USA Today article highlights scope of service expansion at nation’s pharmacies
The nation’s pharmacies are no longer just for prescription medications and states are proving to be the enablers to a broader the scope of practice.
In light of the evolving healthcare landscape, USA Today published an article on Friday about how pharmacists are increasingly working with doctors to assess patients, identify drug interactions and medication errors and, in some cases, even write a prescription.
Illustrating its point, the article features Diana Arouchanova, who owns Clinicare Pharmacy, who recently discovered that one of her patients had been prescribed by her doctor a dangerous combination of two medications. After discovering the error, Arouchanova got the doctor to change the prescription and started checking her patient’s high blood pressure to ensure it dropped.
As the article notes, several states such as California are giving pharmacists greater flexibility. In October, California Gov. Jerry Brown signed into law a provision that allows pharmacists to perform physical assessments; order and interpret laboratory tests; refer patients to other providers; start, adjust and terminate medications under physician protocol; and work with other healthcare providers to evaluate and manage a patient’s health issues.
Other states, including New Mexico and North Carolina, also allow pharmacists to take on more clinical responsibilities, USA Today noted.
The article also mentions that CVS Caremark is a prime example of how pharmacies are taking on a greater role in promoting good health by deciding to stop selling tobacco products in all of its stores.
Q&A: Taking the pulse with Mitch Rothschild of Vitals
Selecting a doctor can be a frustrating process filled with too many unknowns, especially in today’s evolving landscape. Looking to help patients take the guesswork out of finding the ideal doctor, Vitals has developed online tools at Vitals.com to give patients visibility into quality, cost and availability. With its finger on the pulse of the state of doctor-patient relationships, Drug Store News caught up with CEO Mitch Rothschild to talk about some of the consumer healthcare trends, the ongoing physician shortage and how Vitals can work with retail pharmacies.
DSN: As healthcare reform takes effect, what impact will this have in the midst of an ongoing physician shortage?
Mitch Rothschild: One of the other impacts of the Affordable Care Act that is not as well known, but clearly is happening, is that you have the development of Accountable Care Organizations, or ACOs. ACOs shift the risk to the provider or the system. … So, because you’ve got that shift now of the risk to the providers, they are saying, ‘Well as long as we’re taking the risk, we might as well also take the insurance risk.’ So, there are a large number of partnerships that are happening between hospital systems and the insurance companies. … What is happening with a lot of primary care doctors is they are shifting from a fee-for-service to where the hospital system or partner plan is saying [for example], ‘We are going to give you a patient population of 500 diabetics and your job is just to take care of them.’ … As a result, the doctors are able to handle a lower volume of patients. … So, there is a chronic and institutional shortage that is happening and is going to occur.
DSN: Can you elaborate on the impact on alternative care?
Rothschild: What has happened is you are having alternative care [sites] coming up. For example, Walgreens has, I think, 375 of these healthcare clinics, and CVS has the MinuteClinic. Those are now providing the lower level care that would normally have been provided by a doctor. … Ten years ago it was almost all administered by the doctor, and now that has been pretty much outsourced to nurse practitioners and the folks in the wellness clinics. You also have a large growth of urgent care centers where people are going in for a specific need, knowing they will pay a little bit more but will wait a little bit less and will be seen right away. … There’s also been a huge growth of telemedicine. … Similarly, the doctors themselves who are still in the old fee-for-service model are taking on more patients. We saw average wait times of when people are sitting in the waiting room go up 6% in 2013.
DSN: Tell us more about the findings of Vitals’ research on the nationwide physician shortage.
Rothschild: Generally speaking, the wait times go up in direct proportion to the number of doctors, by and large, there are per 1,000 patients in a city. The average in this country is a little [more than] three [doctors] per 1,000. Some places, like the Deep South, have lower percentages, so the wait times get hit harder. … If you look at the [cities] that have the best access, it tends to be more urban; if you look at the place where it’s the worst, you are [looking at the] Southwest. So, it is a function of population growth and historically where the doctor shortages have been.
