The Problem
Every year, hundreds-of-billions in U.S. health care spending is related to preventable hospitalizations associated with adverse drug interactions — particularly among individuals living with disabilities and multiple chronic conditions. While most long-term care facilities have pharmacy services provided to their residents, less than five percent of home health agencies have a pharmacy affiliation, placing these patients receiving their care at home at higher risk of adverse drug reactions, lapses in medication adherence, and other poor health outcomes. Unfortunately, federal policies are currently structured in a way that limits opportunities to improve the delivery of LTC pharmacy services in the home.
Our Solution
The Alliance has worked to develop a targeted federal policy approach that will reduce costs and improve outcomes for the most medically complex Medicare beneficiaries living in the community. Our approach brings an LTC facility-level of pharmacy care to individuals living at home. By better utilizing LTC pharmacies to support individuals in the community, we can improve outcomes while lowering costs for some of the most medically complex patients. When appropriately incentivized, LTC pharmacists are capable of reducing duplicative and dangerous drug interactions, improving medication adherence, determining appropriate medications and dosing that will reduce preventable hospitalizations, improving the well-being of Medicare beneficiaries, and ultimately lowering costs.
As evidence of the potential for such an approach, a recent study on one notable LTC pharmacy at home model concluded that the program yielded $196 in savings per member per month (as detailed in the chart). As the study reports, these savings were largely attributable to decreases in hospital inpatient costs and SNF costs. Additionally, the study concluded that an even more targeted approach — focusing on the highest acuity patients with the greatest risk — could yield additional savings, up to a total of $395 per member per month.
As evidence of the potential for such an approach, a recent study on one notable LTC pharmacy at home model concluded that the program yielded $196 in savings per member per month (as detailed in the chart). As the study reports, these savings were largely attributable to decreases in hospital inpatient costs and SNF costs. Additionally, the study concluded that an even more targeted approach — focusing on the highest acuity patients with the greatest risk — could yield additional savings, up to a total of $395 per member per month.
Additional Bacgkround
To learn more about our approach to aligning federal incentives to support LTC pharmacy services at home, click on the resources below.