Medication Reconciliation Programs: Reducing Risk for Hospital Readmission

When patients are discharged from a hospital they may be sent home with several new medications. These new prescriptions may be in addition to existing medications, and during the transition from hospital to home, new medication regimens and dosing schedules may be difficult to manage and confusing for patients. As a result, patients may not take all of their medications as prescribed and could experience drug interactions, unpleasant side effects and adverse events that lead to another hospital stay.

In fact, one in seven patients discharged from a hospital is readmitted within 30 days. Startlingly, hospital readmissions are associated with more than $41 billion in additional health care costs per year with the majority – approximately 66 percent – of these readmissions related to preventable adverse health events, such as medication non-adherence.

This presents a major opportunity for providers and payors who are looking for new ways to help reduce hospital readmission rates and curb unnecessary health care spending. At CVS Health, we are exploring how a pharmacist-led medication reconciliation program can help our pharmacy benefit management clients lower health care costs by helping their members improve medication adherence following a hospital stay. In the program, pharmacists provide in-home or telephone-based counseling to patients based on their risk for readmission for the first 30 days following discharge from the hospital. Specifically, pharmacists:

  • Compare patients’ pre- and post-hospitalization medication regimens;
  • Identify discrepancies, redundancies and safety concerns; and
  • Provide medication use and adherence education and support.

Researchers from the CVS Health Research Institute recently evaluated impact of this program implemented by a national health insurer. The study findings, published in Health Affairs, showed that for those members who received pharmacist-led medication reconciliation following a hospital stay, their risk of hospital readmission at 30 days fell by 50 percent. This led to lower costs for the insurer, which saved $2 for every $1 spent on the program, representing a total savings of more than $1,300 per member.

Since finding ways to curb wasteful health care spending continues to be a major priority for the entire health care system, this study shows that medication reconciliation programs may be a cost-effective payor solution to address medication adherence challenges, improve health outcomes, reduce readmissions to the hospital and ultimately lower costs.