Robert Schenk was an independent pharmacy owner since 1986 when pharmacy technology was in its infancy. From the start he looked to the newest software updates to improve his operations. After 18 years as an independent owner, he moved into consulting pharmacy. In 2006, Hackensack Meridian Health’s Ocean Medical Center founded the Pharmacology Institute to provide medication therapy management to the community. He went from consulting in nursing homes to doing the same work for the general public. With his retail background he was promoted in 2009 to manage the retail pharmacy arm of the hospital system. After adding a second pharmacy in less than eight years, the growth took off as the hospital switched from using its inpatient pharmacies to outpatient to better service its employees and take advantage of lower drug costs.
The pharmacy’s impact on clinical operations came to the forefront when CMS (Centers for Medicare and Medicaid) started paying health systems and hospitals based on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores that involved a whole number of parameters. One of which was that the patient was told about his or her medication and side effects when discharged from the hospital.
Schenk convinced Hospital administrators that the outpatient pharmacists were well-positioned to provide medication reviews before discharge. Hackensack Meridian started pilot programs on certain floors in the hospitals to see how medication reviews at bedside could improve HCAHPS scores. This eventually became what is now known as meds-to-beds.
Hackensack Meridian Health and Transaction Data Systems
Schenk credits the Rx30 pharmacy software from Transaction Data Systems (TDS) with making it easy to implement a meds-to-beds program in the hospital setting. Since meds-to-beds is a retail model of service, the system can handle typical aspects of ambulatory pharmacy such as checking insurance before filling a prescription and collecting a copay.
“Early on TDS came out with a real-time insurance lookup. This functionality made the whole process possible for us,” says Schenk. “Without that we would have been stumbling. Right away we were able to look up about 60% to 70% of the patients’ insurance plans with everything we needed to bill for the prescription. Rx30 was always on the cusp of anything new.”
The other obstacle was collecting copays. “There were no iPads that processed credit cards in 2011,” says Schenk. Rx30 now has an app that allows the pharmacy’s technicians, called navigators, to execute the meds-to-beds program. Navigators can also troubleshoot if there’s missing information or a need to contact a physician.
Meds-To-Beds
Meds-to-beds isn’t necessarily all about revenue. The revenue from these prescriptions is enough to cover the cost of the service, but the true purpose of the program is about quality through patient satisfaction scores and to prevent readmissions.
“We know that something like 30% of readmissions are related, at least visits to the emergency rooms, to medication problems,” Schenk points out. “If those problems are because patients didn’t get their medications after they were discharged or they couldn’t afford them — that’s another barrier that they face. We can fix all that before they leave the hospital.”
When the program started in 2011 there was a pharmacy technician whose sole responsibility was to facilitate meds-to-beds. Historically hospitals with ambulatory pharmacies would just tell the nurses at the station that a patient should stop by and get the prescription on the way out. That didn’t work well, as the nurses already had so much to do and they didn’t want to get involved with handling prescription insurance or explaining prior authorization, explains Schenk.
At Hackensack Meridian Health each site has a number of liaisons who handle the program based on the hospital size. Some health-systems will balk at the idea of hiring a full-time employee, but Schenk says there is a low threshold to profitability (20 prescriptions a day and you can cover the cost of the technicians salary).
The meds-to-beds program drives the pharmacy growth since it’s time sensitive, which means it can’t be done remotely. “And it’s so critical to patients’ outcomes now that it really is the driver of the pharmacy expansion,” he says. Hackensack Meridian Health has added five pharmacies in the past year and a half. “You can serve employees with a centralized pharmacy, like a hub and spoke and ship prescriptions to the hospitals. But with meds-to-beds, you have to be onsite.”
Another initiative from Rx30 was meds on cue. The pharmacy liaison explains that the QR code will give the patient information when he or she gets home and needs to get more information. This was an extra value-added service from Rx30.
Health-systems have changed and evolved. For example, in addition to its 17 hospitals, Hackensack Meridian Health has more than 500 patient care locations, including ambulatory care centers, surgery centers, home health services, long-term care and assisted living communities, ambulance services, air medical transportation, a fitness and wellness center, rehabilitation centers, urgent care centers and physician practice locations. All these team members are covered under the same health insurance but not all work in the hospitals where the ambulatory pharmacies are primarily located. Until the springof 2021, the pharmacies were operating as 10 independent locations. Rx30 had functionality that allowed each pharmacy to check drug inventory in other pharmacies, but the new central-site service aggregates the patient database of all 10 pharmacies. This is key with a giant network like Hackensack Meridian Health with its 36,000 employees who need the flexibility to go to a location near their job, which isn’t necessarily in the hospital.
“We’ll have one giant patient list, one doctor list,” says Schenk. “Really the important thing for us is it’s going to help us manage our drug purchasing better. Instead of 10 managers buying possibly 10 different generic drugs, we want to have everyone making purchases that are aligned with the network’s contracts. It’s going to streamline a lot of that for us.”
Now employees can go to one facility and get a prescription filled or go to another location to get a prescription filled closer to their home.
Another service Hackensack Meridian Health offers its employees is the Asteres ScriptCenter, which is a 24/7 prescription pickup kiosk, which supports the goal of keeping the hospital benefit costs down by serving as many team members as possible, including those that work on second and third shifts. The ScriptCenter gives Hackensack Meridian Health pharmacies the ability to provide that 24/7 access when they use the in-house pharmacies with lower copays and convenience.
TDS has accommodated requests for interfaces that support the health-system pharmacy’s long-term plans. An example includes a payroll system that gives team members the option to pay copays by payroll deduction. CT