Pharmacist-Led Medication Optimization Tied to 19.4% Lower Medical Costs in Medicare ACO Population
核心洞察
A retrospective study published August 26, 2026 in Health Affairs Scholar links DecisionRx (搜索)'s pharmacist-led medication therapy optimization program to 19.4% lower medical costs in a Medicare ACO population.
Savings deepened with program exposure, reaching 31.9% ($462 per member per month) after a nine-month implementation window, with results significant at p < 0.001.
Matched analysis of 1,003 treated patients and 14,031 controls showed 43.1% fewer inpatient admissions, 41.3% fewer emergency department visits, and 28.3% fewer outpatient visits.
Participation in a pharmacist-led medication therapy optimization (MTO) program was associated with 19.4% lower medical costs among Medicare accountable care organization (ACO) patients, with savings rising as exposure to the program lengthened, according to a study published online August 26, 2026 in Health Affairs Scholar.
The research, co-authored by DecisionRx (搜索) executives in collaboration with researchers at the Johns Hopkins Bloomberg School of Public Health, evaluated how pharmacist-led medication optimization and pharmacogenomic (PGx) testing affect health care utilization, prescribing patterns, medication-related outcomes, and cost across populations with varying morbidity burden and pharmacy complexity.
Study Design and Population
Investigators used propensity score matching across 13 risk-adjustment metrics to compare 1,003 treated patients with 14,031 matched controls, comprising 334,531 member-months of analytic exposure between October 2022 and September 2025. All 1,003 treated patients underwent pharmacogenomic testing via an at-home cheek swab to identify genetic markers affecting their ability to metabolize more than 200 medications.
The analysis drew on the Johns Hopkins ACG® System, a population-based risk assessment and predictive modeling platform, to assess outcomes across patient groups with differing levels of clinical complexity.
Utilization and Cost Findings
Compared with matched controls, MTO participation was associated with 43.1% fewer inpatient admissions, 41.3% fewer emergency department visits, and 28.3% fewer outpatient visits. Savings increased steadily with duration of program exposure, reaching 31.9% — equivalent to $462 per member per month — following a nine-month implementation window.
In the study, 91% of patients enrolled in the MTO program received at least one actionable pharmacist recommendation, and 53% of patients exhibited lower polypharmacy (搜索) risk one year after the intervention. Approximately one-third of pharmacist recommendations were informed by pharmacogenomic risk, while two-thirds addressed other medication-failure risk factors, including drug-drug interactions, drug-disease contraindications, therapeutic duplication, and probability of adverse events and side effects.
Under the MTO model, clinical pharmacists provide individualized recommendations to patients and prescribers, while prescribers retain final authority over all medication decisions.
"The most expensive medications are the ones that don't work," said Travis Morgan, President and Co-founder of DecisionRx (搜索) and co-author of the paper. "These findings strongly suggest that giving clinical pharmacists a central role in identifying medication-failure risk can help prescribers make more informed decisions and reduce costly medical utilization over time."
Limitations and Causal Interpretation
As a retrospective observational study, the analysis cannot definitively establish causation. However, the authors note that results showed high statistical significance (p < 0.001), and that formal validation of parallel trends combined with a pronounced dose-response pattern support a causal interpretation.
Medication-related problems, including adverse events and lack of therapeutic efficacy, are a persistent source of avoidable spending among Medicare beneficiaries, contributing to unnecessary emergency department visits, hospitalizations, and other medical utilization and morbidity. According to DecisionRx (搜索), medication failure (搜索) accounts for at least 16% of total health care spending, and its MTO program has been shown to reduce total cost of care among polypharmacy (搜索) patients by over 30%.
Parallel Collaboration on Real-World Evidence
Separately, faculty from the Johns Hopkins Bloomberg School of Public Health are collaborating with DecisionRx (搜索) to generate real-world evidence supporting PGx-guided medication management in value-based care. That collaboration is co-led by Chintan Pandya, MD, PhD, MPH, FAMIA, associate research professor in the Bloomberg School's Department of Health Policy and Management and director of research and development for the ACG® System, and Joseph Levy, PhD, assistant professor in the same department.
Pandya leads the strategic and technical advancement of the ACG® System, with research focused on big data, health informatics, digital health, and AI-driven approaches using large-scale claims and electronic health record data to improve population health outcomes and support value-based care. Levy's research spans pharmacy, health economics, and health outcomes, supporting the collaboration's focus on translating pharmacist-led medication optimization into real-world clinical practice.
As health systems and payers expand value-based care initiatives, medication-related adverse events, suboptimal prescribing, and variable treatment responses remain significant drivers of health care utilization and costs. The investigators aim to develop scalable, evidence-based approaches that integrate precision medicine, medication management, and advanced population health analytics to strengthen value-based care delivery and reimbursement models.