IT TAKES A CERTAIN SPIRIT AND VISION TO transform a pharmacy business with new revenue streams. For Tim Mitchell, R.Ph., of Mitchell’s Drug Stores based in Neosho, Mo., who was presented with the 2022 the NCPA (National Community Pharmacists Association) Innovation Center Outstanding Adherence Practitioner Award in recognition of his commitment to improving medication adherence, several pieces came together in building medication synchronization and adherence programs — a situation typical
for many successful pharmacies.
As an owner Mitchell has experienced market conditions that have required him to reevaluate his priorities. When he reviewed what was already in place — a central-fill system that supplied maintenance meds to patients, and Dispill and RxSafe’s RapidPak for adherence packaging — he realized he had what he needed to increase enrollment in his med sync program.
Tim Mitchell, R.Ph., has focused on building his pharmacy‘s med sync and adherence programs. He was recognized by the NCPA for his efforts.
Mitchell added an appointment-based model along with staff trained as community health workers to the building blocks of his integrated pharmacy system to shift his workflow to med sync. The med sync enrollment is now 55% to 60% of his patients, and his goal is to reach 75%. His adherence packaging program has 200 patients enrolled and another 400 in the medication synchronization program.
MEDICATION ADHERENCE BUILDING BLOCKS
The original pharmacy, Family Pharmacy of Neosho, was founded in 1992 and operated inside a grocery store. Mitchell purchased the pharmacy in 2003 and established Mitchell’s Uptown Drug Store in 2004. While at one point he had three pharmacies, including one that shared space with a physician who brought a large patient base and allowed for collaboration, Mitchell ultimately moved out of that location and consolidated to two locations — Neosho Boulevard and Downtown. He also offers an infusion pharmacy with compounding and DME (durable medical equipment). The pharmacies employ 30 staff members, including six pharmacists.
At the time there was a central-fill model in place, with many maintenance prescriptions filled at the Boulevard location using RxSafe automation. Mitchell’s also offered Dispill blister packaging and RapidPak. A small number of customers were in the med sync program and taking advantage of the adherence packaging. The pieces were there, but Mitchell wasn’t quite seeing the traction he wanted.
“We thought, we’ll do something innovative and try to decrease our cost to dispense,” he says. “We targeted individuals that had prescriptions that were $500 or more. We felt that would help manage our inventory.”
Then the COVID-19 pandemic hit, and it became clear that managing patients’ refills through a med sync program made a lot of sense. Using his pharmacy system and the RapidPak adherence packaging, he began moving patients to the program.
Mitchell identified 10 patients each week who would be a fit for the med sync program. “Most of these people had expensive meds, as well as seven to 10 meds,” he says.
It took about six months to get comfortable with the workflow. What started as a paper system is now totally digital. A technician or trained community health worker contacts patients to review their medications and check on adherence. If there are gaps, Mitchell’s staff contacts the physicians and helps with prior authorizations or finding a patient assistance program.
“The workflow started to manage itself,” says Mitchell. “The RapidPak and the pharmacy system have been key to smoothing this out. Now we’ve got four or five technicians who are focused on medication synchronization, and I told them that anytime someone is moved to maintenance medications, they will go into the med sync program.”
EFFICIENCY AND COST SAVINGS
The central-fill model, which was in place to supply his multilocation retail pharmacies and a long-term care business, became a key part of building the adherence program. Central fill also enables Mitchell to better manage his inventory and staff hours. As he looked to enroll patients in the med sync and adherence programs, he saw the benefits of predicting what medications they would need.
The appointment-based model associated with med sync programs lets staff evaluate when they need to re-order specific medications. “What’s great about our pharmacy system is you can see what’s in the sync queue each day,” says Mitchell. The inventory decreased by $150,000 at his stores for a total between $600,000 and $650,000.
THE HUMAN ELEMENT
Counseling patients is part of the process too. There is a learning curve for patients to understand the benefit of getting a call each month and reviewing any changes in their medical history or their prescriptions.
On his 30-person staff Mitchell has several people trained as community health workers. Their understanding of the social determinants of health (SDoH) has been helpful in creating a full picture of the patient. The staff will touch base and ask questions to get to the reason a patient missed a refill pickup, for example. Everything is documented to track the patient’s progress and make adjustments to the care plan as necessary.
“It’s built loyal customers,” says Mitchell. Many customers who were choosing new Medicare Part D programs came to the pharmacy for help, he says.
LOOKING AHEAD FROM MED SYNC AND ADHERENCE
As the med sync and adherence programs continue to expand, Mitchell is looking to implement other programs, including medical at home. Mitchell’s son Tanner, who is a recent pharmacy school graduate, is participating in a fellowship program with the NCPA. His capstone project is to implement a medical-at-home program in a community-based pharmacy, which Mitchell says he plans to implement.
Mitchell sees potential revenue for the pharmacy from medical at home, as he looks to contract with third-party companies to pay for the service; he also expects a reduction in DIR (direct and indirect remuneration) fees, since the service will go through the long-term care closed-door pharmacy. CT
Maggie Lockwood is senior VP and director of production at ComputerTalk. She can be reached at maggie@computertalk.com.