More than two decades ago, medication reconciliation was established as a National Patient Safety Goal by The Joint Commission, recognized as a vital safeguard against adverse drug events during transitions of care. The goal was straightforward: ensure that every patient’s medication list is accurate, complete, and consistently updated across care settings to prevent errors and hospital readmissions, protect patients, and improve outcomes.
Yet despite its long-standing importance, medication reconciliation remains inconsistent in execution. Many hospital readmissions, emergency visits, and medication-related complications stem from discrepancies in patients’ medication regimens. The problem is rarely a lack of intent since healthcare organizations understand the value of reconciliation. The challenge lies in execution.
Now, with advanced pharmacy software available for in-house teams and remote pharmacists alike, healthcare providers are better equipped to address risks tied to care transitions and ensure safe and effective treatments.
What is medication reconciliation?
Ensuring patient safety and optimizing therapeutic outcomes are vital objectives for every health plan and clinical provider. Central to this mission is the meticulous process of medication reconciliation, which is a critical component of safe, effective, and coordinated healthcare.
It’s a formal process in which healthcare providers systematically collect and verify a patient’s complete and accurate medication list during transitions of care, such as hospital admissions, discharges, or referrals to other care settings.
This list includes all prescribed medications, over-the-counter drugs, supplements, and herbal remedies the patient is taking. With this process in place, providers can identify and resolve discrepancies, such as omissions, duplications, dosing errors, or drug interactions, which are common during care transitions and can result in preventable adverse drug events (ADEs).
Consider a patient who was recently discharged from the hospital following treatment for congestive heart failure. At discharge, the patient’s care team prescribed a new diuretic and adjusted the dose of their ACE inhibitor. However, during a follow-up telepharmacy consultation, the remote pharmacist conducting the medication reconciliation discovers that the patient is still taking the higher pre-admission dose of the ACE inhibitor and didn’t fill the prescription for the new diuretic, both of which could have serious consequences for recovery and long-term health.
By reconciling the patient’s medication list and educating them about the new regimen, the pharmacist not only prevents a potential ADE but also fosters medication adherence and empowers better condition management.
This example underscores the value of medication reconciliation as both a safety measure and a patient engagement strategy. When performed consistently, medication reconciliation helps health plans and care teams reduce hospital readmissions, enhance quality metrics, and, most importantly, improve patient outcomes.
Why is medication reconciliation important?
Transitions of care are high-risk periods for medication errors, particularly when communication between providers is fragmented or incomplete. During these transitions, communication gaps, incomplete records, and inconsistent documentation can all contribute to medication errors.
But a structured medication reconciliation process mitigates these risks by ensuring that the patient’s medication regimen is accurate, complete, and aligned with their current clinical needs. In doing so, it supports safer, more efficient, and more coordinated care delivery.
Enhancing patient safety
Medication reconciliation is a foundational patient safety strategy. Inaccurate or incomplete medication information can lead to ADEs, which account for 21% of emergency hospital readmissions within 30 days of transition. By verifying and aligning medication orders across transitions of care, medication reconciliation prevents common errors.
For patients managing chronic conditions or multiple prescriptions, this process is essential to ensure their treatment is safe and effective while avoiding polypharmacy risks.
Preventing costly adverse events
Avoidable hospitalizations, duplicative prescriptions, and emergency interventions due to ADEs can result in significant healthcare costs. By reducing these preventable events, medication reconciliation supports more cost-effective care.
Additionally, patients who are taking five or more prescription medications are faced with more than $17,000 in higher healthcare costs in comparison to those who are taking fewer medications. For health plans, the ability to proactively identify and resolve medication issues also helps contain costs and improve population health management strategies.
Improved STAR Ratings & HEDIS performance
Accurate medication reconciliation directly contributes to the achievement of quality metrics tied to value-based care programs, including HEDIS, STAR Ratings, and CMS quality measures. For example, the Medication Reconciliation Post-Discharge (MRP) measure assesses whether a patient’s medications were reviewed and reconciled within 30 days of discharge.
High performance on these metrics not only reflects better clinical care but also impacts reimbursement rates, payer contracts, and accreditation status.
