NACDS, PhRMA research: Increased Rx use reduces Medicaid recipient’ health costs
Expanding pharmacist role key to better outcomes
LAS VEGAS — The role of the pharmacist in the U.S. healthcare system has expanded beyond dispensing to include vaccinations and medication therapy management, and that role could expand further with pharmacy provider status on the horizon. That was the subject of a CE session at Good Neighbor Pharmacy’s ThoughtSpot 2015, during which the American Pharmacists Association’s Vice President Professional Affairs Anne Burns outlined the ways that the changing role can provide opportunities for both pharmacists and patients.
One of the biggest challenges facing pharmacists today that Burns outlined in her CE session, titled “National Initiatives to Advance Pharmacists’ Patient Care Services,” is the need for pharmacists to be recognized as providers under Medicare Part B. Currently, legislation is working its way through the U.S. House of Representatives and Senate that would include pharmacists as providers under Medicare Part B, which would mean that pharmacists could practice at the top of their license, filling chronic disease management roles in medically underserved areas.
Since the implementation of the Affordable Care Act, pharmacists have found the traditional fee-for-service model changing as the Department of Health and Human Services is emphasizing a pay-for-performance model, putting quality of care above the number of scripts filled. And while this change is substantial, it presents an important opportunity for community pharmacies to provide care that can diversify revenue sources and opportunities.
“What we’re promoting is that access to health care is a real issue for patients and pharmacists can help; people on complex medications benefit from pharmacists' services,” Burns said. “When pharmacists are on a patient’s healthcare team, costs go down and quality improves, and while successful passage of these two bills is a priority for our profession, it is critical for our patients.”
Especially given the growing cost of chronic disease (which the Partnership to Fight Chronic Disease found constitutes more than 75% of healthcare spending) and the cost of medication nonadherence (estimated by the New England Healthcare institute to be $300 billion), pharmacists are uniquely positioned and willing to provide solutions to a strained healthcare system.
“There is a plethora of different services that community pharmacies can think about implementing that can provide value to the system,” Burns said. “Starting with immunizations and medication administration and med sync, which I consider … [to be] things that can be implemented within normal models, and then moving through the continuum … to more complicated services, like MTM and disease management.”
As back-to-school season kicks into full gear, immunizations in particular are a focus of many community pharmacies around the country. AmerisourceBergen’s Global Sourcing and Manufacturing team is working to ensure that Good Neighbor Pharmacy members will be able to provide the necessary services in terms of vaccination and beyond, the company said.
“Good Neighbor Pharmacy members and community pharmacies need to be able to practice at the very top of their license,” Peyton Howell, Executive Vice President and President of AmerisourceBergen’s Global Sourcing and Manufacturer Relations division, told Drug Store News. “And that to us means making sure they have access to the product to do that. That means a full suite of all types of vaccines, a wide range to preventive vaccines as well as some of the new vaccines that are coming out, a wide range of specialty products … and products that are designed to treat specific acute diseases, as well as chronic diseases.”
Howell also shared with Drug Store News that AmerisourceBergen’s priority is making sure that pharmacists are equipped to deal with the changing face of health care, and are ready if provider status is achieved and community pharmacies become the front lines of chronic disease management and MTM.
“This is essential when you look at the healthcare landscape,” she said. “We're going to need pharmacists that can serve patients across that patient life cycle and continue to be able to make sure that they have access to changing needs as new treatments come out.”
Good Neighbor Pharmacy operators equipped for future of pharmacy
LAS VEGAS — Good Neighbor Pharmacy highlighted a lot of good news at its ThoughtSpot 2015 earlier this summer, such as how the winds of change are whipping up the need for a patient-focused pharmacy model that supports an outcomes-based patient management solution. And that bodes well for Good Neighbor Pharmacy members, who are already patient focused and primed to deliver those best-in-class health outcomes.
