Pharmacy-led Transitions of Care Intervention to Improve Medication Adherence

Inclusion Criteria: * Medicaid or uninsured inpatients * 21 years or older * ≥2 of the complex chronic conditions during index admission or prescribed/using ≥2 chronic medications for these conditions * Patients receiving chronic disease medications from the hospital pharmacy. * Patients will be eligible if they have multiple complex chronic conditions including diabetes, hypertension, high cholesterol, coronary artery disease, congestive heart failure, chronic lung disease, chronic kidney disease, arrhythmia, stroke, psychiatric disorders including depression and anxiety, or who are prescribed or using anticoagulants. Exclusion Criteria: * Medicare and Medicaid dual eligible patients. * If the primary reason for the index admission is related to cancer, pregnancy, or a surgical procedure for an acute problem * If patients have diagnoses of active psychosis, substance abuse, or suicidal ideation during the index admission. * If the planned discharge location is not home. * If patients are part of an existing pharmacy discharge program.