Enabling adherence through software, packaging
The costs of medication nonadherence — both in terms of lost lives and a massive waste of therapeutic resources — have weighed heavily on patients and health plan payers, and made adherence efforts a priority for most pharmacy retailers. Technology companies are keeping pace with new software offerings and automated compliance packaging solutions to support those efforts to fight the $300 billion that nonadherence is estimated to cost the healthcare system annually.
Efforts to boost adherence are “the focus of the entire pharmaceutical industry right now,” according to Craig Norman, senior vice president of pharmacy at San Antonio-based H-E-B.
“Not only every retailer, but every brand and generic pharmaceutical company has that same goal,” Norman said.
Nearly every pharmacy chain — from CVS Pharmacy to such regional players as Plymouth, Minn.-based Thrifty White and Sioux Falls, S.D.-based Lewis Drug — has launched an adherence program in recent years. The programs offer a way to boost their patients’ health outcomes, reduce costly hospital readmissions, better their Medicare Star ratings and otherwise contribute to the broader health system. And they’ve enlisted their technology partners in an ongoing campaign to document and measure the effectiveness of those efforts.
“We’re trying to get where we can gather and present adherence data, and we’re talking (extensively) to our vendors about it,” Lewis Drug senior vice president of professional services Bill Ladwig said.
Hand-in-hand with the industry’s adherence campaign is the growing movement among chain and independent pharmacies to offer prescriptions synchronized to a once-monthly pickup schedule for patients.
“It’s clear that medication synchronization is the foundation to better patient adherence and pharmacy growth,” said Jason Turner, owner-operator of Moundsville Pharmacy in Moundsville, W.V.
Turner expanded his store’s medication synchronization program in 2014 with support from QS/1’s NRx pharmacy management system and Workflow platform. By mid-2016, 850 patients were enrolled in the synchronization program, accounting for 55% of the pharmacy’s prescription volume.
In addition to offering patients convenience, med sync also opens the door to a closer long-term relationship between patient and pharmacist, as monthly pickups can be parlayed into regular one-on-one pharmacist-patient consultations about medication regimens, managing chronic conditions and other issues.
In two 2015 studies by the Alexandria, Va.-based National Community Pharmacists Asso-ciation, pharmacies that used the Time My Meds med sync application from Raleigh, N.C.-based Ateb, now a division of Omnicell, increased prescription sales, improved internal workflow and were better able to optimize their purchasing patterns.
The merger between Mountain View, Calif.-based Omnicell and Ateb in late 2016 joined Omnicell’s SureMed adherence packaging and automation with Ateb’s patient engagement platform.
“Omnicell’s platform … includes software solutions that improve workflow … with automation solutions that fill and verify medication adherence blister cards,” Omnicell vice president and general manager of medication adherence Troy Hilsenroth said. “Together, they create more time for pharmacists to shift their attention to patient engagement and counseling.”
The role that robotic prescription packaging systems play in boosting adherence is key, according to Quebec, Canada-based Synergy Medical, a major supplier of blister pack and unit-dose technology. The company noted that blister packs can improve adherence by between 61% and 97%, and that its SynMed XF and new SynMed Ultra automation makes the process scalable in a way that manually preparing blister packs is not.
“The benefit to the patient is clear. If they are taking their medication as prescribed, their underlying condition will be under better control,” SynMed senior director of North American sales Mark Rinker said. “The benefit to the payer is clear: a patient adhering with their medication regimen is substantially less costly to manage. The benefit to the pharmacy is clear. Patients consuming their medication as prescribed drive revenue through more fills and higher loyalty measures.”
Pharmacies look to tech to deliver outcomes efficiently
For pharmacy technology providers, a fundamental mission has become helping retail pharmacies in their urgent quest to complete their evolution from pill counting and basic medication counseling to being fully engaged, frontline patient care providers. That includes supporting the drive by pharmacists to more fully integrate with the collaborative healthcare team now coming into focus.
Costly investments in robotics, central-fill systems and other devices have helped free pharmacists to engage with patients at a higher level of care. Additionally, they offer labor- and cost-saving benefits, as well as higher accuracy and the elimination of common human errors.
But pharmacy technology’s equally important role is now generating, measuring and analyzing prescription data — and sharing that data with other providers in the patient-care network to build a more complete picture and medical history of each patient. The goal, of course, is better treatment outcomes and healthier patients.
“Outcomes-based measures are the next wave of the future,” said Laura Cranston, executive director of the Alexandria, Va.-based Pharmacy Quality Alliance. “Everyone is going to be held accountable and required to take action when they know their performance in the marketplace. And contractually, health plans and PBMs and other payer entities are driving this move to value-based care.”
That shift, in turn, is driving the increasing use and sharing of electronic patient health records, or EHRs — including the reams of prescription use and patient-interaction data generated daily by pharmacies’ software. The goal: to create a fully integrated, team-based health system that connects pharmacists, physicians, hospitals, health plan coordinators and PBMs in an accountable, hub-and-spoke model of care, with the patient at the center.
Thus, pharmacy’s ongoing quest to gain full health provider status for pharmacists — and to fully engage with patients, payers and the emerging team-based system of health care — hinges on its ability to capture, manage and share up-to-date patient health records in real time with other members of the health provider team. It also includes connecting with patients — both in and out of the pharmacy.
From Product to Knowledge
The task currently facing pharmacy is “the transformation from a product industry to a knowledge industry,” according to Mission, Kan.-based ScriptPro president and CEO Mike Coughlin.
