Many pharmacies find a lot of opportunity in serving the long-term care (LTC) market.
What begins as filling prescriptions for residents at a few local facilities as a retail-LTC combo shop can ultimately become a much bigger closed-door LTC operation. Enterprising pharmacy owners can get the tools and support they need to build a substantial LTC business from different sources: a pharmacy management system that has what it takes; integrations with LTC-focused technologies; and relationships with expert partners.
LTC PHARMACY SOFTWARE MAKING THINGS EASY
Hitesh Patel, Pharm.D., is the owner of Rapps Pharmacy, with three locations in New Jersey; two are retail community pharmacies. Patel started his LTC business as a combo shop, but has since split it off into a 7,000-square-foot closed-door location with 40 workstations and serving 2,500 patients. He’s been using the PrimeRx pharmacy management system to run both retail and LTC dispensing for three years. He has found two reasons why his choice of software has been key for his growth from a retail-LTC combo shop to the closed-door LTC pharmacy model: ease of use and customization.
Patel points out that long-term care is a very complex area of pharmacy. “It’s not just filling a prescription and putting it in a bottle,” he says. And in a closed-door LTC pharmacy there typically are more employees than in retail or combo-shop pharmacies. “You could easily have 50 technicians, 20 pharmacists, and a few billing specialists,” says Patel. “With this level of staffing, you’re bound to have turnover. So how easy a pharmacy system is to learn and use becomes critical for maintaining quality, as well as being able to take on new business when the opportunity arises.” He has found that he is quickly able to bring new staff up to speed on all the dispensing tasks in PrimeRx.
To reinforce the importance of ease of use, Patel relates a story about a colleague of his, who also uses PrimeRx. “One of the examples I like to give,” says Patel, “and it’s an example from a retail pharmacy, but one of my friends had a new pharmacist come in to work for one day. This was someone who had not used PrimeRx before. My friend was planning to work in his office and he said, ‘Listen, if you need my help, let me know.’ The new pharmacist worked the whole shift without any questions. That’s the beauty of the software to me.”
A major element of this ease of use, according to Patel, is user-managed customizations within PrimeRx. He reports using these extensively to deploy just the right features, workflow steps, and views in the system, depending on the pharmacy setting. This means that he can run the full range of his pharmacy operations with just one software license, one point of contact for maintenance and upgrade requests, and one platform for all his staff to learn. “There is LTC software out there that cannot do retail, or retail software that cannot do a good job at LTC operations,” says Patel. “This one can do both.”
FITTING THE SYSTEM TO THE TASK
For example, Patel explains that he can select which elements and columns the staff sees, depending on the setting and the patient being served. “In long-term care, you always want to see more information than in retail,” he says. “We have set up customized views for retail and LTC that keep the information available to just what’s necessary, and minimize the number of clicks to accomplish a given task.” He is also able to set different labels or med sheets to meet each facility’s needs, and still maintain a separate label for retail patients.
Patel further reports easily being able to print a packaging type code on LTC labels, which is very useful, since Rapps Pharmacy offers five different kinds of packaging. “Our technicians can see at a glance which filling station a prescription label goes to,” says Patel, “without having to look back in the pharmacy software.”
And then there are cycle fill tools. Sometimes the LTC staff needs to exclude a medication from a patent’s cycle fill, according to Patel. This is not something that comes up in a retail setting. PrimeRx makes it easy for Rapps Pharmacy staff to do this.
“These are all examples of the details we are able to set, according to our needs, so that we can run both retail and LTC operations from one system,” says Patel. There’s another level of customization that’s important too, according to Patel. This is when a pharmacy requests new features or changes from the software developer. “I have been very impressed with how PrimeRx responds to our feedback,” he says. “They take input from me as a pharmacy owner very seriously. It’s clear that they are discussing the best solutions for the issues internally, and then coming back with upgrades to the software that are well thought out.”
LTC TECHNOLOGY INTEGRATION
Long-term care pharmacy has its own separate and often complex ecosystem of supporting systems and technologies. Successful growth means being able to deploy the right technology to address your needs, with tight integration back to your pharmacy management system.
