documented. In a 2007 study published in the Annals of Internal Medicine, there was a 19.4% reduction hospital readmissions in patients seen by pharmacists.