Enhanced member satisfaction and retention
When patients feel confident that their care team is aware of their full medication regimen–and that their concerns are being addressed–they’re more likely to trust the healthcare system and remain engaged in their care.
Medication reconciliation fosters this trust by ensuring personalized, attentive follow-up, especially during periods of transition. This also translates into higher member satisfaction, improved retention, and stronger long-term relationships.
Streamlined care coordination
Many treatment plans are executed in a team-based care environment, and that means multiple clinicians may be involved in managing a patient’s medications across settings. Medication reconciliation ensures that all stakeholders–including primary care providers, specialists, remote pharmacists, and care coordinators–have access to the same, accurate medication list.
This unified view of the patient’s therapy reduces fragmentation, eliminates redundant efforts, and promotes collaborative decision-making across the spectrum of care.
Understanding the medication reconciliation process
While medication reconciliation can be adapted to various clinical settings, the core process remains consistent. It involves collaboration between patients, pharmacists, providers, and care teams, all supported increasingly by digital health tools that streamline workflows and improve data accuracy.
Here’s a closer look at the five-step process that shapes medication reconciliation:
Step one: medication history collection
The process begins with collecting a complete and accurate list of all medications, including specialty medications, that the patient is currently taking. This includes:
- Prescription medications
- Over-the-counter drugs
- Herbal supplements
- Vitamins and dietary aids
The pharmacist or care team member confirms the name, dose, frequency, and route of administration for each drug. In many cases, multiple data sources are used to verify the accuracy of this list, such as pharmacy fill records, EHR data, and direct patient or caregiver interviews. For remote or telepharmacy models, this step may be conducted via phone, video, or secure digital intake forms.
Step two: medication classification and clinical assessment
Once the medication list is verified, each drug is reviewed in the context of the patient’s current conditions and treatment plan. Clinicians assess therapeutic intent, identify potential duplications, and flag high-risk medications to ensure optimal patient care. Special attention is given to:
- Drug-drug or drug-condition interactions
- Medications without a current indication
- Therapy gaps, such as missing cardioprotective medications for patients with heart failure
This clinical classification step ensures that the regimen is not only accurate but also appropriate and aligned with best practices.
Step three: reconciliation against new orders
The verified and classified list is then compared against any new medication orders, such as those written during an inpatient stay, emergency visit, or specialist consultation. The goal is to identify and resolve discrepancies, including:
- Medications that were stopped or changed but are still being taken
- New prescriptions that duplicate existing medications
- Incorrect doses or timing
- Unintentional omissions
The clinician resolves these issues through clinical judgment and, when needed, direct communication with the prescribing provider or care team.
Step four: patient engagement and education
Once the medication list has been reconciled, the next step is engaging the patient and keeping them informed of treatment plan updates, care, and ongoing medication regimen requirements. The care team reviews the final regimen with the patient or caregiver to:
- Explain any changes in medications or dosages
- Reinforce the importance of medication adherence
- Discuss potential side effects and storage requirements
- Ensure the patient understands what to take, how, and when
This step is critical for promoting adherence and empowering patients to manage their care confidently. In remote settings, telepharmacy enables this through secure video calls, digital medication guides, or follow-up messages.
Step five: documentation and transition
The final reconciled medication list is documented in the patient’s health record and shared with all relevant stakeholders, such as primary care providers, specialists, pharmacists, and care coordinators. This ensures that the entire care team is working from the same up-to-date information. Additionally, timely and accurate transmission ensures continuity of care, supports patient understanding, and reduces the risk of future discrepancies.
Secure transmission of this data is particularly important in fragmented systems or multi-provider environments, where the risk of information loss is high. Today’s digital pharmacy platforms can streamline this step and reduce the administrative burden on care teams by making patient data visible across teams while remaining HIPAA compliant. And, these tools also provide actionable insights to help teams make the best decisions for their patients regarding medication reconciliation and medication therapy management.
Together, this framework creates a repeatable and reliable framework that supports medication safety, enhances care coordination, and ultimately leads to improved patient outcomes.
Common challenges in medication reconciliation
Despite its clear clinical value, medication reconciliation remains a complex and resource-intensive process. Across care settings, providers encounter numerous operational, technological, and patient-related barriers that can compromise the accuracy and effectiveness of reconciliation efforts.
