Adherence and medication synchronization programs are buzz words in pharmacy — and have been for several years. Clearly these programs benefit the patient and can influence the pharmacy’s star rating. But how do they benefit a pharmacy?
The potential of an adherence-based workflow came to pharmacy owner Jason Turner, R.Ph., in 2013. Although he offered medication synchronization at Moundsville Pharmacy, it wasn’t a major part of his business. Following a meeting in Kentucky where David Nau, then president of the EQuIPP organization, talked about star rating measures and how these were impacting healthcare, Turner saw an opportunity in adherence. “I could see that if quality and measuring outcomes was the direction this industry was going to go, and if these quality measures were in fact reasonable,” he recalls, “then we needed to start performing specifically in those measures and ensuring we were developing our programs and services to be a high performer in the Medicare arena.”
Located near Wheeling, W. Va., Moundsville has been in operation since 1981. Turner joined the pharmacy as a pharmacist in 2000 and became owner in 2012. In 2014, the pharmacy was relocated to a newly constructed, modernized, and patient-focused pharmacy design. It was also around that time that Turner purchased a second location in Sistersville, W.Va. Today the pharmacies have different prescription volume, but the goal is the same: to process between 55% and 60% of their prescription volume through a robust medication synchronization program.
“Our goal is to consolidate many of the prescription-driven tasks into two days per week, so that we can better incorporate performance-driven tasks into our weekly workflow using multiple members of our staff,” he says. “The future of pharmacy revolves around a performance-driven pharmacy workflow, one that is based on medication synchronization.” The time invested to develop and expand a medication synchronization program is compensated for by the increase in volume from the current customer base. If you get 100 patients enrolled in the program, there is a high likelihood that you are going to add up to an additional 2,000 prescriptions annually. “If a pharmacy truly expands its program to control 50% of its volume, with 500 to 1,000 patients enrolled in the program, there is the potential to expand the prescription volume up to 10,000 to 20,000 prescriptions annually — just by helping existing patients become more adherent to the medications that improve their health and decrease their risk of complications and hospitalizations,” Turner says.
As Turner built a workflow focused on performance, the goal was to increase patient enrollment in the sync program by 10% each quarter. As the program expanded, Turner looked at Moundsville’s physical space, which was originally about 1,500 square feet. Turner moved all the med sync processes together, which proved to be an effective change, and filled them two days a week. “We learned early on that separating the process had a tremendous value to pharmacy, as it took the volume away from the primary workflow,” he says. “It separated our staff into two teams on certain days of the week — making everyone more productive because they weren’t competing for the same resources, like counter space, printers, and phones.”
“What we found through Sistersville Pharmacy is that while they have smaller space and less staff, they were still able to accomplish the same goals — a separate synchronization workflow, two days per week, to process about 55% of our prescription volume,” says Turner, who now trains other pharmacists on implementing synchronization workflow. “We developed a pencil-and-paper model that integrates with technology to achieve a high level of success. We try to train pharmacists that, regardless of the size of their pharmacy, they can do it.”
Medication synchronization is really a customer service program. Staff calls patients regularly to review their medication list and any changes. Automation and technology create the efficiencies and time needed to make these personal connections. A ScriptPro SP 200 and Kirby Lester counters, both with barcode technology, support efficient and accurate counting. Turner uses CoverMyMeds for prior authorization services, and for now, simple cold-seal packaging for patients requesting compliance packaging. QS/1’s pharmacy system handles reporting, refilling, and the workflow through three modules. Turner says that by collaborating with QS/1, he has been able to take the practice to the next level. “We are currently using what I would consider the majority of the ‘bells and whistles’ of the QS/1 NRx system and the point-of-sale system to be high performing in both our pharmacy management and in our pharmacy workflow,” he says. The NRx Tickler File feature helps to schedule prescription refills when they’re due, and they generate late refill reports using the Health-Minder report. “We’re trying to tackle adherence using a variety of the features in NRx and services in our pharmacies,” Turner says.
Turners says there are about 930 patients in the med sync program, with the same amount of staff as three years ago, when they first started the process. Consolidating patient interactions is about having productive interactions, not fewer. “When we have interactions with patients, they are more productive, with positive outcomes for the patient,” he says. “It’s our role to answer their questions, or help them understand their condition or their disease, and offer them additional solutions.”
An Efficient Process
The pharmacy’s performance-driven workflow wasn’t always as robust as it is today. Turner explains, “Initially, the program was focused on enrolling as many patients into the program as possible.” As the program expanded, he started using more of the features in QS/1.
The staff uses QS/1’s Health-Minder to identify nonsync patients who are late to refill on Medicare-monitored medications. The Moundsville staff contacts these patients to provide adherence counseling, Turner explains: “We call patients and use adherence counseling techniques to talk to the patients about how they are doing and what may be reasons they miss taking their medication, and then offer the best solutions for the patient.”
Once a patient is in the adherence program, the prescriptions are flagged by the QS/1 system and processed each month with QS/1’s InstantFill process, which drops the refill prescriptions into a queue to fill and adjudicate the claim with fewer key punches from the pharmacy staff. The workflow module, Pharmacy-at-a-Glance, has made the day-to-day management more efficient, allowing the staff to see when the quality assurance queue is backing up, or when pharmacists need to redirect themselves to checking prescriptions rather than perhaps spending time on clinical or management tasks. “The workflow has really changed how we manage our prescription volume,” says Turner. “All of our pharmacists use Pharmacy-at-a-Glance; it allows us to get to the pharmacy workflow sections quickly, and the system is designed to allow us to enter ticklers and notes quickly.”
Improved Performance, Improved Adherence
Improved performance with an adherence program can mean a difference in fees charged to the pharmacy by third parties. Turner gives the example of a network that charges a $5 holdback on claims. For a low-performance pharmacy, that will have a detrimental impact on that pharmacy’s balance sheet. A high-performance pharmacy can earn back that $5 holdback, plus an additional $1, and that can have a positive impact on the pharmacy. In other words, processing 5,000 claims can cost the pharmacy $25,000 in holdbacks with low performance, says Turner, but it can earn the high-performing pharmacy an additional $5,000. In other third-party models, the fees assessed on the pharmacy can actually vary by up to 2% based on the performance of the pharmacy.
Another financial benefit that may not be obvious is the reduction in the time staff spends on patient checkout and home delivery. For Moundsville Pharmacy, with over 900 patients enrolled, it has reduced patient checkouts by 1,800 per month and eliminated over 400 deliveries monthly, compared to when it didn’t have a sync program. That equates to about 80 point-of-sale checkouts per day and 20 deliveries per day — which gives the staff time to do other things.
“Insurances aren’t paying pharmacies any more money to check patients out multiple times throughout the month or to deliver to patients multiple times throughout the month,” says Turner. “Pharmacies need to develop processes and a workflow that consolidate these interactions for maximum efficiencies and cost-effectiveness.”
Better adherence with a medication sync program is a win-win for both the patient and the pharmacy. “While better adherence improves the patient’s health, a well-designed synchronization program will improve customer service and create more positive interactions and relationships between the pharmacy and the patient,” says Turner. Identifying medications due for refill in advance allows the pharmacy time to order inventory, resolve insurance issues and prior authorizations, and request refills from the prescriber — all reducing the need for multiple visits by the patient.
“Pharmacists need to creatively look at their workflow and their staff to develop new and efficient processes and better solutions to the existing challenges we all face in pharmacy operations,” says Turner. “Synchronization offers a solution and a foundation to additional solutions that address a number of pharmacy management challenges, but it must be implemented effectively and expanded to a high percentage of the prescriptions to achieve the ultimate success for the pharmacy.” CT