Continuing education brings provider partnerships, med sync to the forefront
McKesson ideaShare 2016 may have officially kicked off Monday afternoon with the conference’s Opening General Session, but even before McKesson executives took the stage and this year’s Pharmacy of the Year award winners were announced, many attendees already had been busy in continuing education sessions, learning about new aspects of patient care as well as how to grow their independent pharmacy businesses.
Among the clinical programs, major educational themes this year ranged from trends in value-based reimbursement and the growth in specialty pharmacy to advancing pharmacy-based clinical services and building partnerships with providers in ways that turn pharmacists into key members of the healthcare team
In all, McKesson ideaShare hosted more than 30 CE sessions over the course of the conference. Drug Store News reporters sat in on a number of the sessions. Following is a brief recap from a few of them:
Keeping an eye on quality
As the Centers for Medicare and Medicaid Services have begun the transition to value-based payments, it is critical for pharmacies to understand and achieve the key performance measures by which CMS — and soon, a growing number of commercial payers, too — will evaluate and compensate them. Elliott Sogol, VP professional relations for Pharmacy Quality Solutions, talked about the current Star ratings measures in place today and also gave attendees a look at what’s coming next.
Among the new Star Ratings measures for 2016 are evaluations of medication therapy management completion rates for comprehensive medication reviews, as well as display measures for drug-drug interactions. Another, which looks at statin use among people with diabetes, will likely be among the Star Ratings measures by 2019, Sogol said.
Looking to 2017, Sogol outlined a planned suite of asthma measures and medication possession ratio for patients with asthma — as well as a focus on high-risk medications and overuse of opioids.
The opportunity for pharmacists, Sogol said, lies in positioning themselves to improve outcomes by screening high-priority patients and counseling those taking cholesterol or diabetes medications, while implementing medication synchronization. A pharmacy that can implement these solutions and deliver outcomes is also well-positioned to partner with providers as part of the overall patient care team, he said.
“As we see these metrics continue to emerge, you’re probably well aware that hospitals are being penalized if patients are readmitted within 30 days of being released,” Sogol said. “That allows me to recognize that if pharmacy can be involved, we may be able to begin to stop that trend.”
Enhancing prescriber relationships
Tackling the different ways pharmacists can leverage their clinical training with the physician community, Thrive Pharmacy Solutions president Tony Willoughby talked about how pharmacies can partner with local provider groups to help deliver improved outcomes through patient-centric care.
“An integrated pharmacy team,” Willoughby said, “begins with understanding such common ground between pharmacy and providers as declining reimbursements, increased patient volume, a rise in competition and a heightened focus on quality. These trends are forcing all healthcare stakeholders to look to form partnerships and help share financial risk.”
“You’ve got to do your homework and understand what the provider’s pain points are,” Willoughby said. “There are both long-term and short-term areas you can work on, and you want to start where you’re solving problems that providers feel the results of quickly.” Often it’s more fundamental pharmacy services like medication reconciliations, chronic care management and medication synchronization before building up to bigger qualitative issues, such as decreasing cost of care, reducing hospitalizations and ER visits, and improving adherence over the longer term, he said.
According to Willoughby, the key for pharmacies looking to partner with providers is to be proactive in seeking out these relationships, be willing to test new ideas fast — and be willing to fail — but to bounce back quickly to test another new idea.
Managing digital listings for independents
Monday morning, Ebus Innovation chief idea officer Elizabeth Estes impressed upon independent pharmacy owners one of the most important things they can do to grow their business — to make sure its digital listings are being seen by potential patients searching for pharmacies online.
According to a 2014 study by Google, 4-out-of-5 consumers used search engines to find local businesses, and 50% who used their smartphones to search visited that business the same day.
Estes helped attendees understand which digital listings and online directories are most important to an independent pharmacy business, and walked through such popular platforms as Google, Bing, Yelp and Foursquare, as well as YellowPages.com. In addition, Estes talked about the types of information and content needed to create an effective digital listing, how to encourage positive reviews online, as well as how to respond to negative reviews in a way that flips the script — and allowing them to highlight the many positives their business offers the community.
Also important, Estes explained, is the need to grow one’s online presence organically, rather than paying to improve search results. Independents can have a natural advantage over big chains because they are naturally more tied into what local customers think is important.
“Creating listings that are optimized for organic search… is so important, because we’re not going to compete with Walgreens on a local level,” she said. “We’re not going to compete with the amount of money they’re going to spend to make sure they’re No. 1 in paid listings. But you can beat them because you [created your digital listings] the right way.”
