Medication Reconciliation Reviews

Medication reconciliation is the process of avoiding inadvertent inconsistencies within a patient’s drug regimen which can occur during transitions of care. Plainly, these reviews are conducted to assure that the patient is on the appropriate drug therapy regimen after experiencing care transitions. The focus of this program is on patients who have been discharged from the hospital within the previous 72 hours.

Why is Medication Reconciliation needed?

Patients admitted to the hospital commonly receive new medications or have changes made to their existing medications. Hospital based clinicians may not be able to easily access patients’ complete medication lists, or may be unaware of recent medication changes. As a result, the new medication regimen prescribed at the time of discharge may inadvertently omit needed medications, unnecessarily duplicate existing therapies, or contain incorrect dosages.

Medication discrepancies are common at hospital discharge and can result in adverse events, hospital readmissions, and emergency room visits.

Approximately 20% of patients discharged from the hospital to home experience post-discharge adverse drug events (ADEs), nearly two-thirds of which are medication related. Twenty-nine percent of these adverse drug events are serious or life threatening, sometimes resulting in emergency department visits and additional hospital admissions.

It is estimated that 60% of post-discharge ADEs can be prevented or ameliorated, and studies suggest that redesigning the discharge process to incorporate medication reconciliation, discharge counseling and post-discharge follow-up can help reduce the incidence of these ADEs and their associated costs.

PPCN is 100% independent and fully committed to improving patient outcomes, which generates savings for the plan sponsor and its members. It has no ties to pharmaceutical firms or other major health care vendors. And, there are no rebate arrangements or soft-dollar reimbursements that can influence PPCN’s work.

Everything PPCN does for its clients is 100% transparent. The analyses performed and the cost savings recommendations will be fully explained in laymen’s terminology.

This program uses a targeted approach with a focus on safety and cost

o There is a high level of communication between pharmacist, patient and physicians in this program.

o Based upon predetermined risk criteria, the Aetna Case Manager would inform the PPCN Clinical Pharmacist that a high-risk patient has been discharged from the hospital. Risk criteria are based upon disease states and number of medications the patient is taking.

o A Clinical Pharmacist will review each patient’s medication profile to identify therapy issues. The medication profile will consist of hospital discharge orders, medications the patient reports taking, pharmacy claims and medications that the primary care physician has prescribed.

o The Clinical Pharmacist will create an action plan consisting of recommendations to address therapeutic issues, designed to reconcile the patient’s drug regimen from the four sources of input described above.

o The Clinical Pharmacist will communicate with the physicians and the patient to act upon recommendations.

o Using feedback from interactions with the physicians and claims analysis, the actions taken based upon the Clinical Pharmacist’s recommendations will be reconciled.

o A report quantifying the initial reconciliation recommendations and the enacted reconciliation recommendations will be provided for the employer.

o The Clinical Pharmacist will conduct one or two patient compliance consultation to review the changes in drug therapy.

Benefits

o Rapid results are seen by patient and the employer, as the patient’s drug regimen can be changed quickly and the employer can begin realizing immediate ADE savings.

o Reduction of drug costs by eliminating duplicate, ineffective and or expensive therapy.

o Reduction of physician visits, emergency room visits, hospitalization readmissions, tests and procedures due to less than effective or inappropriate therapy.

o The program can generate a 2:1 Return on Investment.

Pricing

Fee: $300.00 per patient per hospitalization for patients with seven or less prescriptions and $500.00 per patient per hospitalization for patients with eight or more prescriptions.

For more information contact;
 
Scott Moss
Vice President Sales & Marketing
336-542-7844
Scott.Moss@EmailMM.com