An insurer's care transition program emphasizes medication reconciliation, reduces readmissions and costs

Health Affairs

Volumn 35, Issue 7, 2016, Pages 1222-1229

  Polinski, Jennifer M ^a   Moore, Janice M ^a   Kyrychenko, Pavlo ^a   Gagnon, Michael ^a   Matlin, Olga S ^a   Fredell, Joshua W ^a   Brennan, Troyen A ^a   Shrank, William H ^a  

^a CVS Caremark   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; ARTICLE; ASTHMA; BIPOLAR DISORDER; CHRONIC OBSTRUCTIVE LUNG DISEASE; CONGESTIVE HEART FAILURE; CONTROLLED STUDY; COST CONTROL; DIABETES MELLITUS; DIZZINESS; END STAGE RENAL DISEASE; FEMALE; FOLLOW UP; HEALTH INSURANCE; HIGH RISK PATIENT; HOSPITAL READMISSION; HOSPITALIZATION; HUMAN; INCIDENCE; MAJOR CLINICAL STUDY; MALE; MEDICATION THERAPY MANAGEMENT; PHARMACY BENEFIT MANAGER; PNEUMONIA; PROFESSIONAL PRACTICE; RISK ASSESSMENT; RISK REDUCTION; SCHIZOPHRENIA; TELECONSULTATION; TOTAL QUALITY MANAGEMENT; TREATMENT OUTCOME; ADVERSE DRUG REACTION; AGED; COHORT ANALYSIS; COMPARATIVE STUDY; ECONOMICS; HEALTH CARE DELIVERY; INSURANCE; MIDDLE AGED; ORGANIZATION AND MANAGEMENT; PATIENT CARE; PATIENT TRANSPORT; PHARMACIST; PROCEDURES; PROFESSIONAL STANDARD; PROPENSITY SCORE; STATISTICS AND NUMERICAL DATA; UNITED STATES;

ADULT; AGED; COHORT STUDIES; CONTINUITY OF PATIENT CARE; COST SAVINGS; DELIVERY OF HEALTH CARE; DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS; FEMALE; HUMANS; INSURANCE CARRIERS; MALE; MEDICATION RECONCILIATION; MIDDLE AGED; PATIENT READMISSION; PATIENT TRANSFER; PHARMACISTS; PROFESSIONAL ROLE; PROPENSITY SCORE; UNITED STATES;

EID: 84980347713     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2015.0648     Document Type: Article

References (32)