DSN: How is Vitals helping consumers navigate the current climate?
Rothschild: We come at it from a consumer-centric point of view. The normal decision making that you use to buy anything else — whether it is a car or a television set — the three criteria you typically use are, for some crazy reason, not available in the doctor world. The three factors, when we’ve broken it down into how you decide to buy anything, are based on quality, cost and availability. … What we are trying to do with Vitals — and we’ve been pretty successful at it as we have 12 million people a month that come to the site — is give you visibility [or transparency] on all three: quality, cost and availability.
DSN: How can Vitals help retail pharmacies and clinics?
Rothschild: I would certainly encourage any drug store to work with us because we work with a lot of providers. We have 12 million people [who] want access. The more information we know about what’s open and when is the pharmacy open — getting that information to us we can publicize that. … With the clinics, that is something we want to integrate into the mix. We have a lot of pharmaceutical advertising on the site, which basically pays for the ability to [provide our service] free to consumers, and the reason we have that is because 82% of the people who come to our site see a doctor they found on Vitals within 30 days. So, they are going to get a prescription and get it filled. So, if you want them to go to your drug store we can geo-target that. If you are giving them an incentive to come to the store, we can geo target and drive those folks to drugstore A versus drug store B.
Industry players join Blue Button initiative
WASHINGTON — Several retail pharmacy chains and associations are pledging their support of the Blue Button Initiative — a public-private partnership between the healthcare industry and the federal government that aims to empower all Americans with access to their own electronic health information, the Office of the National Coordinator for Health IT and the White House Office of Science and Technology Policy have announced.
The concept behind Blue Button: Consumers should be able to securely access their own health information and share it with healthcare providers, caregivers and others they trust.
In 2010, with the support of the White House, the U.S. Department of Veteran Affairs launched the Blue Button initiative to give veterans the ability to access and download their health records on a secure, online patient portal. Since then, the initiative has expanded and more than 150 million Americans are able to use Blue Button-enabled tools to access their own health information from a variety of sources including healthcare providers, health insurance companies, medical labs and state health information networks.
Committing to work over the next year toward standardizing patient prescription information to fuel the growth of private-sector applications and services:
- Walgreens, which currently provides its customers with the ability to view and download their prescription history from a Blue Button-branded online portal, plans to adopt BlueButton+ guidelines to make it easier for customers to easily and securely share their data with others, including third-party applications to help people better manage their health and coordinate their healthcare. Walgreens also recently announced a new partnership with the VA which gives veterans convenient, online access to a broader set of personal health data, including immunization records;
- Kroger, which provides approximately half of its customers access to their own pharmacy records through a secure online portal, will be launching a secure portal for the remainder of its stores, many of which operate under local banner names — including Smiths and Fry’s — in addition to developing new functionality that will enable all of its customers to download a copy of their records, and is exploring plans to provide customers with a machine-readable copy of their records that can be shared and uploaded into third-party applications and services;
- CVS Caremark currently provides its customers with the ability to securely access and download their medication lists and prescription history, as well as refill prescriptions through its various online portals, including CVS.com and Caremark.com;
- Rite Aid, through its MyPharmacy online portal, currently provides its customers with electronic access to their own prescription history, tools to better manage their prescriptions and medication management reminders via phone, email or text message. Rite Aid has committed to improving patient engagement and empowerment through expanded access to their own health data and an evolving set of online service capabilities;
- Safeway, one of the newest members of the Blue Button community, is committing to enable its customers to securely access and share their own electronic pharmacy records;
- National Association Chain Drug Stores, which represents traditional drug stores, supermarkets and mass merchants with pharmacies. Chains operate more than 41,000 pharmacies and employ more than 3.8 million employees, including 132,000 pharmacists;
- Pharmacy Health IT Collaborative, which represents nine national pharmacy professional associations representing more than 250,000 members; and
- National Alliance of State Pharmacy Associations, which promotes leadership, sharing, learning and policy exchange among state pharmacy associations and pharmacy leaders nationwide.