Recognizing these challenges is essential for health plans and care organizations aiming to improve health outcomes and scale medication reconciliation efforts.
Incomplete or inaccurate medication histories
One of the most persistent challenges is obtaining a complete and accurate medication history. Patients may forget to mention certain medications, misunderstand dosing instructions, or omit over-the-counter drugs and supplements.
In some cases, multiple prescribers are involved, and records may be fragmented across health systems or pharmacies. Without access to comprehensive data, clinicians may reconcile based on outdated or partial information, increasing the risk of errors.
Fragmented healthcare solutions
Lack of interoperability between electronic health records, pharmacy systems, and claims data creates significant barriers to effective reconciliation. Providers often rely on time-consuming manual processes to collect and cross-reference medication data. When systems don't communicate, it's difficult to verify fills, track adherence, or identify discrepancies across care settings, particularly during transitions of care.
Workflow and resource constraints
Medication reconciliation is a time-intensive task, especially when done manually. In busy clinical environments, providers may be pressed for time and prioritize immediate clinical concerns over medication reviews.
Additionally, staff may lack training or standardized protocols for reconciliation, leading to inconsistent execution. Without clear roles and dedicated resources, this critical process may be rushed or overlooked altogether.
Limited patient engagement
Patient participation is essential for accurate medication reconciliation, but engagement can be limited by a variety of factors, including low health literacy, language barriers, cognitive decline, or lack of access to technology.
As a result, patients may be unaware of medication changes or unable to explain what they are taking and why. When care teams don’t engage patients in the process or fail to educate them about their regimens, adherence suffers, and discrepancies are more likely to go uncorrected.
Variability across care settings
Reconciliation practices can vary widely across hospitals, outpatient clinics, pharmacies, and telehealth providers. Differences in staffing models, technology infrastructure, and regulatory requirements contribute to a lack of standardization. Without consistent policies and procedures, the effectiveness of reconciliation depends heavily on the individual provider or institution.
Overcoming these challenges requires a coordinated, system-level approach. Health plans and healthcare organizations can address these gaps by investing in integrated technology, expanding the role of remote pharmacists, standardizing reconciliation protocols, and developing patient education strategies that promote engagement and adherence. When these pharmacy solutions are aligned under a unified care model, medication reconciliation becomes not only feasible but also scalable and impactful.
Best practices for optimizing medication reconciliation
Given the complexity and high stakes of medication reconciliation, healthcare organizations must take a proactive and strategic approach to strengthen the process across care settings. For health plans and remote pharmacists, implementing best practices can significantly reduce errors, improve adherence, and enhance patient outcomes.
For health plans
Health plans are uniquely positioned to support scalable, system-wide improvements in medication reconciliation. By leveraging their access to claims data, care management infrastructure, and member touchpoints, plans can strengthen coordination, identify at-risk populations, and facilitate timely interventions.
- Integrate medication reconciliation into care management programs: Embed medication reconciliation as a standard component of post-discharge outreach, chronic disease management, and case management workflows. This ensures that high-risk members consistently receive medication reviews at critical moments of care transition.
- Use claims and fill data to identify gaps: Leverage pharmacy claims data to detect discrepancies between prescribed and filled medications, signal non-adherence, or identify high-risk drug combinations. These insights can help prioritize members for pharmacist-led interventions or telehealth consultations.
- Collaborate with provider networks and pharmacists: Develop partnerships with provider groups and clinical pharmacists to standardize reconciliation protocols across settings. Health plans can facilitate data sharing and help align incentives around quality measures related to medication safety.
- Invest in technology that supports data integration: Support platforms that integrate pharmacy, EHR, and claims data to provide a unified view of each member’s medication history. Interoperability is critical to reducing duplication, ensuring accuracy, and streamlining reconciliation workflows across stakeholders.
- Monitor and report on medication-related quality measures: Track performance on relevant quality metrics such as HEDIS and CMS Star Ratings. Use this data to identify opportunities for improvement and demonstrate value to providers and regulators.
For remote pharmacists
Remote pharmacists play an essential role in delivering medication reconciliation services, especially for patients who are geographically isolated, recently discharged, or managing multiple chronic conditions. To be effective in this role, pharmacists must combine clinical expertise with digital tools and patient engagement strategies.
