THIS MIGHT SOUND FAMILIAR to many of ComputerTalk’s regular readers: A pharmacist who has found the sweet spot of combining technology efficiency with human expertise to fully serve a diverse community. An award-winning mix, really, and one that pharmacist-owner Tiffany Barber, Pharm.D., R.Ph., has embraced at Hillsborough Pharmacy and Nutrition in Hillsborough, N.C. In this community 15 miles west of Durham, the pharmacy is part of daily life, and Barber’s commitment to the community is through the lens of pharmacist provider.
The belief that community pharmacists are the backbone of the healthcare industry, doing more than just checking prescriptions, has been Barber’s business philosophy since buying the pharmacy in 2011. She has crafted a business plan for her pharmacy that reflects the movement toward pay-for-performance as opposed to pay-to-fill. The pharmacy is participating in the Community Pharmacy Enhanced Services Networks, known nationally as CPESN USA and locally as Mutual CPESN, as well as a clinic pilot program sponsored by the UNC School of Nursing and North Carolina Mutual. Barber’s commitment to the community, and to bettering pharmacy through participating in the CPESN program, earned her Community Care Pharmacist of the Year for her state in 2017. Barber is rolling all these little pieces together into what many industry experts are saying pharmacy has to do going forward.
Slideshow: Community and Care at Hillsborough Pharmacy
“I have always loved community pharmacy,” Barber says. “Our customers know I know them and that we work as a team with their doctors to come up with what’s best for them. To win this award makes me proud for community pharmacy. To win is very humbling.”
Hillsborough Pharmacy and Nutrition is an example of a pharmacy that is moving to the clinical world. It fills between 250 and 275 prescriptions a day, almost 40% of which are for Medicaid patients. The pharmacy sees patients, regardless of their insurance, and triages over-the-counter products versus a recommendation to go to the doctor. It offers delivery and adherence packaging to a small population, as well as a curated OTC (over the counter) department, including herbal supplements and vitamins. Last year, Hillsborough Pharmacy agreed to be the pilot location for the UNC clinic, carving out a third of its 1,000-square-foot space for that purpose. Hillsborough Pharmacy can access the health system’s Epic EHR system to review health records and support the transition from the hospital to home.
Community pharmacists participating in the Mutual CPESN® Network (and all 39 local CPESN Networks by the end of the year) create care plans for high risk patients that are designed to improve outcomes related to medication use and coordinate with other care team members. This effort uses existing standards adopted by medical providers in electronic medical records to develop an electronic ‘pharmacy’ care plan or Pharmacist eCare Plan. A Pharmacist eCare Plan is a shared document detailing a patient’s current medication regimen and health concerns, including drug therapy problems and medication support needs, in addition to the pharmacy’s interventions and the patient’s health outcomes over time.
Being able to efficiently and effectively create and share care plans is crucial to integration with the larger care team. The Pharmacist eCare Plan standard allows pharmacists to generate care plans within the technology already in use in the pharmacy and utilizes existing standards for data exchange. Documenting their work using Pharmacist eCare Plan capabilities allows community pharmacies to clearly demonstrate the nature of their contributions to patient care to care team members, payers, and other partners.
Twenty-five technology companies from the pharmacy industry have participated in Pharmacist eCare Plan training with six having achieved Level 2 and Level 3 (advanced) Capabilities with Active Medications. Seven other technology companies have partnered with those that have achieved that same capability level. For a list of these companies, visit https://www.cpesn.com/ecare-plan/.
This program is the second clinical-based pilot Barber has engaged in. Hillsborough Pharmacy is entering its fourth year in a CMS grant that started the CPESN program. In North Carolina, the network is Mutual CPESN, through the Mutual Drug Company. All participating pharmacies offer the standard CPESN clinical services, and many offer enhanced services such as adherence packaging and home delivery. When participating in an integrated network, pharmacies can engage with payers to receive payment for the money payers save when the cost of patient care is lower. A grant from the Center for Medicare & Medicaid Innovation (Innovation Center) pays for pharmacists to offer patient-centered services that improve the health outcomes of complex patients. Enhanced services include medication reconciliation, clinical medication sync, immunizations, clinical medical reviews (CMRs), and personal medication records. Pharmacy management systems can communicate with care management systems, and pharmacists can document their clinical encounters right in the system. Barber’s pharmacy management system, VIP, interfaces with the eCare Plan from PrescribeWellness, one of the eight validated eCare vendors. Community Care of North Carolina (CCNC) has 25 technology vendors participating in the Pharmacist eCare Plan, which uses existing standards adopted by medical providers in electronic medical records to develop an electronic pharmacy care plan.
