Improving patient care and pharmacy performance
With CMS Star ratings becoming more important with the focus on value-driven care, Drug Store News spoke with Myles Hoover, VP marketing and customer solutions at Cardinal Health, about the solutions the wholesaler is offering its independent community pharmacy owners to help them stay ahead.
DSN: You just wrapped up a series of Town Halls across the country addressing CMS Star ratings. What do you hope was the biggest takeaway for retail pharmacy owners?
Myles Hoover, VP marketing and customer solutions at Cardinal Health: The importance of pharmacy performance. Pharmacy performance matters not only to the patient, but to the pharmacy’s financial health. There will continue to be pressure on reimbursement rates. We want to work with pharmacy owners to improve performance and grow their business in new ways.
DSN: We keep hearing about the shift to value-driven health care. How can retail pharmacy owners make sure they stay ahead of this?
Hoover: The shift to value-driven health care is definitely fueling the importance of pharmacy performance. As the government continues to look at ways to save money and drive value through payers and health plans related to pharmacy measures, pharmacy owners need to be aware of their own performance. Pharmacy owners can do this by utilizing EQuIPP, an unbiased performance benchmarking tool, to see how they are doing related to performance. It’s important to note that health plans are looking at the same data in EQuIPP on these pharmacies as they evaluate performance measures in their contracts.
Additionally, pharmacies can drill down to see which patients are impacting their performance in EQuIPP utilizing the Patient Outliers tool as well as the Quality Improvement Tables. Pharmacy Quality Solutions, the makers of EQuIPP, will attend our Retail Business Conference this year, so I encourage everyone to visit them to learn more about how they can utilize EQuIPP to identify these patients.
DSN: How is the shift to value-drive health care impacting retail pharmacy with respect to contracting?
Hoover: As I mentioned before, payers are looking at the data in EQuIPP and including performance measures in contracts. In the last three years, we have seen a significant increase in the number of performance-based contracts, and we expect this to continue.
DSN: What does pharmacy performance mean to you and your PSAO network?
Hoover: Pharmacy-related measures make up more than half of the CMS Star rating measures for health plans. This means that we must put our focus on pharmacy performance in order to help our PSAO members succeed in this ever-evolving marketplace. As we continue to look at the future of our PSAO network, pharmacy performance and helping our network improve is at the forefront of all that we do.
DSN: Any advice for how retail pharmacy owners can improve their pharmacy performance?
Hoover: Pharmacy performance is a journey and is heavily patient-centric — understanding the patient and having conversations with them on why they are not taking their medications will go a long way.
If a pharmacy owner is looking for a simple way to start improving their performance, I would suggest looking at their diabetic patients as they can potentially impact multiple pharmacy related CMS Star rating measures. It’s important that pharmacists are completing the medication therapy management cases that are assigned to their pharmacy, as many times this patient base is the same as those impacting the pharmacy’s EQuIPP scores. Finally, I would highly recommend checking out all of the tips and tricks available on the EQuIPP website.
DSN: How does Cardinal Health play a role in helping retail pharmacy owners improve their performance?
Hoover: We are fully invested in helping our pharmacies improve their performance and patient care. We have a number of tools available to help identify and manage patients impacting the measures. Reimbursement Consulting Services has a user-friendly dashboard that shows pharmacies which patients are not adherent to their medications in both the Medicare and commercial space. Cardinal Health MedSync Advantage provides pharmacies with an online tool to better identify and synchronize patients’ medications to decrease the number of trips to the pharmacy, as well as increase medication adherence. These are just two of a number of solutions we have available for pharmacies to utilize to improve performance. In the Retail Business Conference Showcase this year, attendees will find a five-star icon on all of the solution booths that offer a solution for improving pharmacy performance, so I encourage everyone to stop by these booths.
