Provider Responsiveness to Pharmacist Recommendations in a Population Health Setting.

OBJECTIVE: Geriatric patients are more sensitive to medications and are at risk for polypharmacy, requiring a medication review. It is hypothesized that a justin-time message to the primary care provider (PCP) recommending a change to potentially inappropriate medications may increase the rate of acceptance of pharmacist recommendations.
DESIGN: Prospective, quality improvement study.
SETTING: Health-system-based primary care facilities.
INTERVENTIONS: Providers were contacted two business days prior to the patient's appointment with a recommendation based on a Beers criteria-derived algorithm. If a PCP was colocated with a pharmacist in the clinic, the preferred method of communication was queried.
PATIENTS, PARTICIPANTS: Medical records of patients 65 years of age or older enrolled in the Johns Hopkins Medicine Alliance for Patients Accountable Care Organization were evaluated for tricyclic antidepressant use in neuropathy, insomnia, and depression; and benzodiazepine use in anxiety and insomnia if prescribed by the PCP.
MAIN OUTCOME MEASURE: The primary outcome was to determine the number of recommendations accepted by the PCP.
RESULTS: A total of 252 recommendations were made with a total of 26.2% recommendations being accepted (22.1% for benzodiazepines and 22.7% for tricyclic antidepressants). Of the 26.2% of recommendations accepted, 56% had a pharmacist in the clinic. A total of 96.7% of PCPs preferred a message to be sent through the patient's medication record.
CONCLUSION: A just-in-time approach in making recommendations to PCPs was successful in leading to medication changes. There was no statistical difference between physician acceptance of pharmacist recommendations in relation to a pharmacist being embedded in the clinic.

Strategic Review Process for an Accountable Care Organization and Emerging Accountable Care Best Practices.

Accountable Care Organizations (ACOs), like other care entities, must be strategic about which initiatives they support in the quest for higher value. This article reviews the current strategic planning process for the Johns Hopkins Medicine Alliance for Patients (JMAP), a Medicare Shared Savings Program Track 1 ACO. It reviews the 3 focus areas for the 2017 strategic review process - (1) optimizing care coordination for complex, at-risk patients, (2) post-acute care, and (3) specialty care integration - reviewing cost savings and quality improvement opportunities, associated best practices from the literature, and opportunities to leverage and advance existing ACO and health system efforts in each area. It then reviews the ultimate selection of priorities for the coming year and early thoughts on implementation. After the robust review process, key stakeholders voted to select interventions targeted at care coordination, post-acute care, and specialty integration including Part B drug and imaging costs. The interventions selected incorporate a mixture of enhancing current ACO initiatives, working collaboratively and synergistically on other health system initiatives, and taking on new projects deemed targeted, cost-effective, and manageable in scope. The annual strategic review has been an essential and iterative process based on performance data and informed by the collective experience of other organizations. The process allows for an evidence-based strategic plan for the ACO in pursuit of the best care for patients.