Cannon Loughry is COO of TwelveStone Health Partners, based in Murfreesboro, Tenn., about 31 miles southeast of Nashville. TwelveStone Health Partners is a multidivisional company that is focused on patients with chronic, complex, and rare diseases. It has a home infusion division, home health, a specialty pharmacy that’s licensed in all 50 states, URAC and ACHC accreditation, and 20 infusion centers in four states. TwelveStone services 50 facilities with approximately 2,500 beds total.
Loughry can offer an example of the importance of integrating new technology to address his operation’s delivery needs. “Logistics is our third-largest spend,” says Loughry, “and it’s one of our largest pain points.” When he found a new logistics management application from Virtue Technologies, he was impressed with the ability to place all delivery types into one pane of glass and integrate it with the different pharmacy software platforms TwelveStone uses to manage four different business divisions, including the SoftWriters technology suite used to run its LTC division.
Before the integration, when TwelveStone patient care technicians would get a call from a facility about the location of a delivery, they would have to take multiple steps to track the prescription. “With Virtue Technologies we can immediately go to the orders dashboard and pull up the patient information,” says Loughry, “or search on a particular delivery and see the status. It shows where it is in the workflow, from processing to in transit or delivered.”
Loughry shares a FedEx delivery example. The interface pulls the FedEx manifest into the SoftWriters’ FrameworkECM content management solution. That then goes back into the system record. This eliminates the need to pay additional fees to carriers to store manifests for a longer period of time or printing and scanning them to attach to the patient record. When you click on the delivery number it gives you all the information about that delivery, including the driver, what system it came from, and the tracking number.
“The nice thing here is the interface creates a unique proof of delivery, pulls the tracking number, and keeps track of that delivery as well,” says Loughry. “Before, it could be days, if not weeks, before we got some of the physical pieces of paper back from the couriers.” The Virtue Technologies app also brings additional benefits. “We use the app to capture details like a photo of the delivery, a geo stamp, or a signature,” says Loughry. “That’s immediately sent back into our system, which can speed up billing cycles by days.”
Virtue Technologies also addresses delivery route planning, which is a complex task that can put a real limit on growth if it’s not managed efficiently. As Loughry describes it, routing dispatchers use a dashboard to work with TwelveStone’s 15 scheduled daily routes. The system can also have deliveries to facilities automatically go into a scheduled route. When you create an ad hoc route, the system will optimize the route rather than relying on drivers to create a route based on their knowledge of the area. The routes will show you estimated time and mileage. Loughry is pleased with this enhancement to the SoftWriters’ system.
Hitesh Patel offers several more examples of the importance of integrations. He reports that his PrimeRx software integrates with three different adherence packaging systems, as well as several different electronic medication administration record systems. “PrimeRx is always working to build out integrations as rapidly as possible,” he says. And this is another important area for collaboration, notes Patel. “We are constantly looking for the latest technology we need,” says Patel, “and things change so quickly in LTC.”
THE RIGHT LTC PARTNER
Another critical element in achieving success and growth in the LTC market is finding a strong service partner, such as a group purchasing organization (GPO). Michael Ansel is chief growth officer at Managed Health Care Associates, Inc. (MHA), the country’s largest alternate-site GPO. Ansel himself has 37 years of experience in healthcare, mainly on the healthcare services side.
In his view, LTC pharmacies have a variety of opportunities that can grow the business and improve financial health, including same-location sales growth from expanding closed-door services; getting the best pricing on prescription inventory and getting access to specialty products; and even buying business and medical products through negotiated contracts.
“MHA has built an exclusive network of pharmacy members,” explains Ansel. “We currently have over half of the closed-door long-term care pharmacy market contracted with us, and more than half of the Medicare Part D long-term care pharmacy claims come through our network. That gives us a lot of buying power and a lot of leverage when we are talking with manufacturers, wholesalers, and even pharmacy benefit managers.”
