Failure to adhere to a medication regimen is often cited as the No. 1 reason people — especially older adults with multiple chronic conditions — are sent back to the hospital following discharge. To change that, many home care providers have started to make in-home medication management a core component of their operations.
That group includes home- and community-based care provider BrightSpring Health Services, which has positioned itself to potentially lead the charge on medication management after merging with pharmacy powerhouse PharMerica in a $1.32 billion deal finalized in early March.
Global investment firm KKR and an affiliate of Walgreens Boots Alliance Inc. (Nasdaq: EBA) acquired BrightSpring — formerly known as ResCare — as part of the deal.
The combination of BrightSpring and PharMerica will give the overall enterprise a footprint with difficult-to-top proximity to the patients and clients it serves, CEO Jon Rousseau told Home Health Care News via email. That includes behavioral health and specialty populations, along with older adults.
Daily medication support will be an essential part of the enterprise’s three-pronged approach to integrated care, he said, in addition to daily non-clinical support services and intermittent clinical interventions.
“It’s extremely important,” Rousseau said. “While daily non-clinical support services and more intermittent clinical services delivered in home and community settings are proven to improve outcomes and reduce hospitalizations, optimal medication management is, perhaps, most critical to managing care and reducing hospitalizations, particularly right after a discharge and during transitions.”
The combined BrightSpring and PharMerica company will have revenues of about $4.5 billion and serve more than 300,000 clients daily across 47 states, in addition to Puerto Rico and Canada.
“By providing our clients and people the right medications for their ailments in a timely and reliable manner, helping them understand when and how to take their medications and then helping to make sure they do so consistently, we can effectively address medication needs while also providing caregiver services,” Rousseau said.
On its end, PharMerica has maintained a strong medication delivery accuracy rate and an over 99% medication order completeness rate, generally outperforming retail pharmacies and traditional medication distribution avenues.
Communication breakdowns between patients and providers throughout the continuum of care are often to blame for medication issues that pop up in the home, experts say.
Having a point person with prescriptive authority who can help coordinate medication management between hospitals, physicians and home health providers would drastically improve medication-related problems, Allison Squires, an associate professor at the New York University Rory Meyers College of Nursing, told HHCN.
Squires recently investigated home-based medication management as part of a study published in the journal Medical Care Research and Review. The study was funded by the Nursing Education, Practice, Quality and Retention program, supported by a U.S. Department of Health and Human Services agency.
“Medication management coordinated from home care has the potential to improve medication safety for older adults and reduce the risk for initial hospitalization and readmission to hospitals,” Squires said.
To learn more about medication challenges, Squires and a team of fellow researchers spent time interviewing nearly 80 home-based care professionals, including nurse practitioners, social workers and pharmacists.
During those interviews, more than 54% of participants said a patient taking the wrong drug was the most common error they’ve observed in the home. Another 32% said a patient taking the wrong dose was the most frequently witnessed error, while 13.6% identified taking a drug at the wrong time as the top error.
The overarching takeaway: If home care providers quarterbacked medication management efforts among older adults, the U.S. health care system would likely see far fewer hospitalizations and re-hospitalizations.
“We as nurses spend so much time helping patients and working with patients on medication issues, figuring out what we can fix — but also what the system-wide issues are that we have to address in a bigger-picture way,” Sarah Miner, an assistant professor at St. John Fisher College’s Wegman School of Nursing and home care nurse by training, told HHCN. “There are things we can do right now in home care to help improve this — some of that being remembering how important communication is with our patients and how important it is between each other as providers. [Medication management] is not a soft skill.”
Besides her assistant professor role, Miner also serves as a home care nurse for Rochester, New York-based HCR Home Care.
Among other medication management challenges, the current structure of health care delivery often affects providers’ ability to spend time with patients and families, preventing them from doing the teaching and intervention typically needed for better medication management.
Patient-level challenges include a lack of trust with new providers, as well as a lack of understanding around safe practices.
There are dozens of technology products on the market to assist older adults with medication. Pillo Health, which has raised more than $7.9 million since launching in 2015, is just one example.
But technology is only effective under certain circumstances, Squires said.
“Tech is an option if you are computer literate, if you can afford a smartphone and if you have internet access in your house,” she said. “I think if you are an elderly dual-eligible, medically complex individual, the odds of you having access to that technology and those resources are pretty slim.
A foot in the door
Prior to the PharMerica merger, BrightSpring had maintained a closed-door pharmacy business serving its behavioral and mental health populations in 30 states.
Now that the merger is finalized, the enterprise is looking to gain the attention of payers and other health care partners.
“We provide opportunities for [payers] to realize additional value … while improving outcomes and satisfaction,” Rousseau said. “Our enhanced platform and added scale also position us to be a provider of choice in many fragmented markets, as comprehensive solutions, scale and systems matter more and more.”
Moving forward, the combined BrightSpring-PharMerica will likewise look to build out its relationships with skilled nursing and senior living clients, he said.
It will keep its focus on medication management and the home setting all the while, especially when it comes to transitions of care.
“It can take too long for people to get their medications upon transitions of settings. And in-home settings, adherence can be a challenge, leading to recurring and heightened medical issues,” Rousseau said. “We ensure medications are available when needed and orders are accurate. And in some settings, such as in-the-home, we help ensure the medication administration is right.”