- Conduct comprehensive, patient-centered reviews: Use a structured approach to collect, verify, and reconcile medication lists, while taking the time to educate the patient. Tailor the discussion to their level of health literacy and involve caregivers when needed. Ask open-ended questions to uncover unreported medications or adherence barriers.
- Leverage telepharmacy platforms for real-time engagement: Use secure, HIPAA-compliant telehealth tools to conduct virtual medication reviews, especially within 7-14 days post-discharge. These platforms allow for real-time patient interaction, efficient documentation, and easier scheduling of follow-up touchpoints.
- Document and communicate findings clearly: Ensure that all medication changes, concerns, and recommendations are documented in a standardized format and shared promptly with the broader care team. This transparency supports coordinated, informed clinical decision-making and reduces care fragmentation.
- Utilize decision support tools and databases: Incorporate drug interaction checkers, clinical guidelines, and EHR-integrated tools to identify contraindications or duplications during reconciliation. These tools enhance clinical accuracy and help pharmacists make evidence-based recommendations.
- Follow up to reinforce adherence and safety: Medication reconciliation is not a one-time task. Remote pharmacists should establish follow-up workflows to monitor medication adherence, address new side effects or questions, and ensure continued alignment between prescribed therapies and the patient’s current status.
By adopting these best practices, health plans and remote pharmacists can strengthen the medication reconciliation process, reduce errors and hospital readmissions, and improve patient outcomes. However, to truly scale these efforts and ensure consistency across diverse care settings, technology plays a pivotal role.
The role of pharmacy technology in revolutionizing medication reconciliation
It’s no secret that the healthcare landscape is complex, and only becoming more so as time goes on. But, the right pharmacy technology can make a world of difference when it comes to efficiently and effectively providing patient-centered care.
Fragmented data systems, manual documentation, and inconsistent processes make it difficult for providers and pharmacists to maintain continuity of care, especially during transitions. These limitations not only put patients at risk but also hinder the performance of health plans and provider organizations striving to meet quality benchmarks and reduce preventable utilization.
Advanced pharmacy technologies are closing these gaps by streamlining reconciliation workflows, improving data accessibility, and supporting collaborative care models. Platforms that enable real-time data sharing, structured clinical documentation, and decision support tools empower healthcare teams to conduct thorough medication reviews with greater speed and accuracy. Importantly, these technologies also expand access to high-quality pharmaceutical care, enabling pharmacists to engage with patients virtually and deliver services that are timely, personalized, and culturally competent.
For health plans and remote pharmacists seeking to modernize their medication reconciliation processes, Aspen RxHealth offers a solution that meets the demands of today’s healthcare environment.
With Alliance by Aspen RxHealth, health plans and provider groups can empower their in-house teams to take full control of their medication management strategy. The platform’s targeted member segmentation and customizable workflows make it possible to tailor reconciliation services to the needs of diverse patient populations. By supporting seamless collaboration between in-house teams and Aspen RxHealth’s nationwide network of multilingual, specialty-trained pharmacists, Alliance ensures every patient receives safe, effective, and coordinated care.
Built on the BeWell platform, Alliance equips pharmacists, pharmacy technicians, nurses, and care coordinators with real-time access to patient data, guided clinical workflows, and intuitive tools for documentation and reporting. This makes it easier to conduct thorough medication reconciliations, identify and resolve discrepancies, and engage patients in meaningful, outcome-focused conversations. And, BeWell’s web-based model means pharmacists can conduct consultations across devices, making care more efficient and effective.
No in-house team? No problem. If your organization doesn’t have the internal resources to manage medication reconciliation, BeWell by Aspen RxHealth can help. We connect patients with a nationwide network of licensed pharmacists who deliver timely, remote consultations from anywhere. With guided clinical workflows, secure documentation, and seamless patient engagement, BeWell ensures your members receive safe, accurate, and coordinated care without the need to build a team from scratch.
For organizations burdened by inefficient systems or struggling to meet reconciliation goals, Alliance and BeWell offer a proven, future-ready foundation for safer, more effective medication management. To learn more about these pharmacy solutions, reach out to the Aspen RxHealth team today to request a demo!