“Pharmacy operators who want to participate in this future should begin to view their primary product as knowledge and put systems in place to acquire it, embed it in their organizations and make it available at the right place, at the right time, at the right price and with a plan for how they will be reimbursed for it,” Coughlin said.
With the shift toward value-based reimbursement, integrated technology is becoming more of an imperative, according to Bernie Reese, senior vice president and general manager of San Francisco-based McKesson Pharmacy Systems.
“With today’s healthcare system moving toward a value-based reimbursement approach, integrated technology … becomes more essential,” Reese said. “By leveraging new technologies to execute clinical services at a high level, community retail pharmacies can carve out new, sustained revenue streams and become key stakeholders in value-based healthcare models.”
To that end, McKesson Pharmacy Systems joined forces last year with Rochester, N.Y.-based PharmaSmart, which provides health screening systems and online health management services, to incorporate PharmaSmart patient data into McKesson’s EnterpriseRx pharmacy management system. The result is McKesson’s new Clinical Programs Solution, which Reese said is aimed at helping pharmacies use their pharmacy management system to manage their clinical programs directly. With an increase in the clinical role of pharmacists, leveraging patient data is becoming one of their main roles if they want to stay ahead.
“Integrating comprehensive pharmacy data analytics to track and monitor drug spend and use, patient care and quality is a top priority for health systems,” McKesson noted in a 2017 report on health system pharmacy trends. “Organizations can use this information to make better financial, clinical and operational decisions, and drive improved outcomes. This type of investment can provide meaningful drug-spend analysis, giving pharmacy leaders the evidence they need to successfully establish and track cost-containment initiatives. This also can help to reduce drug spend, decrease manual work hours and improve efficiency so health systems can focus on medication safety and patient care.”
Both retailers and their technology vendors are working to align pharmacists’ patient-care and disease-prevention activities with the overall clinical efforts of hospital systems, physician groups and other health providers. Data sharing and electronic health records are the conduits.
“As pharmacists expand their scope of services and play a more prominent role in the healthcare continuum, their ability to exchange information with primary care providers will … be of vital importance,” noted Healthcare Data Solutions, or HDS, in its report “How Real-Time Data Integration is Changing the Face of Healthcare IT.” “Pharmacists will need the ability to send information about patient immunizations, health screenings, medication compliance and more to the right primary care provider.”
The Mobile Pharmacy Connection
To be sure, the automation and data-mining revolution extends well beyond the pharmacy workspace. It’s something that John Standley, former chairman and CEO of Camp Hill, Pa.-based Rite Aid observed in 2017 before he departed the retailer to lead Vitamin Shoppe.
“Improving digital connectivity between patients and providers is critical to achieving value-based, patient-centered care,” the New York City-based Deloitte Center for Health Solutions reported. “Many healthcare organizations are exploring strategies to leverage technology, including telehealth, to increase consumer engagement and focus on prevention and chronic care management.”
In order to keep up with its connected consumer, Woonsocket, R.I.-based CVS Health is using digital technology to personalize the shopping experience in its CVS Pharmacy stores, according to CVS Pharmacy president Helena Foulkes. “We’ve seen great adoption of our CVS Pharmacy app,” she said.
At its Digital Innovation Lab in Boston, Foulkes said CVS Health “is focused on developing cutting-edge digital services and personalized capabilities that offer an accessible and integrated personal pharmacy and health experience.”
Though discussions about reaching digitally engaged patiens largely focus on younger, tech-savvy one, some retailers are expanding the scope of who they want to reach. Increasingly, older Americans also are embracing mobile technology to connect with their local pharmacy for prescription refills, dosage reminders, online chats with a pharmacist or appointment scheduling.
Walgreens, for instance, has seen its mobile pharmacy app gain a lot of traction with seniors. According to the Deerfield, Ill.- based company, patients age 55 years old and older account for 27% of its mobile app users in general, and 37% of customers use its refill-by-scan feature and other mobile pharmacy tools. They also can use the app to upload prescription insurance eligibility information to the Walgreens pharmacy, schedule appointments at any in-store clinic or connect with a doctor via the online telehealth site MDLive.
“One of the things we repeatedly hear is that customers really value their connections with individual pharmacists and staff,” Walgreens divisional vice president of loyalty Mindy Heintskill. “We wanted to replicate that connection digitally, so customers can get a high-value, personalized experience even when they can’t make it into a store.”
The health and data link
As pharmacists embrace efficiency and chains make moves to engage patients digitally artificial intelligence and predictive analytics continue to make steady inroads. Technology experts assert that healthcare providers can improve outcomes by better utilizing data provided by EHRs, insurance claims and even fitness monitoring. Advocates believe that such tools as IBM Watson Health Cloud, which uses data from multiple sources, can improve outcomes for patients with chronic conditions.
The potential for improving population health has spawned some creative alliances between pharmacy chains and data analytics sources. CVS Health, for instance, is more than two years into a partnership with Armonk, N.Y.-based IBM to help chronic disease sufferers through the deep mining and analysis of their health records. And Walgreens made its Balance Rewards card program available to Menlo Park, Calif.-based MedM’s Health Cloud users.
A data-driven approach also was behind a collaboration between Minnetonka, Minn.-based UnitedHealth Group’s OptumRx and Walgreens. The partnership included goals of leveraging Optum’s massive data repository and improving the companies’ ability to “communicate health data and analytics to ensure members receive the most effective prescription drugs at the right cost.”