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Readmissions drop when pharmacists visit patients' homes


Jim O'Neil

Imagine this: During an appointment with a primary care doctor, a patient pulls out a brown paper bag filled with prescription medication bottles, half of which are open and the pills have spilled out. Some of the medications were prescribed upon his discharge from a hospital, but others were prescribed prior to the hospitalization. He looks at the doctor and asks which, if any, meds he should be taking.

It's an all-too-familiar scenario, Thomas Ebert, chief medical officer of Springfield, Mass.-based HMO Health New England (HNE), told FierceHealthPayer. But the patients in these situations are the fortunate (and rare) ones because Ebert, when he worked as a primary care physician, would review the meds and explain what the patients should be taking. In that one simple step, he helped avoid unnecessary hospital readmissions.

Unfortunately, the increasingly common circumstance that post-discharge patients, particularly Medicare Advantage members, find themselves in lacks such a primary care consultation. Follow-up appointments with patients' primary care providers are rarely scheduled, and primary care physicians often never know their patients were admitted to the hospital.

Post-discharge follow-up is so important because discharge instructions are often hard to understand, and many patients are unable to follow them. Because most Medicare Advantage members are older, sicker and have more chronic illnesses, they usually leave a hospital stay with a long list of meds but aren't always clear about how to manage those prescriptions.

These breakdowns in communication and care following a hospital stay has led to a 20 percent 30-day readmission rate for Medicare Advantage patients--a number Ebert calls "alarming."

A very central aspect of the lackluster care transition is the patient's medication management (or lack thereof), often resulting in patients taking too many meds, taking meds that are contraindicated or not taking enough meds. "The most common cause of unnecessary hospital readmission is a mistake related to drugs," Ebert said.

That's why Ebert and HNE have implemented a new model addressing medication management post-discharge for its Medicare Advantage members. The program involves pharmacists making home visits to patients who are at an increased risk for readmission, including patients with chronic diseases or who take multiple medications.

"Pharmacists are key because medications play such a large role in early and unnecessary hospital readmissions," Ebert said. "There's always some level of confusion or lack of understanding when the pharmacist goes into the home."

During the in-home visit, which occurs within 72 hours of discharge, the specially trained pharmacist reviews the patient's prescription and over-the-counter medications, provides clear instructions for how the meds should be taken and answers any medication-related questions. If needed, they will discard any unnecessary meds, which Ebert said, is a "critical element of preventing drug-drug interactions."

The results have shown this is a tactic worth exploring. The HNE pilot program has decreased its Medicare Advantage members' hospital readmission rate, dropping from 14 percent of patients who are readmitted to the hospital within 30 days of discharge to 8 percent, within the first six months of the pilot program.

Ebert recognizes that Health New England's program is treating only a symptom of the overall failing system rather than addressing the root cause. He cautioned that this new program is just "one piece of the puzzle in the systemic problem around transitioning of care for patients." However, he remains hopeful that it can contribute to the ultimate improvement of reducing unnecessary readmission rates. So do I. -Dina (@FiercePayer)