Health System Enlists Pharmacists to Help Reduce Readmissions

As part of a new initiative, pharmacists are performing in-home assessments and creating medication management plans to help keep patients out of the hospital.

Steward Health Care System of Massachusetts has enlisted pharmacists in an effort to cut 30-day readmission rates for Medicare beneficiaries.

Launched this past summer, the Steward Healthy Transitions program identifies Medicare beneficiaries who have a discharge diagnosis of heart failure, acute myocardial infarction (MI), or pneumonia. These patients are offered a home visit and telephone follow-up from a geriatrics-trained pharmacist, who reviews the patient’s medication regimen, suggests appropriate changes, and assesses whether the patient is able to take the medications as intended.

Individuals who have been diagnosed with congestive heart failure, acute MI, or pneumonia are often readmitted within 1 to 5 days after discharge, with a key factor being medication errors made at home, according to Tina Whitney, director of care coordination and case management at Steward. “That’s why we have engaged the pharmacists to be going into the patient’s home and making sure that the patient understands what they’re supposed to be taking when they get home,” she said in an American Society of Health-System Pharmacists article.

The pharmacists are hired through an arrangement with Dovetail Health of Needham, Massachusetts, but work as Steward employees, Whitney said. The Dovetail project is part of Steward’s efforts to support the approximately 1600 physicians who provide ambulatory care to patients served by the health system’s network.

Dovetail’s care model for reducing readmissions relies on clinical pharmacists, preferably certified in geriatric care, to perform in-home assessments and create medication and health management plans for elderly patients. The company states that its services are fully integrated into its business partners’ medical management programs and function in collaboration with the partners’ health care providers.

“We really have embraced them as employees working with us,” Whitney said of the 5 pharmacists who had joined the program in October. She estimated that each hospital that routinely discharges patients with the targeted diagnoses averages about 10 visits from home pharmacists per month.

A common issue in patients with heart failure is adherence to furosemide therapy, she said, nothing that these patients have edema when they are admitted to the hospital, but the fluid is managed during the inpatient stay. When the patients arrive home, they often stop taking their medication because they feel better, which in turn results in exacerbation a few days later that can lead to another inpatient stay.

In addition to managing medication issues, the pharmacists also assess whether patients need a visiting nurse service and whether they can afford their medications, Whitney noted. “Some patients, even though you think they have good pharmacy benefits coverage, just don’t, and they don’t feel they can afford their medications and just stop [taking] them,” Whitney said. “So we look for resources for that.”

Steward hospitals’ average baseline 30-day readmission rates for heart failure, acute MI, and pneumonia were about 24%, 19%, and 18% before the home visit program started, Whitney said. Although it’s too soon to gauge the program’s effect on readmission rates, the health system expects to see them decline over time.

“I think it will really be an excellent return on investment,” Whitney said. She expects a cost savings to result from the use of community resources instead of more expensive inpatient care.