Patient Centered Medical Home
Patient Centered Medical Home (PCMH)/Accountable Care Organization (ACO)
CLINICAL
❱ Reduce and optimize medication therapy.
❱ Increase compliance and adherence with medication regimen.
❱ Improve quality of life.
❱ Improve clinical outcome of disease management.
❱ Employ self-management.
ECONOMIC
EFFCIENCY
❱ Optimize medication therapy through comprehensive and coordinated approach.
❱ Improve transition of care.
❱ Improve record keeping and communication; increase accountability.
❱ Provide Personal Medication Record and Medication Action Plan.
❱ Improve Quality Metrics including MIPS, MACRA, STAR Ratings and HEDIS.
❱ Decrease morbidity, mortality and cost burdens that result from inadequate management of chronic disease states.
❱ Reduce readmission rate.
❱ Reduce drug costs.
❱ Increase access to care; increase patient satisfaction.
❱ Increase provider experience.
❱ Avoid litigations resulted from ineffective outcomes or adverse events.
❱ Resolve and prevent medication related problem.
❱ Avoid adverse outcomes.
❱ Avoid medication error.
Patient Centered Medical
Home/ ACO
SAFETY
FACTS:
❱ People 65 or older account for 13% of the U.S. population but take > 1/3 of prescription and over the counter medications. Average 75 years old take 3 or more Rx’s.
❱ 1 in 3 older persons taking at least 5 medications will experience an adverse drug event (ADE). Risk factors: Polypharmacy, multiple medical conditions, prior ADE’s, dementia.
❱ About 99,628 emergency hospitalizations for ADE’s in adults 65 years or older each year (2007-2009).
❱ Medication-related errors are a top preventable cause of serious adverse health events and avoidable readmissions.
❱ Patients experiencing a treatment failure, new medication problem or both are estimated to be $528 billion for one year.
❱ Non-optimized medication therapy results in 275,689 deaths per year. Medication-related errors are a top preventable cause of serious adverse health events and avoidable readmissions.
❱ Unrelieved pain can result in longer hospital stays, increased rates of re-hospitalization, increased outpatient visits, and decreased ability to function fully leading to lost income and insurance coverage.
❱ Estimated 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death.
❱ Patient with diabetes medical expenditures that are 2.3 times higher than the expenditure would be in the absence of diabetes. Approximately $1 in $10 health care dollars is attributed to diabetes. Indirect costs include increased factors such as absenteeism, reduced productivity, and lost productive capacity due to early mortality.
❱ In the US, about 111 million (46%) of the US adult have high blood pressure per American College of Cardiology/American Heart Association. Hypertension can lead to stroke, myocardial infarction (MI), or peripheral arterial diseases, chronic kidney disease (CKD) or retinopathy.
Our board Certified Clinical Pharmacist Practitioners in collaboration with physicians and other medical providers -
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Perform comprehensive medication therapy management and a systematic approach to optimize patient outcomes and reduce costs.
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Evaluate and manage chronic disease states based on clinical practice guidelines.
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Recommend and individualize disease state goals based on patient’s need.
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Employ motivational techniques to tailor programs for smoking cessation, lifestyle and behavior changes, and educating groups about disease risk reduction.
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Formulate patient‐centered treatment plans for complex patients and self-engagement.
Our Clinical Pharmacist Practitioners will address Medication Therapy Management (MTM) in a compassionate, comprehensive and integrative manner utilizing a collaborative and coordinated approach. Emphasis is placed on the delivery of rational drug therapy, a comprehensive review of herbal products and supplements patient is
Be Physically active for at least 30 minutes/5-days a week.
Maintain a healthy weight and waist size.