NMSOAP offers pharmacists opportunity to expand clinical services, build patient relationships
Independent pharmacies are increasingly in need of new ways to improve patient outcomes. With that in mind, The National Medication Safety, Outcomes and Adherence Program® (NMSOAP®), created and owned by MediMergent, LLC improves patient health by collecting near real-time data about medication side effects, adherence and outcomes, while creating stronger relationships among patients, pharmacists and physicians. NMSOAP is a partnership between MediMergent and the U.S. Food and Drug Administration. MediMergent has contracted for NMSOAP participation to a number of community pharmacy chains, and independent pharmacies including, among others, Cardinal Health.
Currently there is one research program offered to pharmacists affiliated with Cardinal Health. The program looks at the side effects among patients taking new oral anticoagulant drugs, Eliquis, Pradaxa and Xarelto and its comparator, warfarin.
Drug Store News recently spoke to Jacqueline Gleason, director of Network Strategy & Business Development – MTM Performance & Outcomes at Cardinal Health, to hear about how NMSOAP participation can help pharmacists to improve patient health, while expanding their pharmacies' clinical services offerings.
Drug Store News: What are some of the ways NMSOAP can help participating patients and pharmacists, and how does it work to improve outcomes?
Jacqueline Gleason: The program elevates the opportunity to build the bond between a pharmacist and a patient. Participating patients are identified based on the drug they're taking. They register in the program, sign consent forms and provide permission for the NMSOAP to access their medical records. Patients are prompted to complete a five-minute survey every month when they come into the pharmacy — they can also do it on their computer or by calling into a call center. That data is then collected and is available in near real time for the pharmacist to review and understand how the patient is feeling on a drug and side effects from their experience — and it illuminates reasons why the patient may not be adherent.
It’s important for the pharmacist to interact with the patient as it relates to medication adherence and usage because this is a collaborative effort, and can help physicians and pharmacists identify and resolve any problems that are specific to the patient's needs. We can learn how their experience compares with thousands of other patients because NMSOAP is collecting de-identified data and creating aggregated results that the patient will have access to, as well as the pharmacist and the physician. Overall, it will improve patient safety through the learnings collected.
DSN: Once this data is collected, what can patients do to determine whether their side effects are common or not?
Gleason: NMSOAP is an opportunity for the pharmacist to encourage the patients to take ownership of their own health care and seek the advice and support of their pharmacist. It’s a strong benefit for the patient to have that closer collaborative effort with the physician and pharmacist. Another benefit is to have access to that information. NMSOAP did a lot of focus groups, asking patients what would be of value to them, and they heard loud and clear that patients want to understand how other people are doing on the same medication they're taking.
DSN: Beside fostering these relationships with their patients and understanding better the side effects of these medications, what are some ways that pharmacies and pharmacists can benefit from working with NMSOAP?
Gleason: The pharmacies receive payment for participating in NMSOAP and working with their patients to improve adherence, so there's a new revenue category for pharmacies. If you think about this under the medication therapy management umbrella, NMSOAP is providing the additional support with the patient while giving the pharmacist an opportunity to get paid for their services. In the retail pharmacy space, pharmacists advise many patients and work diligently with them each day. This is an opportunity to be more focused on particular studies — and it's a new revenue stream for pharmacies, which is exciting.
DSN: What have been some of the learnings for pharmacies that have come out of the study?
Gleason: We've found ways to make it easier for the pharmacies to identify patients in their workflow, and we encourage pharmacy technicians to be trained in the surveys so they can assist. Leveraging technicians to provide the survey and elevate any issues, is very valuable from the pharmacy’s perspective. From a marketing and support perspective, MediMergent created a ‘pharmacy playbook’ to help pharmacists and other pharmacy staff implement NMSOAP. It includes guidance on how to talk to patients about the program and the steps needed to enroll. Each week we have a one-hour, standing webinar for our customers, and provide an overview for pharmacist that might be newer to the program and address any questions. Our sales team has completed training to support these efforts, too.
MediMergent also created a bag stuffer to be included with patient prescriptions. If a patient doesn’t have time to enroll, or doesn’t fully understand the program at first, the bag stuffer provides additional information for them to review at home and learn more. The pharmacist can then follow-up during the patients’ next visit to answer more questions and help get them enrolled in the program.
