Overcoming barriers to patient-facing care
There is no shortage of hurdles when it comes to achieving patient-facing care. Here are some key challenges and how the industry is trying to address them.
Long wait times: The biggest reason for dissatisfaction with a pharmacy is long wait times, said Oscar Cateriano, director of dispensing U.S. Retail, at BD.
“This should not be happening, and collectively BD is working with retailers to help solve this,” he added, citing third-party research that his company supported. One way to address the challenge of wait times is to “bifurcate” strategies by becoming more efficient with prescriptions for certain patients in order to open more time for those who need individualized pharmacist services, said Kevin Hourican, CVS Health executive vice president of retail pharmacy and supply chain.
Provider status: The industry needs to have pharmacists get reimbursed for services other than just dispensing medications. “That’s one of the biggest barriers holding us back as an industry,” said Rick Gates, Walgreens group vice president of pharmacy. “Provider status is going to give us a reimbursement mechanism for additional healthcare services.”
Technician staffing ratios: States mandate different ratios for the number of technicians per pharmacist. The lack of uniformity makes it hard to standardize across the country. “We have pharmacists doing technician labor in select states, because in those states the ratios don’t allow for them to be doing purely pharmacist work,” Hourican said. “We believe passionately that this needs to be changed. We can improve access to health care with legislative reform.”
Electronic health records: Pharmacists need more access to patient records in real time. “As intimate as we get with the patient, it would be great to have even more connectivity with the providers they have, at the time of point of sale when we’re really engaging with the patient,” Thrifty White COO Tim Weippert said.
Changing ecosystem: Industry disruption has led more dollars to flow out of hospitals and has produced changes in the traditional ranks of healthcare providers. This is a challenge, but also an opportunity for pharmacists to expand their levels of care by adapting to these fast-paced changes. Technology “is the great enabler” for connecting pharmacists to the wider ecosystem centered on the patient, said Doyle Jensen, executive vice president of global business development at Innovation.
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Industry Issues Summit: Charting a roadmap for patient-facing care
There’s no single magic bullet for enabling patient-facing care in community-based pharmacy, but there are proven strategies to make substantial progress.
That’s the conclusion being reached by top leaders in the pharmacy industry who discussed the issue in a panel at the Drug Store News Industry Issues Summit in New York City in November. As they analyze lessons of recent years to determine the best ways to achieve this goal and discuss the best ways to make progress, much of the industry dialogue centers on the role of community pharmacy in supporting face-to-face interactions with patients.
Success will require freeing up pharmacists to deliver a range of services, changing traditional reimbursement models and connecting pharmacists to the wider ecosystem centered around a patient.
Industry executives underscore the importance of delivering on the key missions of community-based pharmacy, capitalizing on the pharmacist’s trusted status, embracing emerging technologies, collaborating with industry partners and overcoming regulatory barriers. All of this will help ensure patients get the care they need.
“For select prescriptions, we need to become significantly more efficient, so that for those patients that need more pharmacist interaction time, we can give them that time,” said Kevin Hourican, executive vice president of retail, pharmacy and supply Chain, of Woonsocket, R.I.-based CVS Health. “We never want to have to turn away a patient for an immunization because we’re too busy filling a monthly maintenance prescription a patient has been taking for years.”
At Deerfield, Ill.-based Walgreens, the focus is on both accessibility and care, group vice president of pharmacy Rick Gates said. “When we look at delivering patient care, we start with bundling the right offerings at the right time for each patient, while being accessible on their terms, both physically and digitally.”
Expanding pharmacist responsibilities
“We engage our pharmacies to be more than a dispenser of medications,” said Tim Weippert, COO of Plymouth, Minn.-based chain Thrifty White. “We want to spend as much time with the various services we can provide, from immunizations to screenings. Having more touchpoints and face-to-face engagements produces the greatest results for patients, and also reduces costs.”
Much of enabling patient care comes down to fully establishing this wider role for pharmacists as solution providers, said panel moderator Chris Dimos, who is president of retail solutions for McKesson U.S. Pharmaceutical and Specialty Health.
“The future of patient care must evolve from dispensing of products to knowledge provision for pharmacies in the community setting,” Dimos said. “It’s about the knowledge for staying well when you are well, and helping you manage any sort of illness you may have.”
There are challenges to accomplishing this, however, a fact the industry has long recognized. “Today, I still see most pharmacists tethered back behind the counter, they aren’t able to make that personal interaction yet,” said Doyle Jensen, executive vice president of global business development at Johnson City, N.Y.-based pharmacy automation company Innovation. “We’ve talked about this for years, but we’ve yet to see that evolution.”