1. Agency for Healthcare Research and Quality. All patient readmissions within 30 days: national statistics, 2013 [Internet]. Rockville (MD): AHRQ; [cited 2016 May 17]. Available from: http://hcupnet.ahrq.gov/HCUPnet.jsp?Id=D8072526039C960C&Form=DispTab&JS=Y&Action=Accept
2. Hines AL, Barrett ML, Jiang HJ, Steiner CA. Conditions with the largest number of adult hospital readmissions by payer, 2011 [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; [last modified 2014 May 9; cited 2016 May 10]. (H-CUP Statistical Brief No. 172). Available from: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb172-Conditions-Readmissions-Payer.jsp
3. Horwitz L, Partovian C, Lin Z, Herrin J, Grady J, Conover M, et al. Hospital-wide all-cause risk-standardized readmission measure: DRAFT measure methodology report [Internet]. New Haven (CT): Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation; [last updated 2011 Aug 10; cited 2016 May 10]. Available from: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/downloads/MMSHospital-WideAll-ConditionReadmissionRate.pdf
4. Aetna [Internet]. Hartford (CT): Aetna. News release, Aetna, Genesis HealthCare take aim at preventing hospital readmissions; 2011 Aug 10 [cited 2016 May 10]. Available from: https://www1.aetna.com/news/newsReleases/2011/0810_Aetna-Genesis_HospitalReadmissions.html
5. Adamy J. Well Point shakes up hospital payments. Wall Street Journal. 2011 May 16.
6. Centers for Medicare and Medicaid Services. ACO #8-risk-standardized all condition readmission [Internet]. Baltimore (MD): CMS; [cited 2016 May 10]. Available from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/Measure-ACO-8-Readmission.pdf
7. National Committee for Quality Assurance. HEDIS® and performance measurement [Internet]. Washington (DC): NCQA; [cited 2016 May 10]. Available from: http://www.ncqa.org/HEDISQualityMeasurement.aspx
8. Rau J. A guide to Medicare's readmissions penalties and data. Kaiser Health News [serial on the Internet]. 2014 Oct 2 [cited 2016 May 10]. Available from: http://kaiserhealthnews.org/news/aguide-to-medicare-readmissionspenalties-and-data/
9. Mathews R, Wang TY, Honeycutt E, Henry TD, Zettler M, Chang M, et al. Persistence with secondary prevention medications after acute myocardial infarction: insights from the TRANSLATE-ACS study. Am Heart J. 2015;170(1):62-9.
10. Overlack A. ACE inhibitor-induced cough and bronchospasm. Incidence, mechanisms, and management. Drug Saf. 1996;15(1):72-8.
11. Harris CM, Sridharan A, Landis A, Howell E, Wright S. What happens to the medication regimens of older adults during and after acute hospitalization? J Patient Saf. 2013;9(3): 150-3.
12. Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI. Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med. 2012;27(11):1513-20.
13. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003; 138(3):161-7.
14. McDonnell PJ, Jacobs MR. Hospital admissions resulting from preventable adverse drug reactions. Ann Pharmacother. 2002;36(9):1331-6.
15. Hawes EM, Maxwell WD, White SF, Mangun J, Lin FC. Impact of an outpatient pharmacist intervention on medication discrepancies and health care resource utilization in posthospitalization care transititions. J Prim Care Community Health. 2014;5(1):14-8.
16. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5): 565-71.
17. Kilcup M, Schultz D, Carlson J, Wilson B. Postdischarge pharmacist medication reconciliation: impact on readmission rates and financial savings. J Am Pharm Assoc (2003). 2013;53(1):78-84.
18. Walker PC, Bernstein SJ, Jones JN, Piersma J, Kim H-W, Regal RE, et al. Impact of a pharmacist-facilitated hospital discharge program: a quasiexperimental study. Arch Intern Med. 2009;169(21):2003-10.
19. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009; 150(3):178-87.
20. Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, et al. Reduction of 30-day postdischarge hospital readmission or emergency department visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211-8.
21. Kwan JL, Lo L, Sampson M, Shojania KG. Medication reconciliation during transitions of care as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2): 397-403.
22. Patel SM, Welchel W, Thompson AN. Evaluation of pharmacist-managed medication reconciliation process after hospital discharge at an internal medicine clinic. J Pharm Pharmacol. 2014;2:482-8.
23. American Hospital Association. Fast facts on US hospitals [Internet]. Chicago (IL): AHA; [updated 2015 Jan; cited 2016 May 10]. Available from: http://www.aha.org/research/rc/stat-studies/101207fastfacts2015.pdf
24. Kirch DG. How sequestration will hurt patients. Congress Blog [blog on the Internet] 2013 Feb 13 [cited 2016 May 10]. Available from: http://www.thehill.com/blogs/congress-blog/healthcare/282793-how-sequestration-will-hurt-patients
25. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987; 40(5):373-83.
26. Census Bureau. American Community Survey: ACS data tables on American FactFinder [Internet]. Washington (DC): Census Bureau; [cited 2016 May 13]. Available for download from: http://www.census.gov/acs/www/data/data-tables-andtools/american-factfinder/
27. Schneeweiss S, Walker AM, Glynn RJ, Maclure M, Dormuth C, Soumerai SB. Outcomes of reference pricing for angiotensin-convertingenzyme inhibitors. N Engl J Med. 2002;346(11):822-9.
28. Deddens JA, Peterson MR. Approaches for estimating prevalence ratios. Occup Environ Med. 2008; 65(7):481, 501-6.
29. Schneeweiss S. Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics. Pharmacoepidemiol Drug Saf. 2006;15(5):291-303.
30. Walker AM. Observation and inference: an introduction to the methods of epidemiology. Chestnut Hill (MA): Epidemiology Resources, Inc.; 1991.
31. Phillips CV. Quantifying and reporting uncertainty from systematic errors. Epidemiology. 2003;14(4): 459-66.
32. CMS.gov. New data on geographic variation [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [last modified 2015 Jan 27; cited 2016 May 17]. Available from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Geographic-Variation/GV_PUF.html