The Affordable Care Act (ACA), also known as ObamaCare, didn’t just transform health insurance. It also earmarked funds for various demonstration programs and pilot programs. These programs aim to transform the delivery of care, and impact a variety of professionals in the health care field. Pharmacists are encouraged to take part in the programs and pilots. Pharmacists may also be directly impacted by changes to prescription drug benefits in Medicare.
Medicare Shared Savings Program
In order to reduce costs and improve care, the ACA encourages the formation of Accountable Care Organizations, or ACOs. An ACO is typically a set of health professionals that work together to serve a certain population of patients. An ACO helps patients and caregivers manage their health and health care, such as avoiding duplicate tests and procedures, which saves money. In addition, within an ACO the medical professionals all have access to the same patient information, allowing them to share ideas for care and make well-informed decisions.
All of these benefits lead to lower costs and improved care for patients, one of the goals of the ACA. Pharmacists are encouraged to participate in ACOs and to be part of the circle of care that patients receive through this program.
Community-Based Care Transitions Program
Another innovative program funded by the ACA is the Community-based Care Transitions Program, or CCTP. This programs seeks to improve the transition of patients from inpatient hospital care to other care settings, while ensuring quality care and reducing the readmission rate. Hospital readmissions, especially soon after care was received, are the result of multiple factors both in and outside the hospital setting. In seeking to improve care and facilitate smooth transitions, the CCTP will realize savings in healthcare costs for insurers, patients, and Medicare.
Community based organizations receive funding for providing transition care intervention to Medicare members who are at a high risk of readmission. Pharmacists can partner with these community organizations to provide support and help them meet their goals.
Medicare Part D Prescription Plans
Pharmacists are more directly affected by the changes in Medicare Part D. Eligible beneficiaries have more than one chronic health condition, take several different medications, and have substantial total prescription drug costs, $3,017 in 2014. Previously, MTM was required but since there were no specific guidelines, the programs varied widely.
The ACA codified these requirements for certain beneficiaries, including an annual medication review by a licensed pharmacist and follow-up interventions as warranted by the annual review. Medicare beneficiaries can opt-out of the MTM process, but the Part D plan must still review medication use quarterly.
The ACA changed the way health insurance operates, but it also impacted other areas of healthcare. In addition to providing funds for pilot programs aimed at improving care, the ACA made important changes in Medicare Part D MTM programs. Pharmacists can choose whether or not to participate in an ACO or to assist a community-based organization with transition care. Overall, pharmacists are a key part of the changes that bring about improved care for all Americans.