Frank Maione, chief business officer at Mountain View, Calif.-based PerceptiMed, said freeing up pharmacists to deliver more personalized care is a major goal. “If I had a magic wand, I would want to prevent the pharmacist from ever being behind the counter,” he said, adding that this is important so “they are visible and able to be accessible.”
Maione added that the importance of achieving this becomes clearer as the provider landscape changes, “with the pharmacist as the most highly trusted professional and often with immediate access, and as the number of practicing physicians continues to go down.” He emphasized the importance of getting pharmacists more engaged with patients in order to deliver needed levels of care.
Technology plays a crucial role
Technology already is supporting progress in this regard, freeing up pharmacists to enhance patient interactions, according to industry leaders.
“At Innovation, we see ourselves as the technology insider behind the company’s operation,” Jensen said. “We’re in the business of enabling our customers to redeploy their pharmacists to provide that patient-facing care. All of our efforts are around quality and efficiency; how can we make the process more safe and efficient to translate to more time with the customer.”
Maione said PerceptiMed is a “technology enabler” that supports the pharmacists’ efforts to do more of what is needed. “It takes the handcuffs off them,” he said. “We’ve evolved our model so that today, in the right retail footprint and with the right retailer future vision, we can work together and enable that pharmacist to do the things we’re talking about today. Our technology is simply an enabling component of the continuum.”
At Supplylogix, a provider of software solutions, “our goal is to make sure the right products are in place at the right time,” said Vic Vercammen, vice president of strategy and industry relations at the Irving, Texas-based company. “As a pharmacist myself, I realize that product availability and accessibility is part of patient care, especially today. And there’s a lot to run back of house. We’re proud to partner with pharmacies to help take that labor-intensive task and provide some trusted tools to push that labor back out front so it can be repurposed for patient care activities.”
Part of the solution is to understand the changing ecosystem, and how pharmacists need to play bigger roles in this landscape. Oscar Cateriano, director of dispensing U.S. Retail at BD, said his company and the wider industry is impacted by these dynamics. “A lot of our business is in the hospital, but as more and more of the dollars flow outside of the hospital, it’s imperative for us to start connecting the dots in that ecosystem, and I think we have a lot of different products, technologies, services and solutions for doing that.”
The industry is eyeing the next generation of technology to further help in this regard, Cateriano noted. “Some of the trends, such as the emergence of Internet of Things, are helping the industry to connect the dots. We’re starting to work with different collaborators and partners on how do we provide the right platforms for the future so that when there’s a transition that happens at pharmacy, they connect that along the entire continuum of health care.”
One example he cited is connecting data from wearable products to cloud-based services so it’s accessible. “When you get discharged from a hospital, how is data being captured so that retailers are able to understand a more holistic perspective from patients?”
Industry collaboration drives progress
Collaboration can play a big role in all of these activities, and is necessary to make further gains, panelists said.
A great example of positive industry collaboration involves the response to the opioid epidemic, said Hourican. “The biggest players in the industry have come together to help change how pharmacies interact with prescribers in dispensing opioids.”
He cited the example of the reduction in the number of days of opioid-based medication provided to patients after dental surgery, which is a case of “partnering to change the industry to a maximum of seven days of supply for an acute opioid script.” Further, he urged suppliers and other partners to collaborate on new solutions for patient needs.
“If you are a company with a breakthrough innovation that solves patient needs, bring those ideas to us,” he added. “Some of the best ideas start really small, but they start with solving a discrete patient or customer need. My challenge to technology vendors is to think through how you can make your idea something that can be scaled into a production environment that has 10,000 locations.”
Industry executives say pharmacists will step up to face today’s challenges to enable patient-facing care. This is largely because of their professional nature and genuine care for patients. However, there’s a competitive motivator, as well, in this era marked by a shortage in primary care providers and an urgency to enable better communication of information.
“There will be other healthcare providers looking to fill that vacuum, if not pharmacists and the pharmacy industry,” said Vercammen. “My fear is there are others that will do this, if not us.”
Ultimately, a rising tide will lift all boats if best practices are spread across the wider industry.
“If we can drive some uniformity and consistency across the providing of patient care and services, using technology and other tools to help free up pharmacist time, and monitor and publish outcomes, these are things I think will be critical,” Vercammen said. “It will help make sure each pharmacy is able to deliver as uniform an experience in patient care as possible.”