“The last few years, we’ve really worked side-by-side navigating the dramatic changes in health care, changes like the CMS Star measures and how they’re going to [emphasize] preferred networks and increase the importance of medication therapy management,” Bob Mauch, Executive Vice President and President of AmerisourceBergen Drug Corporation, told ThoughtSpot attendees. “We’ve talked about the opportunity this presents for independent community pharmacy because you’re already patient-minded. You’re already focused on the patient, and now the good news is that becomes increasingly important from a financial impact standpoint.”
However, the dramatic changes in health care have created a new paradigm where being intensely patient focused may not be enough. To move the needle on the CMS Star ratings and to become a relevant partner in many of the emerging preferred networks, community pharmacists need to be on the top of their game in every aspect of retail pharmacy operations and administration.
“The healthcare system is moving toward an outcomes-based reimbursement system,” Mauch said. “Independent pharmacists are particularly equipped for this because they spend a lot of time with their customers. They’re uniquely positioned to improve outcomes, [but] we all have to work harder to help measure that.”
Though independent pharmacists are well equipped to handle the patient care end of the business, managing the tasks of marketing and merchandising, inventory, labor and reimbursements can prove daunting at times.
“For the independent community pharmacy, they have a bit of a paradox at times,” added Dave Neu, Executive Vice President Retail Strategy at AmerisourceBergen and President of Good Neighbor Pharmacy. “They’re trying to operate and keep that entrepreneurial independent feel. It’s very important,” he said. “The other piece is that they need the leverage and the scale of the things that their competitors, the chains for example, bring — back-room functions, support on advertising and promotion … and it’s tough for them to get at some of that infrastructure.”
To that end, Good Neighbor Pharmacy launched a number of enhancements at ThoughtSpot 2015 that enable participating owners to operate efficiently within this new paradigm without sacrificing the kind of patient care that Good Neighbor Pharmacy members are known for providing. And it all starts with the company’s revamped Pharmacy Services Administration Organization.
“As the healthcare environment continues to evolve, it’s really important that we help our customers stay ahead of the trends,” Mauch said. “Day-to-day reimbursement on specific products is a big piece of that, but we’re really focused on the future. And in the future we’re going to be helping our customers … transition from what right now is almost a completely fee-for-service environment … to an environment where there will be more pay-for-performance.”
AmerisourceBergen’s newly-named PSAO, Elevate Provider Network, will empower independent pharmacies to improve their profitability through enhanced patient care, better business practices and by leveraging centralized data to support reimbursement discussions with payers. One highlight of the Elevate Provider Network is the expansion of its central pay capabilities with the addition of claim reconciliation services powered by FDS Inc., which enables pharmacists to monitor their receivables balance.
Good Neighbor Pharmacy members will also have access to pre- and post-claims editing services through Emdeon, a leading provider of revenue and payment cycle management, which will help reduce claim errors, improve pharmacy profits and provide greater transparency into payer reimbursement.
Then there is the new Patient Engagement Center and capability set, powered by PrescribeWellness, which independent pharmacies can leverage to drive adherence and enhance patient care, ultimately creating the potential to improve CMS Star ratings and increase reimbursements. That offering features an outbound calling service, an automated message that the pharmacy records in the pharmacist’s voice and deploys out on an ongoing basis around a number of possible topics, including flu shots or other vaccination messages, refill reminders, happy birthday greetings, etc.
To help improve front-end performance, Good Neighbor Pharmacy deployed its Pharmacy Transformation Services program, in which they remake a pharmacy’s front end to better meet the demands of today’s business. This program has really taken off, with the typical transformation delivering an overall 20% lift in front-end sales across the stores that have been transformed. Other benchmarks of success include a 2.7% lift in gross margin and an overall 8% increase in prescription volume.
Using the revamped InSite pharmacy performance tool, which is part of the Elevate Provider Network, Good Neighbor Pharmacy members can monitor front-of-store sales data, which allows pharmacies to measure their performance against similar stores.
And the new offerings to come out of ThoughtSpot 2015 also include a new mobile application that provides pharmacists key information they need to manage their business, such as the next day’s bank deposits for purposes of managing cash flow and a six-month trending view of the pharmacy’s performance in the four highly rated CMS Star clinical measures. The mobile application also keeps track of credentialing documents for pharmacists.