Clinical services profit igniter
One of the hot issues in the industry is the greatly anticipated passing of federal provider status legislation for pharmacists under Medicare Part B. Indeed, the potential that provider status holds both to expand access for patients in underserved areas as well as to expand the scope of practice for pharmacy and open up new revenue streams for the industry is a source of much excitement.
But according to Nicolette Mathey, creative solutions specialist at Pharmacy Development Services, there is no need for pharmacists to wait for provider status — there is a host of clinical services that they can offer patients right now that will also add new revenue streams.
In particular, Mathey highlighted several ways pharmacies can partner with local providers to provide support and introduce new services that can be billed through the physician’s office, from annual wellness visits — which can be performed by a pharmacist at the physician’s office — to chronic care management and transitions in care management.
Even if pharmacy operators feel like they aren’t yet ready to partner with physicians, Mathey emphasized that there are a number of other existing services — MTM, immunizations, diabetes education, hormone testing and pharmacogenetics — that can bolster a pharmacy’s billable services while providing areas for pharmacists to offer more services to customers, something she called “upsolutions.”
“It’s the mindset of ‘What else can I do for you?’” Mathey said. “A lot of times pharmacists don’t like [to do that sort of thing]; they don’t like how it feels to be a salesman.” But Mathey offered attendees a different way to look at it: “If you don’t use your clinical expertise to recommend something to the patient that could benefit them with one of their side effects, you’re actually doing them a disservice.”
Implementing med sync
Trey Crawford, owner of three pharmacies, including Diket’s Professional Drugs in Laurel, Miss., has some 600 patients enrolled in his medication synchronization program. His message to McKesson ideaShare 2016 attendees was that getting patients synced is not as daunting a task as it sounds, and it can provide new efficiencies and opportunities for revenue while improving adherence and assisting with other clinical offerings.
Beyond simply improving a pharmacy’s financials by helping to balance workload and better manage inventory, Crawford also talked about how med sync can help improve quality performance measures, facilitating such activities as medication therapy management, comprehensive medication reviews and checking up more regularly on patient adherence.
Crawford instructed attendees to create an action plan and emphasized the importance to start slowly and to set realistic goals in order to build to a critical mass.
“Once you get to 100 patients, you’re going to be able to tell the difference … in your workflow,” he said.
Advances in specialty pharmacy
In order to help McKesson ideaShare 2016 attendees understand the potential that specialty medication can play in their pharmacies and to underscore just how big the boom in specialty medications is, Catalyst Enterprises president and CEO Marsha Millonig took a macro look at recent progress in the rapidly emerging “life sciences” arena.
As innovation continues at an amazing rate, the industry is seeing the convergence of the pharmaceutical, device and technology manufacturers, and blurring of the lines of conventional medication therapy, she explained, as nanotechnology plays a key role in preventive medicine and scientists are able to map the human genome.
This convergence is giving rise to a new class of highly targeted therapies, with some 50 new biologics approved in 2015, she said. Given the rate of advancement in specialty and the high cost associated with the treatments, Millonig noted that it is a space that offers a lot of potential for pharmacy owners, and one that also comes with its share of challenges, including access to drugs whose manufacturers have sought to limit.
Independent pharmacies, particularly ones that deal with specialty, do have an advantage over larger, national specialty pharmacies, Millonig said. “I think often locally you have relationships with providers that put you at an advantage over another kind of specialty pharmacy that maybe is nationally known but doesn’t really have any relationships in your community,” she said.
Improving outcomes by being involved
Ten years ago Randy McDononugh, co-owner of Towncrest Pharmacy in Iowa City, Iowa and Solon Towncrest Pharmacy in Solon, Iowa, left his job in academia to focus more on pharmacy practice. And though the industry has changed much in that time, McDonough has managed to make his pharmacies high-performers when it comes to quality measures, and he shared his best practices with McKesson ideaShare 2016 attendees.
Some of the largest areas of opportunity, McDonough explained, include clinical partnerships with local providers and performing pharmacist interventions for every patient. And though the latter sounds like a difficult task, McDonough shared workflow solutions and some of his own strategies for success, including making a small note on every prescription dispensed to patients.
“If you think this is impossible, you’re wrong,” McDonough said. “I’m not saying you have to look at every single medication. It might just be the medication the patient is getting at that time, and in that particular instance you need to say ‘Is this drug therapy OK for this patient?’ You can do that and do it consistently with every patient. Every single patient gets a touch. How comprehensive that touch is will depend upon the complexity of the case.”
Leveraging global strategy to help independents navigate macro trends in health care, business
Health care is local. But the back-end service that enables the delivery of that localized healthcare experience has become increasingly global both in size and scope.
