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WITH THE GOAL OF IMPLEMENTING medication therapy management (MTM) and compliance packaging at her pharmacy, Germ’s Thrift Clinic in Opelousas, La., Germaine Robinson found leveraging compliance packaging from Medicine-On-Time with data in her EQuIPP (Electronic Quality Improvement Platform for Plans & Pharmacies) dashboard to be the combination she needed to run a five-star pharmacy on autopilot. A pharmacist for 34 years, Robinson had seen the benefits of MTM and compliance packaging when she worked as a staff pharmacist at a large chain. When she bought her pharmacy in 2018, she knew she wanted to implement an MTM program from the get-go. She put the program in effect using Medicine-On-Time blister packs and has been happy that it allows her to manage the workflow in her small pharmacy, where she and one technician fill about 130 scripts per day. Tracking the refills helps meet contract requirements with payers, who are grading the pharmacy’s performance on refills as part of comprehensive medication review (CMR) and MTM documentation. But Robinson was still missing the mark on her performance scores and wanted to see improvement there, recapturing money lost to DIR (direct and indirect remuneration) fees. She talked to Medicine-On-Time, and was one of the first pharmacies to pilot the company’s Performance program, run in partnership with Pharmacy First, which designs a pharmacy’s workflows around quality measures to lower DIR fees and increase PBM (pharmacy benefit manager) performance payouts. Robinson uses the data to develop strategies to enroll more patients in her MTM program and improve medication-related performance. She started with a select group of 20 patients whom she thought would benefit from being enrolled in the compliance packaging program. In the first phase of the pilot, the study determined the compliance packaging on PDC (proportion of days covered) scores for low-performing patients — a compliance measure that calculates the ratio of number of days a patient is covered by the medication in a period to the total number of days in the period. She focused on the RASA (renin-angiotensin system antagonists), cholesterol, and diabetes PDC outliers. Robinson noted that, for the most part, the pharmacy’s outliers were listed in all three categories. “What perfect candidates for packaging,” she recalls thinking. “Keeping an eye on these monthly allowed me to catch new outliers. I would follow up with the new patients and talk to them to learn that in some instances, they were either discontinued on the medication in question or simply were not compliant. If compliance packaging wasn’t in their interest, then definitely using med sync could help them get all of their meds at the same time, saving another trip to the pharmacy.” After three months, the PDC scores went up, from a percentage in the mid-60s to 90%. Another group was lingering around 70%, and that increased to 90% in six months. Robinson is tracking her patients’ scores regularly now, along with the 30-day supply blister cards. She has a monthly call with the patients, catching any changes in their medication regimen or missed refills. “I couldn’t believe that the scores increased that much in six months,” she says. Medicine-On-Time also helped with reviewing and figuring out third-party payer DIR fee reports to help the pharmacy achieve these results. In the second phase of the pilot, Robinson saw the pharmacy’s DIR fees go from the upper range of its contract to the lowest percentage allowed by the contract. The pilot also resulted in a 500% increase year over year from 2019 to 2020 in the CVS Caremark performance payout based on improved quality measures. Robinson attributes the improvement in the pharmacy’s performance measures to using specific reports out of EQuIPP, a platform with benchmarked performance data available to pharmacies. Robinson had been using EQuIPP but wasn’t sure she was getting the most out of the data, and didn’t realize it could support her MTM program. With customer support from Pharmacy Quality Solutions which hosts the EQuIPP dashboard, Robinson began to see the way trimester reports could help her identify patients who weren’t meeting quality measures, or the number of patients covered by a specific insurance plan. Through her pharmacy management system she would run reports on those patients for specific disease states or medications. “Getting a little deeper into the dashboard showed there was more than just catching outliers,” says Robinson. “The performance tab actually lets me see each insurance company and how many patients I have with each one.” Since several insurance plans score pharmacies on completing CMRs with MTM, tracking by plan allows her to catch any issues early that might affect her score. THE ADVANTAGES Robinson is pleased by how easy it is to keep her five-star rating now, and she says it’s a scalable program. Staffing is another area where pharmacists new to compliance programs express hesitancy. Robinson says the Medicine-On-Time technician training program makes it possible for her to implement the program with current staff, thanks to workflow training as well as monthly webinars and consultations. She’s also found more time for counseling that improves her pharmacy’s quality measures as well as business development by networking with local providers. “This is an opportunity. If patients are using compliance packaging and their adherence scores are good, you can approach a physician and explain how packaging would be good for a patient — and you can show the asset the pharmacy can be in collaborating with the physician,” she says. As physicians have come to see the value of Robinson’s Medicine-On-Time program, she has found physicians will refer patients for compliance packaging if they are having issues with adherence. “Everybody’s always scared to start something new,” says Robinson. “It’s time to get out of that box. I am always ready to try something. And it really paid off. And it’s not that bad, once you get your routine going. It’s just a cake walk.”CT Maggie Lockwood is VP at ComputerTalk. You can reach her at maggie@computertalk.com.