AMCP: Reduce readmissions with MTM

April 3, 2014

A partnership between Catamaran and Health New England achieved a 30% reduction in 30-day readmissions, presented at Session 216 at AMCP

When payers and pharmacy benefits managers collaborate on medication therapy management (MTM), they can drive positive impact on readmission rates.

A partnership between Catamaran and Health New England, a managed care organization in Springfield, Mass., achieved a 30% reduction in 30-day readmissions, according to panelist David Calabrese, vice president and chief pharmacy officer for Catamaran, who will be presenting at Session 216 today.

“Medical errors and non-adherence are two of the primary causes driving readmissions and costly hospital stays,” Calabrese says. “Pharmacists are the most important people to intervene and ensure that patients are filling their prescriptions on time, avoiding duplications and managing side effects and interactions because they have the most direct contact with patients.”

He says multidisciplinary protocols ensure that members are engaged while active monitoring drives improved care-plan adherence.

By combining analytics, technology, clinical expertise, post-discharge medication reconciliation and counseling, comprehensive medication review and medication adherence, MTM programs ensure that patients with a variety of conditions understand their medications post-discharge avoiding confusion with their regimens prior to hospital admission. Industry insights and preliminary results of the program will be presented in today’s case study session.

In June 2007, MedPAC documented that nearly 20% of all Medicare admissions result in readmissions within 30 days of discharge, accounting for $15 billion in spending, of which about $12 billion is for potentially preventable readmissions.

According to CMS, more than 2,200 hospitals were penalized an aggregate of about $280 million in Medicare payments because of their excess readmissions in 2012, with an estimate of $227 million in 2013.

In addition, all-cause readmission rates are part of Medicare’s star rating program measurements under Part C. The average rating for the metric dropped slightly in 2013 when compared to 2012.