Fitting into the Continuum of Care

There are various influencers that tug at the priorities for Absolute Pharmacy in North Canton, Ohio. Stringent regulations, competitive demands from facilities, and the push to a home-based model all stem from the overall goal to reduce the hospital readmission rate.

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“The market is evolving in a couple of ways, but the main way is it’s becoming all about the continuum of care,” says Kevin Fearon, R.Ph., chief operating officer at Absolute Pharmacy. As the emphasis on value-based healthcare increases, Fearon and Absolute’s business development manager, Mary Jo McElyea, want to offer user-friendly medication packaging to their facilities; this will keep patients from returning to the hospital through improved medication compliance, providing a tool in that continuum of care that can follow the patient from hospital, to facility, to home. Absolute Pharmacy, with 135 employees and 20 pharmacists, was using a multidose pouch system for the 7,000 beds it services, including assisted-living and group homes, all in Ohio and western Pennsylvania. The process to produce the pouches was slow, taking up to three days and requiring numerous staff hours to make them patient ready. The growth and flexibility that Fearon and McElyea saw they needed resulted in a two-year search for new automation and a packaging system that would support their desire to meet the changing marketplace.

The Right Features

“We needed a product line that would fit well into the continuum of care, and we didn’t feel we had the utility with the previous product,” explains Fearon. “We wanted packaging that’s user-friendly and gives us the flexibility and ease of use both at the facility and for home-based caregivers.”

Kevin Fearon, R.Ph., chief operating officer at Absolute Pharmacy, with Business Development Manager Mary Jo McElyea and the SynMed XF. Challenges in the pharmacy market prompted Fearon and McElyea to change their automation to open business avenues that weren’t available before.

With this in mind, Fearon and McElyea visited pharmacies in the United States and Canada, and it was during the Canadian leg of the trip that they learned about the SynMed by Synergy Medical. The system can fill 30 different types of multidose punchcards, an important feature, as Fearon says the punchcards give the business that needed flexibility to serve various settings. Nurses like the cards for their compact size for storage, and each medication pass is clearly marked. One feature they saw the SynMed didn’t have was verification — Fearon wanted cards coming out of the automation tote ready. With that feedback, along with a few other ideas for features, the Synergy Medical team went back to develop the SynMed Ultra. It has the capacity for 100 more medications (for a total of 500) and is 50% faster than the original machine. And it has verification.

“Without verification, the pharmacy must extract the data and run it through the pharmacy management system to validate the prescription,” says Fearon. “Validation in the machine is a huge advantage.”

Synergy Medical developed the Ultra when its high-volume central-fill customers asked for more production per square foot of production space. “Essentially, SynMed Ultra will fill over 100 multidose cards per hour, three times the capacity of the SynMed XF, with 25% fewer technician hours, and with only 1.5 times the footprint,” says company President and Founder Jean Boutin.

The SynMed Ultra

To prepare for the Ultra installation, Fearon and McElyea decided to install the SynMed XF this spring to transition customers to the punchcard system. The capacity and speed also give Fearon the ability to scale up. Before the SynMed, filling an order was a logistical puzzle. The staff would take finished products for pharmacist validation, and then a tech would have to prep the pouches for delivery. Now Absolute Pharmacy will be on a just-in-time schedule, with the data going into the SynMed in the morning, and labeled and shipped the same day. They will use the SynMed XF until the Ultra is ready for installation at the beginning of 2018.

The data entry department that is processing prescription orders through SoftWriters’ FrameworkLTC pharmacy system puts a schedule into the system so each day the staff knows who is exporting to the SynMed machine. SoftWriters’ FrameworkLink supports the electronic workflow that is now the standard in long-term care (LTC) pharmacy. Faxes and data entry are replaced by an electronic order system interface that gives nurses real-time updates to medication regimens. Barcoded cards confirm the right patient-right med pass time, as well as providing an alert if there is a change.

Fearon and McElyea inspect the cards in the SynMed XF. The strategy they decided on with Synergy Medical was to install the SynMed XF with a view to transitioning to the higher-capacity SynMed Ultra by January 2018. As expected, Absolute’s operations are going very well, and the volume growth is on target to require the Ultra in the coming months.

“This leads to higher accuracy and less rework, and when it gets to the customer, it’s a much cleaner product,” says Fearon. “It makes the scheduling much better, which is a huge value to us. We needed a high-speed machine that makes sure everything is current, packages it up, and gets it out the same day.”

Capturing New Business at the Transition

Increased speed and capacity bring with them business opportunities. The first initiative will be a Follow Me Home program implemented when patients are discharged from skilled-nursing or assisted-living facilities to capture those patients released back to the retail market. The pharmacy will solicit patients to sign up for home delivery, essentially creating a new mail-order division at Absolute. Fearon and McElyea see the punchcards selling themselves: They are easy for caregivers to use and will increase compliance. Patients can take their medications properly, reducing the chance of those unwanted hospital readmissions.

“When caregivers ask for the packaging, it becomes a nice, seamless transition,” says Fearon.

The assisted-living market is the initial target, says McElyea, although skilled-nursing facilities have already expressed interest in piloting the cards. “We see a lot of possibilities with this packaging,” says McElyea. “Clearly, retention of our existing clients, but then the expansion into the mail-order model when it comes to life.” The growth of assisted-living facilities has been exponential in Ohio, and the potential is clear. “We have a couple of existing clients who are piloting the packaging. It’s going well, and others we’ve brought it up to like the idea of it. In the business development role I can see a lot of opportunity and growth potential,” says McElyea. “And we’ll have the only Ultra in the United States when it’s installed.” CT

Maggie Lockwood is VP, director of production, and can be reached at