Pharmacist-run transition-of-care programs reduce the likelihood of high-risk patients returning to the hospital, and can also create significant savings for health plans, according to a USC-led study published in the Journal of Managed Care & Specialty Pharmacy in February 2018.
“The evidence is clear: Transition-of-care programs by pharmacists, including telephone follow-up, discharge counseling and medication reconciliation, are successful in reducing hospital readmissions and decreasing healthcare costs,” says corresponding author Jeffrey McCombs, associate professor at the USC School of Pharmacy and the USC Schaeffer Center for Health Policy & Economics. “We created a budget impact model to simulate the economic impact of an expansion of these programs to serve even more high-risk patients.”
In a program tested at Kern Health Systems in Bakersfield from April 2013 to March 2015, pharmacists from Synergy Pharmacy Solutions oversaw the transition of about 1,100 high-risk managed Medicaid patients discharged from the hospital. Synergy pharmacists called these patients two to four days after discharge to offer help in resolving any medication-related problems.
USC researchers found that the program reduced the risk of hospital readmission within six months by 32 percent, saving the health plan $2,139 per patient referred, compared with patients receiving the usual discharge care. These estimates are likely conservative, as the analysis included all patients referred, including those who refused service. These results were published in a March 2017 study in the American Journal of Managed Care.
For the February 2018 study, investigators created a budget impact model to simulate the economic effects of expanding such transition-of-care services over a two-year period. According to their analysis, doubling the eligible patient population would lead to cumulative cost savings to the health system of more than $25 million.
Researchers simulated two scenarios: referring patients to the Synergy program for services or giving equally qualified patients from nonparticipating hospitals only the usual post-discharge care. The cumulative inpatient and total healthcare costs over two years were then compared across the two scenarios.
They found that the transition-of-care program saved more than $3 per member per month in the first six months, and $4 per month within two years, which translates to more than $25 million in total healthcare savings. The costs were primarily driven by the estimated reduction in inpatient costs.
“The budget-impact analysis shows that pharmacist-run transition-of-care programs, when implemented effectively, could provide really significant savings for health systems,” says Danielle Colayco, PharmD ’08, MS ’10, co-author of the February 2018 study and director of health outcomes and value strategy at Komoto Healthcare.
Weiyi Ni, MA ’16, PhD Health Economics ’17 was lead author of the February 2018 study, which was funded by the Komoto Family Foundation.