Packaging's got potential

Hospital readmissions within 30 days of discharge cost the Medicare program approximately $15 billion, according to the Medicare Payment Advisory Commission. Laura Cranston, RPh, Executive Director, Pharmacy Quality Alliance Inc. (PQA) shares that the largest component of those costs are due to some medication-related adverse drug event, she explains. The priority of the Centers for Medicare and Medicaid Services (CMS) is to reduce these costs, and effective medication reconciliation and ensuring appropriate care transitions can play a major role.

There is also an opportunity for appropriate, compliance-based packaging to help. "Compliance packaging can play a major role in improving patient adherence, and adherence to safe and appropriate medications will also reduce readmissions,” Cranston says.

Cranston will be speaking March 27 at RxAdherence 2012 at the Hamilton Park Hotel and Conference Center in Florham Park, NJ. PQA develops performance metrics for appropriate medication use that are used by CMS as a component of evaluating health plans participating in Medicare Part D. “CMS is holding the health plans accountable for their performance, including readmissions and overall rates of adherence across several chronic therapeutic classes of medications.” Cranston says. “In 2012, quality bonus payments (QBPs) for Medicare Advantage Plans are tied to the CMS star-rating program. These QBPs are incentives to drive quality improvement and performance across these Medicare plans. In order to achieve high performance, health plans’ natural allies are to work collaboratively with the pharmacies in their network, and position the pharmacists to be part of the solutions to address nonadherence and to enhance the quality and safety of the medications provided through these programs."

PQA has supported several demonstration projects that have identified ways to improve medication adherence and to implement point-of-care interventions to facilitate changes in behavior that lead to improvements in adherence, Cranston reports. When asked whether packaging can play a role in such programs, she says that “the atmosphere is ripe between a health plan and pharmacy, given these incentives for the Medicare population.” She added that health plans understand that improving medication use metrics must involve all stakeholders in the process, including pharmacists and pharmacy providers that will initiate dialogues with patients."

Pharmacists can employ “high-touch” services such as “motivational interviewing” as well as “low-touch tools.” PQA, through its demonstration projects, is working to identify the potential risk of nonadherence with certain therapeutic categories, which can then determine the appropriate intervention to put into place. “Many forces are converging,” she adds.

Packaging has potential, but there needs to a push for payment. “Pharmacists have typically seen compliance packaging as a service, but some patients may not be willing to pay anything additional for such services. Packaging’s benefit needs to be demonstrated to the ultimate payer.”

Pharmaceutical manufacturers should also be considered a partner in helping drive the quality and performance within the Medicare program as well. “They are a stakeholder as well. They should have a vested interest in providing resources to these health plans that encourage beneficiaries to be compliant,” she says.

Can compliance-prompting packaging reduce readmissions? "Yes, it is one tool that can have a role in addressing this multi-faceted problem," she says.

During her RxAdherence presentation, Cranston will discuss the tools, tips, and interventions that have been implemented in PQA-supported demonstration projects, including a performance measurement and improvement platform that has been developed for health plans and pharmacists to see how well they are performing on various medication use metrics.

For details on RxAdherence, visit www.rxadherenceconference.com