Aetna members considered to be at high or moderate risk for hospital readmission within 30 days of discharge will receive support from a pharmacist in the form of in-home medication reviews or telephone consultations.
Aetna is kicking off a pilot program to provide one-on-one medication management support services to members at risk for hospital readmissions.
The Hartford-based insurer is teaming with CVS Caremark and Dovetail Health, a Massachusetts-based care management company, for a 6-month trial. The program will be offered in Maryland, Virginia, and Washington, D.C. Caremark and Dovetail say they will dedicate specific pharmacists to the pilot.
The program is expected to help members manage their health through personal support from a pharmacist including in-home consultations. It will focus on members who take multiple medications and have recently been discharged from a hospital, nursing home or rehabilitation facility.
Reducing hospital readmissions is on everyone's to-do list thanks to quality and outcome measures and incentives introduced through healthcare reform. Medication management issues are linked to more than 60% of "post-discharge adverse events," according to an Aetna spokesperson.
Each year about 3.5 million discharged hospital patients who make medication mistakes end up back in the hospital. Medication non-adherence contributes about $15.2 billion to the nation's annual healthcare costs, according to research cited by Aetna.
Here is how the program will work: Aetna case managers will identify the members considered to be at high risk or moderate risk for hospital readmission within 30 days of discharge. Within two days of discharge, the high-risk members will be contacted by a Dovetail pharmacist to schedule an in-home medication review. The moderate-risk members will be monitored by telephone contact with a CVS Caremark pharmacist.
"Many patients who are newly discharged from a hospital or rehab facility are taking multiple medications. Trying to navigate multiple treatment guidelines provided by the patient's primary care physician and the treatment facility discharge team can be overwhelming," Troyen A. Brennan, M.D., M.P.H., executive vice president and chief medical officer for CVS Caremark said in a press statement.
"Our research shows that the intervention of a clinical pharmacist helps patients better understand their medications and avoid potential setbacks to recovery after returning home."
The focus will be to educate members about their medications and the importance of following physician prescription directions. The reviews will cover all medications prescribed for the member to identify any potential problems with the medication mix that could put the patient at-risk for adverse reactions.
Pharmacists will work with members, their physicians, and case managers to identify gaps in care and to develop and implement a detailed healthcare plan, including physician follow-up visits.
In addition, the home visits for high-risk patients will provide an opportunity to identify other risk factors, such as home safety, that could affect a member's ability to adhere to a medication regimen.
After the initial consultation, both high-risk and moderate-risk members will receive ongoing support for 30 days. In addition to regular contact by a pharmacist, nurses will also mentor the members on the importance of filling prescriptions and taking their medications as prescribed. After the 30 days, the member will be discharged from the pilot and moved into a case management program for continued follow-up and care.
Member participation will be voluntary. Aetna has not set a goal for how many members it hopes to enroll in the pilot but according to a company spokesperson expects to "enroll a sufficient sample size to provide meaningful data on program success."
Readmission rates and member satisfaction of program participants will be measured at the end of the pilot.
Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
