“Free up the pharmacist” is the mantra that drives the vision of Randy P. McDonough, R.Ph., director of clinical services, and co-owner Mike Deninger, RP.h., Ph.D., for Towncrest Pharmacies and Towncrest Compounding in Iowa City, Iowa, and Solon Towncrest Pharmacy in Solon, Iowa.
“We are a community pharmacy that provides clinical services,” says McDonough. “I think over the years, we’ve all used the word retail, and we have commoditized what pharmacists do as product distribution. And we do much more than that.”
These entrepreneurs are talking about a paradigm shift — to where pharmacists are free to handle medication reviews and continuing medication monitoring (CoMM) with every patient. “We don’t just want to get paid to dispense a product,” says McDonough, “but rather paid to make sure the patient has a positive outcome.”
McDonough’s leadership and commitment to innovation in pharmacy practice were the reasons he was awarded the National Community Pharmacists Association’s (NCPA’s) Willard B. Simmons Independent Pharmacist of the Year award in 2016. The recognition highlights McDonough and Deninger, chief technology officer of their related software and consulting company, Innovative Pharmacy Solutions, who together set a goal to transform the delivery of pharmacy services, one that is built on a clinical model to take pharmacy further into the accountable care healthcare model and value-based reimbursement that are transforming the health-care industry.
The Value in Patient Encounters
More than a decade ago McDonough could see the shift to what is now called accountable care and value-based reimbursement and realized pharmacy had to reposition itself in a clinical role, not just a distributor role. When he and Deninger became co-owners of their practice, McDonough talked to Deninger about the need for a clinical documentation record for patient care, including SOAP (subjective, objective, assessment, and plan) notes that can be communicated directly to the physician. From those first wish-list items, McDonough and Deninger have built a full-fledged clinical system that documents SOAP notes, medication-related problems, pharmacists’ interventions, and physician communication. It also provides feedback to the pharmacist to highlight drug therapies that are of interest to payers or associated with a performance metric platform, e.g., EQuIPP (Electronic Quality Improvement Platforms for Plans and Pharmacies). PharmClin, by Innovative Pharmacy Solutions, patent-pending clinical documentation software, gives a community pharmacist the tools to incorporate continuous medication monitoring (CoMM) into everyday practice and conduct regular comprehensive medication reviews (CMRs).
“We say ‘make every encounter count,’” says McDonough. “The best time to conduct a clinical intervention — to collect data and identify any problems — is when the patient is in front of the pharmacist. The pharmacist still has to ask the right question and make a clinical decision, but the software allows them to quickly document it as well.