“Pharmacists help make changes to prescriptions and counsel patients, but we aren’t getting paid. People don’t know we are doing this,” explains Barber. “ The Innovation Center grant has further solidified our place in the healthcare system so the doctors know they can look to us to help dose the medicine or talk them through something or recommend a formulary medicine. Helping doctors with the medication therapy has been good for patients and doctors.”
Hillsborough Pharmacy has definitely been an outstanding participant in CPESN, according to Trista Pfeiffenberger, the network’s director of quality and operations. Not only has Barber adopted the eCare Plan, but over the four years of the program, Barber has developed a dynamic relationship with local physicians, who see the value in her staff monitoring patients for clinical measures like blood sugar levels.
“If pharmacists are identifying drug problems and making recommendations to providers, essentially they are doing the type of activities that warrant eCare Plans,” says Pfeiffenberger. “Pharmacists want to document these interventions — it’s just as relevant in physician practice.”
The ability to offer personal attention with on-demand data comes from Hillsborough’s VIP system. VIP gives staff access to important patient data in the course of the regular workflow, and allows Barber to focus her energy on clinical decision-making. The key to being successful in CPESN is documenting clinical interventions while in the pharmacy workflow and then delivering the reports to providers and payers. Patient data is updated regularly in VIP, giving Barber’s staff immediate access to a patient’s medication information, health information such as when the patient was released from the hospital, and what referrals might be useful.
Barber says the VIP system presents patient insurance information, medication regimens, and risk scores. This is a huge help, as Barber can immediately see the likelihood of hospitalization based on the risk score when a patient is in the pharmacy. A pharmacist can make a recommendation for vaccination based on the immunization history provided by VIP. Barber documents all the care her staff provides in the eCare Plan from PrescribeWellness, which records the clinical interventions and shares the data in a standard format with the CPESN network. VIP loads all patient data into the PrescribeWellness platform, making documentation for the eCare Plan seamless. All pertinent data regarding each patient is already populated and the pharmacist simply documents the type of intervention. eCare plans are immediately sent electronically to CCNC to justify the pharmacy’s value-based care and receive payment. Barber also runs phone campaigns, immunizations, adherence, and Medicare Part D enrollment programs through PrescribeWellness. Although you have to go to a separate platform to document, VIP makes it simple through data sharing and implementation of risk scores. The VIP system is fast and straightforward in processing prescriptions. “VIP helps us because we spend very little time on the actual computer,” she says. “It’s really easy to process the script so that the insurance is out of the way. We can be really present with the patient.”
The pharmacy’s staff includes Barber, who is the pharmacy manager, two part-time pharmacists, and a part-time clinical pharmacist. Barber has shared the clinical pharmacist for the past year and a half, as she builds clinical services as part of the CPESN program. The goal is a full-time clinical pharmacist with a support technician. Currently, a clinical technician floats between traditional pharmacy routines and then helps the clinical pharmacist with adherence packaging, checking electronic health records (EHRs) to see if the medication list has changed, calling the patient for an update, and setting up deliveries.
The clinical pharmacist is constantly reviewing patient records in OutcomesMTM and Mirixa. The more patients the pharmacy manages well, the more patients are sent to the pharmacy. “If the insurance companies see pharmacies are working with the patients with high-risk health needs, and they are staying healthy, this increases star ratings and the insurance companies will continue to send us patients,” says Barber. ”When we first started this, we didn’t know how much work the clinical pharmacist would have. We’ve seen there really is a need here, and how this is going to be the future of the pharmacy.”
On the Cusp of Change
Barber sees that the biggest challenge for community pharmacy is having enough prescription volume to pay for the clinical pharmacist. The old model of pharmacy is not sustainable, as reimbursements are constantly cut and pharmacy moves to the pay-for-performance model. And while getting paid for these services is still lingering out there as the big “what if,” Barber says pharmacy has no choice but to embrace the move to showing quality outcomes.
“We’ve got to build clinical services and get paid for that,” she says. “We know when we look at what we can do as pharmacists that we can impact the healthcare landscape.” CT
Maggie Lockwood is a VP, staff writer, and director of production at ComputerTalk. Her pharmacy profiles serve as case studies on the power of technology.