THREE OPPORTUNITIES FOR LTC PHARMACIES
Ansel offers three areas that MHA pharmacy members can look to in order to drive growth, and he starts with maximizing use of GPO contracts. “That’s the biggest opportunity when you look at a lot of closed-door pharmacies,” he says. This can mean getting the lowest prices on prescription inventory, medical supplies, or even business products. “We can show them how much they could save if they were maximizing the contracts we have with our top distributors and vendors,” he explains.
The second opportunity is participating in programs with pharmaceutical manufacturers for specialty drugs. “The specialty drug market is really growing,” says Ansel. “These are usually low-volume, but very high-cost drugs. The need for some of these specialty drugs becomes high as patient populations age and have growing complexity in terms of their chronic conditions or comorbid conditions. MHA has exclusive programs that give our member pharmacies access to specialty medications at negotiated prices.”
KNOWING YOUR LTC PHARMACY BUSINESS
The third opportunity is all about people. As important as technology is, Ansel emphasizes how much pharmacies can benefit from experienced advisers. “Our account executives are an incredible asset for pharmacies,” he says. “When you think about an account executive being a valuable resource to these pharmacies, they‘re providing them with information that would be very difficult or time consuming for them to get without us.”
The account executive relationship is a unique one between MHA and the member pharmacy, explains Ansel. The bedrock of the interaction is the in-person, quarterly review. “We understand what’s going on in their world and where they’re seeing constraints,” he says. “The quarterly review is an excellent time for the account executive to go over all the opportunities we offer to a member pharmacy. We have the chance to show them how well they are utilizing all the contracts that we provide access to. We show them where their gaps are, and where they could maximize savings.”
This is important for a pharmacy’s continued financial health and its ability to seize growth opportunities, notes Ansel. This is because resident censuses in assisted living and skilled nursing communities are now ahead of where they were pre-COVID, but many LTC pharmacies are experiencing financial and staffing constraints that hold them back from growing to serve these residents. “Through their utilization of our contracts, they save money, thereby freeing up resources they can direct toward serving residents,” says Ansel.
This advisory relationship extends to powerful analytics that can provide a pharmacy with several layers of benchmarking insights. The first level is internal performance. “Because we have access to pharmacy claims data,” says Ansel, “we can see which pharmacies are taking advantage of the contracts that we have.”
Pharmacies can also see how they are doing compared to others, according to Ansel. “We can benchmark their performance against the performance of other MHA members,” he says. “We can also tell them how they are doing compared to members similar to them in areas such as size, types of facilities served, and geography.”
MANY WAYS TO GROW YOUR LTC PHARMACY
Growing Rapps Pharmacy, and the move from a combo shop to a closed-door LTC business, was the result of hard work, notes Patel, but also of his realization that working smarter is valuable too. “You need technology that is not putting up barriers,” he says. “The more you can automate, the more efficient you are, particularly since it’s not so easy anymore to just hire new staff.
Since our move to PrimeRx, I have been able to do more with the same amount of staff.” His advice? Spend the time it takes to make sure you are invested in good software and automation platforms. In the long run, this will take you further.
Be on the lookout for any technology that creates efficiency and eliminates work silos, advises Cannon Loughry. “Prior to bringing in Virtue Technologies, our logistics solutions were siloed within each individual pharmacy management system,” he explains. “What we like about Virtue is that all of our pharmacy management systems are able to use the same technology to manage our last-mile logistics solutions. It makes it much simpler for us.”
And work with partners that can position you to be the best. Everyone wants to buy at the most competitive prices, for example. But being sure of this isn’t so easy, according to Michael Ansel. “That’s why we don’t just work hard at the contracting component of MHA’s offerings,” he says. “Pharmacies also have to have access to the right tools and advice to show them how well they’re taking advantage of savings and other opportunities.”
Pharmacies that excel at deploying technology for maximum efficiency and navigating fundamentals such as lowest-cost purchasing and performance analytics will, in the end, be the ones that can stay on a growth path that offers the most programs and highest level of service to facilities and residents. CT