Lahey Health and vendor Dovetail Health have launched a medication management program targeting the 35,000 patients managed through Lahey's Medicare Shared Savings Accountable Care Organization.

The program, called Lahey Health Enhanced Care Program, is targeting the most clinically complex patients within the Lahey Health ACO and engaging them in their home and community to prevent hospital readmissions through medication reconciliation, optimization, and education.

To do this, Dovetail Health schedules and sends trained clinical pharmacists into the homes of patients identified as high risk, and then continues to manage the patients with a pharmacist-led call center. The pharmacists help patients understand what medications they are supposed to be taking and why, help patients remove any barriers to taking medications as prescribed, and ensure the patients are not having any medication side effects.

The pharmacists can also take steps to optimize medication regimens based on patients' medical conditions.

"While there is a focus on medications, visiting the patient in their own environment enables the Dovetail Health clinician to evaluate the holistic picture of the patient and their challenges to staying healthy," said Dovetail executives. "These challenges can include their home environment, their social support system, and their level of understanding of other instructions for care from a variety of physicians, among others. The Dovetail Health team gathers this information, coordinates a care plan tailored to the patient, and shares that plan with the patient, the patient's physicians and other care team members."

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