McKesson's Brian Bertha and Darren O'Neill, head and senior director of sponsored clinical services respectively, have a mission. They not only want to increase the number of clinical interactions pharmacists have with patients, but also make them fit easily into pharmacy workflow while providing the pharmacy with revenue. Bertha and O'Neill took time during McKesson's 2011 ideaShare to talk with ComputerTalk senior editor Will Lockwood about how McKesson is making all this possible.

At left, McKesson's Brian Bertha

CT: First, tell us exactly what the sponsored clinical services program is.

Bertha: Sponsored Clinical Services is an administrative and technologic infrastructure designed to allow pharmacies to provide high quality, fee based clinical care to their patients. It includes services sponsored by both payors and manufacturers; we facilitate it through a network of pharmacies that McKesson recruits, trains, and manages.

O'Neill: Yes, we not only manage the network of pharmacies that delivers these services to patients, but we also provide all the supporting technologies that make it operationally easy for the pharmacies to execute.

CT: What technologies are these?

Bertha: Foremost there is our technology that delivers the service opportunity messaging and supports the documentation and billing of the service delivered at the pharmacy. It is supported by our relationship with RelayHealth. In addition, we are also providing pharmacies with patient-oriented messaging solutions, such as texting and outbound voice and email messaging. These communications channels are very prevalent in travel, retail, and financial services, and increasingly we're seeing them in retail pharmacy. Initially, these direct to consumer services were introduced by the large national chains that have thousands of stores on common systems. What McKesson is doing via Sponsored Clinical Services is enabling independent pharmacies such as those attending ideaShare to offer similar consumer experiences.  These services are available to all McKesson customers who are on the RelayHealth network, which is the enabling data aggregator.

CT: What's the connection between these patient messaging tools and sponsored clinical services?

Bertha: Patient messaging allows pharmacists to deliver services to their patients not only when they are at the pharmacy counter-but also when they are not. For example, we enable refill reminders and prescription ready for pick up notices, which means that the patient is going to be more likely to stop by and pick up prescriptions. Pharmacies can also can go a step further and enable auto-refills of chronic medications through our service. Experiences with auto refill programs suggest that there are more fills per year for each patient in a pharmacy on auto-fill for chronic medications. Think about the difference between a patient who gets a reminder and a prescription ready message and picks up a prescription right away as compared to  one that doesn't and forgets until a week or two later. In the second case, all the patient's refills are pushed back by that one or two weeks. The pharmacy never regains those two weeks and the impact on the patient's health is negative.

O'Neill: Looking at the numbers, improving prescription pickup timeliness is powerful.  For example, let's look at a forgetful patient with a 30-day fill that picks up prescriptions on a 36-day cycle. If we can shave just four days off of that because the patient gets a notification delivered through the messaging channel of his choice, while still not perfectly adherent, it represents 1.5 extra fills per year. This metamorphosis can happen. We know there are a lot of barriers to adherence. These barriers can be financial or educational, but a nudge to refill a prescription can often help, and the patient understands that the pharmacy is caring for him by helping him stay timely with his prescription regimen. Patient messaging is a powerful way for pharmacists to demonstrate that they are looking out for patients.

CT: Darren, you mentioned a choice of communication channel. So the patient can pick a preferred method?

O'Neill: We allow the pharmacist a choice first.  As the pharmacist, I can elect to offer one or more of these channels. A pharmacist could choose to emphasize text messages, if they feel that best fits their service model.  In the end, however, each patient picks how he or she wants to be contacted. Each patient can select the method which best works for them. 

CT: What about apps for smartphones? Are these an option?

O'Neill: In our first phase, which is basic messaging via text, email, or phone, it's not dependent on any mobile operating system. This means no apps right now. We'll develop an app for Android first, since it has the biggest share of the mobile market. As we go through the pilot, we'll develop an app for iOS as well.

Bertha:   First, this technology is all working in the background, once the pharmacist does the intake and marks the patient's messaging preferences. Second, assuming that 80% of people have a mobile phone (either a feature phone which allows for text messages, or a smartphone which allows for more functionality), then we have the basic messaging that works anywhere.  For those consumers who have a smartphone we'll have an app for them as well. The goal is to meet the market where it is headed.

CT: These reminders should be particularly important as e-prescribing increases and patients stop dropping prescriptions off at the pharmacy. There'll be an even greater need to make sure that they know a prescription is filled and ready to pick up.

O'Neill: Yes, that's right. Using reminder messaging will mean fewer of these prescriptions sitting in will call and it will also mean that pharmacists won't have as much restocking to do, so there's a real operational impact. From the patients' perspective, whether they drop off paper prescriptions or their doctors send them electronically, they receive a notification that the prescription is ready and walk in knowing that the trip is worthwhile.  There may be two people in line in front of them, but they now know they aren't going to wait and then find out a prescription isn't ready.

CT: Let's circle back to clinical services. We're engaging patients through the messaging of their choice and ideally brining them in to the pharmacy more regularly to pick up their prescriptions.  Now what?

O'Neill: Conversations can become differently focused. Through our network and our underlying technologies, we've created a very operationally simple way to get information into pharmacies to have reimbursed patient interventions around adherence coaching. This is one thing that you can do with the time that better messaging can create.  You can have higher-value patient interactions.

CT: Keeping this operationally simple seems critical.

Bertha: Yes, and it's also important to keep these processes in the workflow for the pharmacist.  Our processes and systems automatically trigger the message to the pharmacy to engage with the patient. And they allow for very quick documentation and reporting of clinical services without any complex integration, additional software, passwords, or additional workflow. These services take place at the counter and in the workflow, as the patient picks up his medications. These in workflow processes eliminate the need for scheduling, missed appointments, and the staffing implications.

O'Neill: The administrative overhead for a pharmacy is little to none. We're not even talking minutes, but increments of minutes.  Maybe 30 seconds to complete the billing and documentation for these interventions and get the information on the service provided back to us.

CT: This sounds like a good, incremental way to build a clinical services model within a pharmacy and position the pharmacist in an accessible professional role without asking for drastic change.

Bertha: Exactly. Many patients already have brief interactions with pharmacists about appropriate OTCs or items to buy to complement a prescription. In a similar amount of time, a pharmacist can coach a patient on adherence, talk about enrolling in a CRM program, discuss a copay offset or do a short survey about their knowledge and understanding of a therapy - all prompted and documented through our technology and paid for by program sponsors.

CT: I don't think we can overestimate the importance of payment for these services. Pharmacists need to have this recognition by payers for their clinical capabilities if they're going to reach their full potential within healthcare.

Bertha: Our goal for sponsored clinical services is to create benefit for the patient, benefit and reimbursement for the pharmacy, a connection and loyalty between the two, and an accessible and valued channel for patient service delivery for both payers and manufacturers.