It is estimated that 5 percent of patients account for over 50 percent of total healthcare costs. These individuals, referred to as high-utilizers or high-cost patients, often have multiple complex health conditions and social needs compromising their health.


Many health systems are implementing innovative approaches, including services to reduce homelessness, increasing access to healthy foods, teaching people how to self-manage their medical conditions, and providing transportation to medical appointments. These changes highlight the importance of collaboration among service providers. Partnerships that include doctors, first responders, law enforcement, schools, social service providers, and more are essential for truly addressing complex health and social needs to improve health and reduce cost of care.


Often times, people with complex medical conditions have multiple medications to manage, prescribed by several specialists who may not know which other medications the patient takes. It’s no surprise that medication management is one of the most important and often overlooked challenges for reducing avoidable trips to the emergency department.


In order to improve medication management, health systems are practicing “team based medication management,” which includes doctors, care coordinators, pharmacists, patients, and the patient’s family into the medication care team. Pharmacists have the capability of ensuring that each patient’s medications are individually assessed to determine that they are appropriate for the patient, effective for the medical condition, and safe given the person’s other conditions and other medications being taken.


In addition, pharmacists are uniquely able to recognize when patients are not taking medications as prescribed by their doctors because patients will not come in for their refills. Including pharmacists on the care team reduces adverse drug reactions and increases medication compliance. Including patients and their families as a part of the care team allows the patient to understand their medical condition and take control of their health.