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The COVID-19 pandemic has made healthcare an international focus as bureaucrats and scientists debate the best mechanism to control t he spread of the virus and treat those impacted. While routinely undervalued, pharmacists have long been the most available healthcare professionals for much of our population, and as healthcare facilities experienced enormous operational challenges, the unsung passion and commitment of community pharmacists emerged.
Pharmacies have been quick to adapt workflow to protect, and care for, their patients and staff while simultaneously reaching out to support other members of the healthcare team. Federal and state regulations restricting pharmacy practice have been relaxed to leverage pharmacist services to improve the response to COVID-19. Through this public health emergency, pharmacists have provided policymakers a better understanding of their true value.
Pharmacists willing to take on more responsibility to improve patient care is not a new concept. In June 2019, the Community Pharmacy Foundation (CPF) and the Community Pharmacy Enhanced Services Network (CPESN) announced a five-year partnership, aiming to transform community-based pharmacies through a new dynamic program, Flip the Pharmacy (FtP). The goal of the program is to provide the scale to “flip” pharmacy from a professionally unsustainable, point-in-time, prescription-level practice model to a professionally sustainable, longitudinal, patient-level practice model.
For years, community pharmacy advocates have dedicated resources and efforts to innovative practice models showing better clinical outcomes and lower overall healthcare costs. Though evidence exists, we’ve never been able to gain enough scale to make a significant impact in the payment and policy model.
FtP provides a structured process with enough intensity and duration to support the pharmacy after the transformation process is complete. This 24-stage transformation process uses local support and practice transformation coaches that help ensure accountability with specific, measurable, attainable, relevant, and timely goals (abbreviated with the acronym “SMART”) across the following six transformation domains.
The Six Domains of Flip the Pharmacy Are:
Domain 1: Leveraging the Appointment-Based Model.
Domain 2: Improving Patient Follow-up and Monitoring.
Domain 3: Developing New Roles for Non-Pharmacist Support Staff.
Domain 4: Optimizing the Utilization of Technology and Electronic Care Plans.
Domain 5: Establishing Working Relationships with Other Care Team Members.
Domain 6: Developing the Business Model and Expressing Value.
Over the five-year partnership, FtP aims to graduate more than 1,000 pharmacies through a two-year transformation process, modeled after similar Center for Medicare & Medicaid Innovation efforts in primary care practices across the country. Additional program goals include:
• Non-product-based reimbursement revenue.
• Care Plan submissions.
• Screenings for behavioral health conditions.
• Reductions in systolic blood pressure and HbA1c percentages.
• Lowered cholesterol in patients with associated chronic conditions.
• Completion of social determinants of health screenings.
The change packages used by practice transformation coaches are available to any pharmacy interested in transforming its practice setting. Change packages, available at flipthepharmacy.com, are released monthly and are designed to build upon the successes and challenges of previous packages.
In April, the FtP program rapidly adjusted change package content to address the immediate needs of community pharmacy practice created by COVID-19. Pharmacy teams are using care planning and clinical documentation skills developed during the first progression, from October 2019 to March 2020, to support their patients during this unprecedented time. For example, here are recent COVID-19 change packages:
View #1: Protecting Pharmacy Workforce and Patient Communications (March 24, 2020).
View #2: Triage COVID-19 Patients and Care Plan Development (April 8, 2020).
View #3: Applying for a CLIA Certificate of Waiver (April 17, 2020).
Getting Started in Your Pharmacy
In the early stages of the program, Troy Trygstad, executive director of CPESN, described it as a residency program for community pharmacies. That statement continues to prove true, and the COVID-19 pandemic has further emphasized the benefit and need. For the pharmacy wanting to get started, or further expand what it has in place, the greatest support will be found by joining the CPESN network. While a grant covers the costs of coaches for those recipients, many networks are leveraging other resources to support interested pharmacies. For those not ready to join CPESN, the Flip the Pharmacy website provides information and change packages for anyone interested.
While pharmacy deals with many challenges, what a great opportunity to be part of the movement changing our practice to better serve our patients, communities, healthcare partners, and profession.