DSN: What are some next steps for pharmacies that want to get involved?
Gleason: Pharmacies that are interested can reach out to their pharmacy business consultant to enroll.
The APhA provides a 45-minute online training session for all pharmacists and staff to complete before any NMSOAP participating location can begin enrolling patients. The pharmacy has to be certified to fully understand the process and how to enroll patients. Cardinal Health also provides an onboarding call for pharmacists to join prior to starting the enrollment process with their patients.
This article replaces a previously published version that contained some inaccuracies regarding the origin and development of the program. DSN regrets the error and any confusion it may have caused.
Cardinal Health focuses on front-end design to capture and keep new shoppers
Cardinal Health will introduce a number of new tools at this year’s Cardinal Health RBC that are designed to energize the front-end of an independent pharmacy’s footprint. Because one of the big challenges facing community pharmacy on the front-end is price perception, Cardinal Health is working with their supplier partners on temporary price reduction promotions and end-cap displays to increase consumer awareness around the complete value community pharmacists can bring to the market.
“Definitely, there’s a price perception challenge,” Sam Hoye, director of Consumer Health Marketing at Cardinal Health, told Drug Store News. “There’s a point of view that this is a small retailer; therefore, they are not going to be [price] competitive. We know for a fact that’s not always the case,” she said. “The other piece of this is having the right product — you’ve got to know what your shoppers are looking for.”
Independent pharmacy operators have already won the hearts and minds of their local community, Hoye said. So their ability to localize and have the kind of niche offerings that their national competitors struggle to get on the shelf should be a core competency for independents.
To boost the front-end further, Cardinal Health is in the process of eliminating that “conversion conundrum.”
“What we saw with retail independents is that they were disproportionately behind the national players in terms of having customers buying items on the front-end,” said Naomi Duvall, director of Category Management at Cardinal Health. Customers patronizing their independent pharmacy were making a bee-line for the back-bench without stopping to shop, she added. And that’s a problem.
“A customer makes 42 trips every year to buy OTC and beauty aids,” Duvall noted. “The average consumer is only coming into a pharmacy two times per year,” she said. “You want to build to that 42. That’s where that conversion conundrum comes into play. You want to earn their loyalty.”
To that end, the Cardinal Health team has developed a front-of-store package that independents can implement immediately upon returning from Cardinal Health RBC.
First, Cardinal Health invested in its private-label product development, growing its current offering of LEADER SKUs and adding health and beauty products to shelves in the coming year. “We’ve spent the last year reinvigorating this brand,” Hoye said. “People are going to be really excited to see the portfolio, how it’s growing and the profitability opportunities.”
Second, Cardinal Health’s front-end team, in conjunction with supplier partners, pieced together a series of promotions and end-cap displays designed to attract consumer attention. Patients visiting their neighborhood independent need to be “wow’d” by what they see on shelf, Hoye suggested. “That visual impression is critically important,” Hoye said. “The shelf is the moment of truth. A well-stocked shelf is important in creating that experience.”
The reality an independent operator faces, however, is limited inventory capacity — both in the dollar-value of the inventory stocked in the store, as well as limited storage capacity beyond front-end shelves and counter space. Hoye suggested a “one to show, and one to go” philosophy that helps reduce the potential for an out-of-stock placement without straining resources.
The end-cap program being rolled out by Cardinal Health features both private label and national brand and is turnkey, Hoye added. “Independents work from a very lean operation [viewpoint], and require solutions that are plug-and-play,” Hoye said. “They also need to make a visual impact to resonate with the shopper and help reset that shopper’s price perception.”
Finally, Cardinal Health is in the process of launching a new portfolio of nationally-known homeopathic solutions, making a direct appeal to that niche customer in search of more natural health options.
The new planogram creates a homeopathic destination center that’s replicative of the kind of brands customers might find at Whole Foods. “Our approach to get [independents] started is, to create a section in the store that stands out [as compared with] what you might see in the mass segment,” Hoye said. In this way, independents are offering their consumers a merchandising experience they won’t find at other retailers.