“We believe that health care is extremely local, but from a McKesson perspective, it is becoming more global. Regarding the overall healthcare ecosystem, for us to be a healthy company in the future, we have got to explore the global opportunities,” Chris Dimos, McKesson SVP corporate strategy and business development, told Drug Store News in an exclusive interview hours before taking the stage Monday afternoon for the McKesson ideaShare 2016 Opening General Session.
“Some of the moves we’re making as a company are to position ourselves to win in that global economy,” he added. “When you think about how we are reacting to the impact of generic scale, it’s around our global relationships with manufacturers and being able to demonstrate that. When you think about innovation and changing the front-end, then it’s about the learnings we can bring from across the globe through our interactions with community pharmacies in Europe and in Canada to deliver the best of all community pharmacy.”
To describe how McKesson’s global strategy is helping to drive success for the independent pharmacy operator, Dimos outlined four macro trends that are impacting the delivery of health care at every level today:
- Generic scale: “Purchasing consolidation is happening everywhere,” Dimos noted. “When there were 10 to 12 buyers acquiring pharmaceuticals, and the wave of branded patent expiries spawned a plethora of new generic introductions, that fueled a lot of growth for pharmacy,” Dimos said. “As the number of new small molecule drug introductions fell off and the generic business became more commoditized, a number of entities — beginning with Walgreens Boots Alliance — began to form generic purchasing partnerships with major wholesalers to gain greater purchasing scale. “Where we’re at today, there are a handful of companies controlling some very large market shares,” Dimos said. “We believe it’s extremely important for us to have ‘stable’ scale … where the manufacturers can count on that long-term relationship with us so we can think and plan more strategically than just year-to-year, product-to-product.”
Consolidation and integration: “Traditionally, industry consolidation has followed the old pharmacy law, ‘like dissolves like.’ Retailers bought retailers, PBMs bought PBMs, manufacturers bought manufacturers,” Dimos explained. “Now, we’re starting to see more vertical integrations — probably the best known is CVS and Caremark.”
“With accountable care, as quality of care becomes much more of an important component, we believe we are going to see entities come together, either through organic growth or by acquiring the assets they need to be successful in the future of a value-based model as opposed to a volume-based model,” he said.
- Product mix shift: “Generic profitability is starting to wane as payers become more transparent … less new innovation in small molecules, the traditional tablets and capsules dispensed in the retail environment,” Dimos said. “You’re seeing the emergence of specialty drugs — large molecule drugs that are really aimed at much smaller, targeted populations at much higher cost. By 2020, it’s expected that specialty drugs may represent half of total pharmacy revenues, but total transactions will still be in the single digits,” he said.
- Reimbursement, performance and access: “Cost will always be important, but value is where we are going to be differentiated and measured,” Dimos said. “We’re seeing different levers used to differentiate healthcare offerings, such as narrow networks or performance-based networks where you have to earn your right to participate,” he said. “Access is being influenced on a product level in terms of limited distribution for some of the larger molecules, and that access is really influencing how providers are being differentiated inside of the overall healthcare ecosystem.”
To help community pharmacy navigate these macro forces and meet the myriad challenges imposed by each, Dimos pointed to four integral strategies independent operators should employ to drive profitability and retain access to patient lives:
- Bolster core business: “This is about managing your expenses,” Dimos said, noting that labor and inventory are two of the easiest costs to manage. “It’s about becoming extremely efficient, managing and balancing not only the clinical care, but also the economic health of your business,” he said. “We’re providing, through Health Mart and the assets that we have, ways to educate and help operators become extremely efficient in running their businesses.”
- Pharmacist-delivered services: “The pharmacist has to practice at the top of his license,” Dimos said. Pharmacists need to be prepared for the day that provider status is enacted for the profession. “Having that status, it’s not the end of the game, it’s just the beginning,” he said. “Pharmacists need to educate themselves about the new services they will be able to deliver as providers before someone pays us for it. It’s about moving from product provision to knowledge provision, and then being able to monetize that.”
- Partnering within the greater healthcare ecosystem: “Healthcare is local, especially for our independent community business,” Dimos explained. “The partnerships they form with the local healthcare providers to provide services, whether it’s in transition of care or helping to prevent readmissions, those types of collaborations are partnerships they can form based on locality and the relationships they have in the local healthcare ecosystem.” But pharmacy operators need to take a proactive role in driving these relationships. “They won’t come to you; you’re going to have to seek them out.” This is another area where McKesson is helping to provide turnkey solutions for its customers. The company rolled out the Collaborative Practice Agreement (CPA) program in a few states last fall. The program has since been expanded to 37 states, covering nearly every state that requires a CPA to prescribe and administer eligible immunizations to patients in their community.
