By John DeGaspari
Gaps in patient care are a longstanding problem in many health provider systems, and especially this fiscal year, when hospitals face penalties for exceeding readmission thresholds set by the Centers of Medicare and Medicaid Services (CMS). Those penalties, under the Affordable Care Act (ACA) are significant: 1 percent in Medicare payments for fiscal year 2013, rising to 3 percent in FY 2015, for avoidable hospital readmissions within 30 days for heart attack, heart failure or pneumonia.
A significant number of avoidable readmissions are linked to medication “misadventures,” in which patients are either taking their medications incorrectly or not at all, according to Joel Wright, vice president of health systems operations at the Deerfield, Ill.-based Walgreens Co. He cites industry statistics that nearly one-third of patients who are discharged from the hospital never get their prescriptions filled at all. In October of last year the retail pharmacy chain launched a program, called WellTransitions, that Wright says could help hospitals improve medication adherence, and in the process, help hospitals improve their readmission rates.
According to Walgreens, the WellTransitions program allows clinicians to review existing prescriptions with new prescriptions issued in the hospital to determine proper alignment. Upon discharge, the system ensures that patients receive their proper prescriptions. The Walgreens pharmacists follow up with the primary care physicians and counsel the patients on the medication regimen. Patients are contacted nine days after discharge, and again at 25 days, to reinforce patient understanding, promote adherence, and offer disease-specific consultation. Walgreens also collaborates with hospitals on monthly joint outcome reports that assess the program’s effectiveness.
The WellTransitions initiative was operated as a pilot project for about a year before its actual launch, during which Walgreens made adjustments and improvements to the program, Wright says. By the time it was out of the pilot stage, early results showed the program was making a positive impact and the company began to approach health systems across the country, he says. In an example of good timing, the Walgreens began its early work just prior to the launch of CMS’ Community-Based Care Transitions Program (CCTP). Under that program, CMS was offering to fund organizations that could better manage the transition of Medicare patients back into their communities and improve their quality of care.
Ultimately, Walgreens did not win CCTP funding, but the program led to the company’s collaboration with Dallas-based Loopback Analytics, the vendor that provided the care transitions platform and dashboard that the WellTransitions program is built on. The Loopback platform establishes real-time connectivity to the hospitals’ clinical information systems, explains Loopback CEO Neil Smiley. The software-as-a-service (SaaS) platform is able to link to various data systems and normalize the data in a common data center that supports its services. When the patient arrives at the inpatient setting, the system sets up a population screen on the front end that identifies characteristics that may make the patient a risk for readmission and draws a connection with the patient as he or she moves through the health system. On the back end, it analyzes the engagement that has occurred with the patient and how it affected outcomes.
Wright says that the WellTransitions program was initially limited to very basic questions, but quickly improved the question set by including more clinical information, as well as questions to make sure that patients followed through on appointments with their physicians.
The platform is designed to be used by Walgreens pharmacies, both its roughly 175 on-site locations in hospitals and medical office buildings, as well as its more than 8,300 retail pharmacy locations. Patients who are admitted to participating hospitals are given a choice whether to work with a Walgreens pharmacist or one of their own preference. According to Wright, the chain’s huge network could make pharmacies an important player in healthcare reform that could help hospitals lower readmissions and improve other metrics such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. “It was an opportunity to provide value to the health system beyond being a convenient place for patients to get prescriptions,” he says.
Patients are given the choice of whether to work with the Walgreens pharmacy or another pharmacy of their choice. In either case, Wright says, “we will work to get the patient transitioned into the community. Our relationship contractually is with the health system.”
Wright says the platform was initially designed for hospitals around the issue of reducing readmissions, but notes that Walgreens has also gotten inquiries from newly formed accountable care organizations (ACOs), large employers and health plans. He said the company is currently working with ACOs, whose business model aligns well with the platform.
Wright describes the dashboard is a workflow tool that allows the pharmacists to see which patients need to be visited or require phone calls or other follow-up. The main user is the pharmacist, whose traditional role is enhanced because they have access to more information about the patient’s disease and care plans than they would generally have, so they can do more as part of the patient care team, he says.
Wright says the WellTransitions platform is now established in about 20 healthcare provider orgsanizations. He says an early implementation of WellTransitions at DeKalb Medical in Decateur, Ga., has resulted in a 40 percent reduction in the likelihood of readmission among patients in the program, as well as a 10 percent improvement in the hospital’s HCAPHS score.