Bringing Pharmacy Into The ACO Conversation: The Missed Link In Integrated Care

The $300 Billion Crisis: Why Your Healthcare Costs Are Spiraling and How Pharmacy Integration Could Save the Day

Healthcare costs in America have reached a breaking point. In 2025, medication non-adherence alone is driving an estimated $300 billion in avoidable healthcare spending and 125,000 preventable deaths annually. With over 53% of traditional Medicare beneficiaries (more than 14.8 million people) now enrolled in accountable care relationships, and medical cost trends projected to rise 8% in 2025, we’re facing a perfect storm of escalating expenses and fragmented care.

The alarming reality is that by 2025, an estimated 164 million Americans will have more than one chronic condition, with projected costs reaching $4 trillion. Chronic diseases already account for 90% of the country’s $4+ trillion in annual healthcare spending, yet 77% of commercial Accountable Care Organizations (ACOs) report being held responsible for prescription spending without adequate pharmacy integration.

Whether you’re a healthcare executive watching margins shrink, a provider struggling with patient adherence, or a payer seeking to control spiraling drug costs, pharmacy integration in ACOs isn’t just an opportunity, it’s becoming essential for financial survival in value-based care. Healthcare organizations using coordinated chronic care management are already seeing 20-30% reductions in readmission rates, and those who act now will have a competitive advantage in the rapidly evolving healthcare landscape of 2025 and beyond.

Healthcare Shifts Towards Value-Based Models

As healthcare shifts toward value-based models like ACOs and Health Maintenance Organizations (HMOs), the goal is to break down silos and create truly integrated care. Yet, one crucial player often gets left out of the conversation: the pharmacy.

Pharmacies are more than just dispensaries; they are an essential hub in the continuum of care. From medication management to patient education, pharmacies are on the front lines of keeping patients healthy and ensuring adherence to treatment plans. However, despite their critical role, many ACOs and HMOs still overlook the pharmacy’s potential to improve outcomes and reduce costs.

Why Pharmacies Matter in Coordinated Care

Medication adherence is one of the most significant challenges in managing chronic conditions. According to the CDC, non-adherence contributes to nearly 125,000 preventable deaths each year and costs the healthcare system between $100 and $300 billion annually. A survey conducted using 2024 data shows that 29% of Americans leave prescriptions for medications unfilled due to cost. Recent 2025 data shows that medication non-adherence costs healthcare systems between $100 billion and $300 billion annually, making it one of the most preventable cost drivers in American healthcare.

Pharmacists are uniquely positioned to address this issue through medication therapy management, counseling, and direct patient interaction. Moreover, pharmacists often see patients more frequently than primary care physicians; especially for those managing chronic conditions. This gives them a unique vantage point for identifying medication-related problems, catching potential drug interactions, and reinforcing care plans in real time.

Closing the Loop: Integrating Pharmacy into ACOs

ACOs and HMOs are designed to foster communication and collaboration among providers to improve patient outcomes. But many of these models focus on the traditional physician-led care team, leaving pharmacies on the periphery. With CMS now supporting 476 ACOs in the Medicare Shared Savings Program serving over 11.2 million people in 2025, the scale of this missed opportunity is enormous.

Integrating pharmacy into ACOs can fill this gap and enhance coordinated care. Here’s how:

Medication Management

Pharmacists can proactively review medication regimens, reconcile prescriptions, and identify cost-saving opportunities, all while supporting adherence. This is particularly crucial as medical cost trends continue rising 8% annually, driven partly by prescription drug spending.

Patient Education

Pharmacists can educate patients about their conditions, ensuring they understand their treatment plans and are empowered to manage their health. This direct patient interaction helps address the knowledge gaps that often lead to non-adherence.

Data Sharing

Integrating pharmacy systems with ACOs allows pharmacists to access patient records, ensuring real-time collaboration with physicians and other providers. This connectivity is essential for achieving the coordinated care that ACOs promise.

Preventive Care

Pharmacists can offer immunizations, screenings, and other preventive services that reduce hospitalizations and improve population health. These services align perfectly with ACO goals of keeping populations healthy while controlling costs.

The Current ACO Landscape: Massive Opportunity

The opportunity for pharmacy integration has never been greater. In 2025, the ACO landscape includes:

• 476 ACOs in the Medicare Shared Savings Program
• Over 11.2 million beneficiaries receiving coordinated care
• 103 ACOs participating in the ACO REACH Model
• 24 ACOs in the new ACO Primary Care Flex Model, which launched in January 2025

This new Primary Care Flex Model specifically focuses on team-based care approaches, creating an ideal environment for pharmacy integration. The model provides monthly prospective primary care payments and incentivizes comprehensive care coordination. This sets up exactly the type of structure where pharmacist services can thrive.

The Path Forward

For ACOs and HMOs to fully achieve the promise of integrated care, they must recognize pharmacies as key partners. This means creating infrastructure and incentives that encourage collaboration between pharmacists, physicians, and other healthcare providers.

It also means leveraging technology such as interoperable electronic health records and secure messaging platforms to connect pharmacists to the broader care team. With emerging payment models like the ACO Primary Care Flex program launching in 2025, there are new opportunities to build pharmacy services into innovative care coordination structures from the ground up.

The financial imperative is clear: organizations that successfully integrate pharmacy services are seeing 20-30% reductions in readmission rates and significant improvements in medication adherence. As healthcare costs continue their upward trajectory, these savings become increasingly critical for ACO success.

ACO Conversion Conclusion

Bringing pharmacies into the ACO conversation isn’t just about checking a box; it’s about recognizing their expertise and their ability to improve outcomes and lower costs. As value-based care continues to evolve, integrating pharmacies into coordinated care models will be essential to building healthier communities and achieving financial sustainability.

With 164 million Americans projected to have multiple chronic conditions by 2025 and healthcare spending reaching unprecedented levels, the question isn’t whether ACOs can afford to integrate pharmacy services—it’s whether they can afford not to.