Technology Corner: March/April 2014 

Changes in Healthcare Demand Different Thinking ––>

There’s an old joke about an extension agent who approaches a farmer and tells him that a $10 book on how to farm better will make him twice the farmer he is now. The farmer scratches his head and says, “Heck, son, I don’t farm half as good as I know how to now.” Times are changing in healthcare, and it’s still early enough in the year to add a few resolutions. Think about each of these changes and challenge yourself as to whether you have aligned your practice accordingly.

Less Provider Centric and More Patient Centric 

In an environment where better outcomes and cost containment are still dominant, healthcare is finally realizing that without patients who are engaged and participating in their own health, the whole thing goes thud. As a practitioner who has more contact with patients, this should give you an opportunity to be actively involved in participatory healthcare. You can identify, measure, and make interventions to help patients achieve healthcare goals that are important to them and to the healthcare system in which you practice. This isn’t to say that you will have to figure out a way to be competitive in the distribution aspect of your practice.

Accountable care organizations (ACOs) are looking to partner with providers who can deliver efficient and effective transactions, but they really need to identify providers who can help manage patients between encounters. ACOs are predicted to double in number during 2014. Check the Internet to see if there is an emerging ACO in your area with which you can affiliate. We believe that pharmacists are uniquely positioned to help patients when they exit hospitals and doctor appointments, and when they begin new therapies. Adherence has been addressed by former Surgeon General C. Everett Koop, who said, “Drugs don’t work in patients who don’t take them.” Adherence is also closely associated with your medication therapy management service offering. The takeaway is whether or not your practice can legitimately claim that you can deliver a patient-centric, observable, and measurable outcome that engages patients and their nonprofessional caregivers whenever possible.

Value-Based Reimbursement and Accountability 

Accountability used to focus primarily on financial accountability. But clinical accountability and quality measures are receiving new attention, especially as CMS implements the Five-Star Quality Rating System for health plans. Do you believe that your practice is better in these measures than your competitor’s? Can you prove it? Are you tracking what value you bring to patient care? How many reports from your pharmacy management system do you regularly review that would provide you with evidence to make the claim that you bring a higher value with your efforts? How often do you perform follow-up with patients to make sure that the medication prescribed is achieving results? How frequently are you chasing down “no-show” patients on both acute and chronic medications?

Continuous and Coordinated Care How connected are you? 

Nearly every hospital in the United States is now performing a medication reconciliation process. Are you actively involved in making sure that patients who were admitted to the hospital have an accurate drug history in hand? Upon discharge, are you receiving discharge medications and instructions that will enable you to pick up the care provided in the hospital in the ambulatory setting? Helping hospitals can open a quid pro quo arrangement, where patients who are active in your practice can be assisted upon admission, and you can get advance notice of their medication changes upon discharge.

Are you using electronic prescribing channels to work with prescribers to keep them informed on whether or not patients are adherent on the therapies they are prescribing? The ability to communicate patient histories that become available in prescriber electronic medical records (EMRs) is increasingly helping with coordinated care. We also recommend that you select a personal health record that you will use to advocate for patients. Alternatively, you will be able to gain access to patient portals created by community health centers to connect with patients and all providers. The nice thing is that patients are able to give you access to this data upon request. This can bring laboratory and diagnosis information into your practice, and give you an opportunity to help coordinate the overall care of your patients. Remember that there is a disincentive in place for physician visits and hospitalization when ACOs take over the care of a population of patients.

Replacing Inpatient 

This is good news for community pharmacy. Inpatient care is always going to be the most expensive care possible. ACOs want as many empty beds in their hospital as possible. This shift opens up opportunities for your practice like never before. We’ve monitored some physician hospital organizations in the past, and they always treated pharmacists better than third-party insurers. This was only true if pharmacists could prove their value in keeping patients out of the hospital. Additional incentives were available to pharmacists for their clinical services under this system. If you have always felt that you could make a difference in the overall ambulatory care of patients, you may get your chance to prove it. You do, however, need to be at the table in your community with the plan for how you will do this.

We think that home-based care is something that pharmacists can take advantage of very quickly. For years, we’ve heard about the aging of America, and we’re definitely seeing a majority of seniors who want to live at home and stay out of institutions for as long as possible. There are many ways that pharmacies can offer peace of mind for the adult children of these elders and concurrently benefit the overall cost of care. Even the states have recognized that they would rather pay money to hospitals and other care providers to keep patients in their homes and out of the more expensive long-term care settings. Can you think of ways, in these times of healthcare reform, to get involved?

Changing from Disease and Treatment to Health, Prevention, and Wellness 

We have all heard in times past that healthcare could more accurately be described as sick care. For years, pharmacists and physicians have given lip service to health and wellness but never really adopted and changed their practices to address this focus and objective. One reason for this is that patients follow lifestyle change advice with an approximate 10% success rate, whereas prescription medication is successful in over 70% of the cases in which it is employed correctly. We know that 40% of the health status of patients is determined by behavioral decisions. Perhaps this is one of the things that you can bring to the table when you discuss how your practice will produce value in a changing healthcare system.

Multidisciplinary Team-Based Services 

We believe that the connectivity offered by our portable information appliances allows the right person to do the appropriate intervention in the right facility for the right patient at the right time. You possess a special skill set that goes beyond what physicians, nurses, and other care providers can do. Do you see yourself as being part of a multidisciplinary care team? Do the other team members know of your capabilities, and do you have the kind of connectivity that would allow “turfing” of care responsibilities within this team? As tech guys, we can spend hours telling you how to make this vision a reality. If you can supply the motivation, we can help you achieve this vision.

The areas we discussed represent the broad strokes of how healthcare is changing. We realize that the distribution side of your practice is demanding and leaves you little time to step back and examine trends. We hope this review has sparked at least one action item that you can put on your list of practice goals for this year. We invite you to continue the conversation by emailing us. We look forward to receiving your comments and questions. CT

Brent I. Fox, Pharm.D., Ph.D., is an associate professor, and Bill G. Felkey, M.S., is professor emeritus, in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University. They can be reached at foxbren@ and