Impact of a PBM clinical program on transitions of care

August 10, 2020

Melanie Herbst, MSN, RN, CCCTM; Elizabeth Giunta, PharmD, BCACP; Binal Patel, MPharm, BCGP; Courtney McMahon, PharmD, BCACP

Adverse drug events are a preventable cause of hospital admissions and readmissions. More than 1.5 million preventable adverse drug events occur each year as a result of medication errors. An estimated 20% of adverse drug events could be avoided with proper communication and coordination of care during transitions.

The hospital-embedded care manager (TOC nurse) has the ability to impact the population being served through modeling and supporting inter-professional relationships while utilizing assessment skills, advocacy, and joint care planning to optimize interventions and engage patients in their own care. Interventions during and after discharge have been shown to reduce adverse drug events, medication related readmissions, and emergency room visits. This population has a high likelihood of having numerous medication related problems and, subsequently, a high likelihood of benefiting from both pharmacist interventions and care management services.

PerformRx’s Drug Therapy Management (DTM) program designed and implemented a transitions of care (TOC) program to reduce hospital readmission rates, decrease health plan expenditure, and improve overall patient outcomes by increasing patient engagement, optimizing medication regimens, and ensuring access to medication therapy. 

Program Workflow

Methods

Program Enrollment:

• Members were identified and enrolled into the program based on hospital admission over the study period.

Inclusion Criteria:

• Members with a designated Medicaid insurance admitted to specified hospital

Exclusion Criteria:

• Members with an active diagnosis of cancer, on hospice, or any severe/terminal condition with little likelihood of recovery

Data Analysis

• Statistical analysis of readmission rates was compared for engaged members (received outreaches from the TOC nurse and pharmacist) to non-engaged members (members who had an inpatient readmission during the same time period in a similar health plan)
• Analysis of readmissions in the engaged group was then compared 6 months pre-engagement verses 6 months post-engagement

Results

Conclusion

Traditionally transitions of care are managed by the inpatient care team with assistance from case managers and social workers, but poor communication and lack of continuity often lead to suboptimal care during these transitions, medication-related problems, and ultimately higher hospital readmission rates. With access to most, if not all, pharmacy and medical information, clinical teams at a PBM are in an ideal position to act as a liaison between the inpatient and outpatient care teams and optimize member outcomes through transitions.

Through the PerformRx DTM Program, the TOC nurse is able to engage members and be active in the care planning during their hospitalization. Innovative technology allows the member the opportunity to connect with a PBM pharmacist before they leave the hospital for education and to address any medication issues or concerns. The TOC nurse can collaborate with the inpatient care team before, during and after the discharge process to ensure medication-related problems are prevented or resolved.

Technology, such as telehealth video consultations, allows the remote pharmacist to engage with members during hospitalization and establish a trusting rapport. The PBM pharmacist is able to capitalize on this relationship after discharge to keep members engaged and achieve sustained optimal member outcomes.

Nurse-led PBM involvement at transitions of care has shown to positively impact healthcare costs, readmission rates, medication-related problems, and patient engagement.

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