Feature | Offering More

Pharmacy Offers Transition of Care to Build Successful Niche

A stint working in hospital pharmacy piqued the interest of Steve DiLollo, Pharm.D., in the clinical and collaborative areas of pharmacy. Now he operates a transitional-care practice alongside the traditional pharmacy at Colonia Natural Pharmacy.

Steve DiLollo Pharm.D. Colonia PharmacySteve DiLollo saw the opportunity to apply the traditional role of a retail pharmacist to the specialized world of transplant care.

 

Before adherence was a buzzword in the independent pharmacy world, Steve DiLollo, Pharm.D., director of specialty services at Colonia Natural Pharmacy in Colonia, N.J., 30 miles southwest of New York City, saw an opportunity perfectly suited to the clinical training of pharmacists and to a personal interest of his: providing clinical care for transplant patients. Transplant medicine is an example of the pharmacist taking retail expertise in medication therapy management (MTM) and applying it to a high-risk patient base. For transplant patients, compliance with immunosuppressive therapy is vital to survival and to avoiding emergency readmissions to the hospital. The workflow of patient engagement, refill reminders, patient education, and MTM is where DiLollo finds the usual routines of the pharmacy staff apply to a specialized clinical niche.

“Traditionally, an independent is your mom-and-pop store,” says DiLollo. “You know the people, and you can end up taking care of generations of customers. I wanted to transition that same relationship to the population of patients that were facing a dire medical situation and, thanks to a transplant, this population has a second chance. It’s so important that transplant patients are compliant to their medications. When they are compliant, it enhances their life, and we can give them the tools and care and compassion that we give all our patients.”

Part of the Team

Pharmacists are considered a part of a transplant patient care team, according to the Centers for Medicare and Medicaid Services (CMS), which requires every transplant center to identify an “individual trained in pharmacology,” which is generally a pharmacist. Recognizing drug-drug interactions, monitoring, and managing the immunosuppressants and other essential post-transplant medications, pharmacists are trained to educate patients on the reason why medication compliance is so important.

DiLollo had worked in the independent setting for 13 years when, in 2011, he happened to talk with a hospital pharmacist colleague who mentioned the issues surrounding transitions of care with transplant patients. The hospital pharmacy filled the discharge scripts, but what happened after that? DiLollo thought his staff at Colonia could offer more.

“I thought we could meld a clinical and retail setting, that the clinical care needed to offer patients with complex medication regimens wasn’t out of the scope of what we could handle in a retail setting,” says DiLollo. “This was something that hadn’t been done by independents. Even my friends in high corporate positions at hospitals told me it was innovative.”

What started as a personal interest for DiLollo is now a division of Colonia Natural Pharmacy. The first step was developing relationships with transplant doctors at Philadelphia hospitals. He knew his pharmacy could handle the ongoing needs of the patients, and in particular, support the necessary compliance work through automation in the pharmacy. From the first hospital and patient in 2011, Colonia now serves 240 patients per month, from Hahnemann University Hospital, Einstein Medical Center, and Thomas Jefferson University Hospitals in Philadelphia, as well as the Christiana Health Care System in Delaware. According to DiLollo, it’s been harder to work in the New Jersey market, as the hospitals in that state do everything in-house with their transplant patients. The Colonia Natural Pharmacy staff had to get certified in each of the states it serves, as well as obtain Medicaid licenses and work out agreements with insurance companies.

DiLollo says he may never meet his patients, but he and his staff speak with his patients over the phone, and the relationship is very important. With the initial conversation, DiLollo outlines the services that his pharmacy can offer, and while patients can be hesitant, DiLollo says 97% of his customers have stayed on as the pharmacy’s long-term patients.

“My goal is to take care of a patient who is at risk even if he gets a fever. I want to make sure at the end of the day that we’ve helped someone who might not get the same care without us,” he says.

Technology as the Foundation

Colonia Pharmacy Transplant Division

 

The transplant pharmacy division has grown at such a rate that it has its own space, above, separate from Colonia’s busy retail pharmacy and front end. 

 

Colonia Pharmacy Interior

 

The medication synchronization and management model that Colonia already offered its retail patients meant DiLollo had the process in place to manage the ongoing medication regimens of transplant patients. He did increase his staff, but it was his pharmacy management system and IVR system that allowed him to develop a proactive program to help his patients. The functionality in Colonia’s HBS system has provided the necessary foundation for the transplant business to increase. Without the support of the vendor, DiLollo says, the staff would have been stretched too thin, as Colonia is a busy retail pharmacy. As of late 2015, the transplant business accounted for 10% to 15% of the pharmacy’s prescription volume, and 2015 was the year in which DiLollo saw the most growth, as referrals continued to increase.

Colonia Natural Pharmacy uses the HBS system to manage patient profiles and provide patient care more efficiently. The process begins with a new patient profile and a review of the medications the patient is taking and when the refills are due. “When offering specialty care like this, tracking adherence is vital, since these are life-sustaining immunosuppressant drugs that must be taken every day without fail and at certain times,” says DiLollo.

Many patients are on three medications or more. At first DiLollo’s staff called patients each month to confirm refills. This was a manual process — reviewing patient profiles and calling the patient and doctors for any changes and scheduling delivery. But as the service grew, DiLollo instituted a proactive refill reminder. With the HBS system, the Colonia staff groups patients in a transplant category and runs a report for a specific point during the month. The staff makes phone calls based on the list. “This would be a monumental task if done manually, since patients can be on between six and 20 medications,” DiLollo says.

With the increase of e-prescriptions, DiLollo says these feed right into the HBS system, along with faxes through the TeleManager IVR. A function that HBS added for Colonia’s transplant division is a pop-up reminder when the patient is on his or her last refill. The pop-up asks if the staff would like to contact the doctor. This is set a month before the refill is due so the staff has plenty of time to handle any changes in therapy and the medication is ready to ship at the right time.

The relationship between the Colonia staff and its patients is a good one — all patients get a branded Colonia Natural Pharmacy bag with the first order of medications, and DiLollo has seen it in waiting rooms when he’s visiting with doctors. Patient training has paid off — patients have been known to call the pharmacy if they feel they haven’t gotten their regular call from the staff. The TeleManager IVR lets patients leave a message, and the Colonia staff can email the tech-savvy patients. DiLollo says the staff is careful with health information, so there isn’t a lot of detail in the email, but the communication is important. Patients email the pharmacy and ask when some medications are due, and then the staff can call them back.

Organized with Reports 

  Colonia Pharmacy Transplant Patient Wellness Bag

Although the Colonia transplant pharmacy staff and pharmacists don’t meet many of their patients, each patient receives a wellness bag when he or she is brought into the program. DiLollo has seen the bags in waiting rooms when he visits with doctors.

Although billing isn’t much different than with a typical patient, reports allow the Colonia staff to organize refills and MTM by patient, by when the refill is due, and by when to bill. DiLollo will have a report run based on allowable refill date or billing date. Managing delivery is also important, as medications need to ship on a weekday and arrive when the patient is home.

On the clinical side, DiLollo has customized quarterly reports that evaluate side effects from the drugs. Sometimes patients have side effects they forgot to mention to the doctor, or something is bothering them, and the survey can tease those issues out. Then the pharmacy staff can contact the physician when necessary.

“When I started this, I thought we could get a handful of patients, and that would be great,” DiLollo recalls. “But we’ve seen exponential growth. The only way to do this well is to commit to this category of patients, and this has built our reputation as being able to handle them. It shows me we are doing something right.” CT

Maggie Lockwood is VP and director of production at ComputerTalk. She can be reached at maggie@computertalk.com.



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