- Identify new revenue streams: “You have to diversify away from dispensing revenue and earnings only,” Dimos said. “Health Mart can help identify those opportunities and provide turnkey solutions to assist in getting those programs off the ground, such as immunizations or medication synchronization,” Dimos noted.
But it’s more than that. “Are you innovating? Are you innovating on the front-end? Are you thinking about new ways to capture and engage your patients?” he asked. “We see a growing interest around healthy food or beauty in the marketplace,” he said. Whether it’s disease-state specific like diabetes, or general like nutrition, pharmacists need to make sure they are diversifying their revenue streams, he said.
AccessHealth demos new suite of tools to help optimize managed care performance
McKesson’s AccessHealth, a market leader in managed care solutions, is showcasing a number of enhancements at McKesson ideaShare 2016 designed to help enable independent pharmacies to gain access to — and compete in — the right preferred networks.
AccessHealth hosted a special sunrise educational session Tuesday morning, at McKesson ideaShare, where two executives from CVS Health talked about the types of activities and outcomes payers are looking for from independent pharmacies in order to maximize performance reimbursements opportunities. In addition, AccessHealth team members were on hand in the McKesson ideaShare exhibit hall to walk attendees through the new enhancements.
But to get a first-hand understanding of how AccessHealth’s contracting and performance programs help independent pharmacy operators understand and navigate the managed care landscape, deliver best-in-class medication-related performance outcomes and optimize reimbursement, Drug Store News caught up with AccessHealth VP and general manager Eyad Farah and director, pharmacy performance Amie Bland in an exclusive pre-ideaShare interview.
“The narrow networks are not going to go away,” Farah told DSN. “They’ve proven successful in doing exactly what they’re supposed to do, reducing overall costs for payers and the PBMs.” This has been an interesting year, Farah explained, “because we’re starting to see more and more of these limited networks within the commercial and the Medicaid space,” which represents about two-thirds of the prescription volume for pharmacies participating in AccessHealth, he said.
Among the recent enhancements to the AccessHealth platform is the Pharmacy Performance Guidebook. Introduced earlier this year, the Pharmacy Performance Guidebook helps McKesson customers understand the overall performance focus of each PBM or plan, and offers detailed instructions for developing action plans to improve patient behavior and boost outcomes through such tools as medication therapy management, refill reminders, medication synchronization and behavioral coaching.
“As all of health care continues to move to a value-based payment model,” Farah said, “it’s becoming increasingly more important for community pharmacies to incorporate performance measures into their practices. Very similar to how performance models have grown in the last couple years, we’re going to see that move toward [limited] performance networks,” Farah said.
“This is the year our pharmacists have more opportunities to obtain performance dollars than any other year we’ve seen,” added Bland. “In 2016, we’re seeing medication therapy management completion activity fees, bonus payments and now variable direct and indirect remuneration fees, so the actual reimbursements can be improved by elevating top performance.”
Direct and indirect remuneration (DIR) is a fee system, originally created by the Centers for Medicare and Medicaid Services and subsequently adopted by private payers, designed to lower costs and improve outcomes for patients. DIR fees are collected at varying times throughout the year, so anticipating and planning for them is critically important for pharmacy operators.
Pharmacies that meet the top PBM performance requirements may be charged a smaller DIR amount than those who underperform, Farah explained. “In 2016, about 40% of AccessHealth Medicare Part D claims had that variable DIR opportunity,” he said. In 2015, there were relatively none.
To help independent pharmacy operators maximize the variable DIR opportunity, AccessHealth also recently added the DIR Estimator Tool to its suite of tools. The DIR Estimator Tool helps estimate accrual and incentive amounts that could impact DIR payments.
After McKesson ideaShare, AccessHealth will be introducing a performance estimator tool that “will help stores identify all the performance opportunities they have available to them — for instance, if there are MTM activity fees available or PBMs that are offering the variable DIR rates,” Bland said. “There’s even a partnership within McKesson that’s offering rebates. So, the new estimator tool will highlight all the various performance reimbursement opportunities in one place for our pharmacies.”
Earlier this year, AccessHealth augmented its McKesson Reimbursement Advantage program with the launch of MRA+, which integrates PrescribeWellness Patient Engagement Center and Medication Synchronization Solution, StarWellness in the MRA program. MRA+ helps pharmacies tap into their performance opportunities and provides a dedicated coach to assist pharmacies on their performance journey, Bland explained. “Our MRA and MRA+ stores have higher performance scores than those that are not enrolled in these programs,” Bland said. “They have constant reinforcement of the importance of pharmacy performance.”
Currently, more than 5,700 small and medium chain pharmacies are members of AccessHealth.