It was great catching up on pharmacy magazines and journals this past weekend. I always find something positive about the profession and the pharmacy team’s role in advancing patient care. One example that I was so pleased to read about is the progress of the Community Pharmacy Enhanced Services Network (CPESN) — a clinically integrated nationwide organization of pharmacy networks designed to advance community-based pharmacy in the United States.
July’s monthly brief in the National Community Pharmacists Association (NCPA) magazine, America’s Pharmacist, provided a look at the numbers. And they are impressive!
CPESN Growing
There are now 49 local CPESN networks in 45 states. CPESN is now the fifth-largest single contracting organization, with more than 3,500 pharmacies. And these networks have active payer contracts: 28 networks have one local or statewide payer contract, and 21 have two or more as of April 2022. And these are good investments for network members, returning 4:1 on their monthly network fee of $95.
Technology is a core part of network member services. Fifteen firms have partnered with CPESN to provide eCare plan technology, allowing network members to administer nearly 2.5 million care plans last year.
Flip The Pharmacy
An important component in growing these numbers has been the Flip the Pharmacy initiative, of which CPESN is a founding partner. Flip the Pharmacy is a “practice transformation initiative that aims to ‘flip’ community-based pharmacies away from point-in-time, prescription-level care processes and business models to longitudinal and patient-level care processes and business models through the use of hands-on coaching.” There are currently 1,111 participants working on transforming their pharmacy models with the help of 241 coaches. More than 40 industry businesses and colleges/schools of pharmacy support the initiative.
Flip the Pharmacy focuses on identifying and adopting best practices for workflows that promote delivery of enhanced clinical services. It is based on the principles of scaled innovation so services reach the “tipping point” where innovative services are sustainable. As noted on the website, “For many decades, grantors, grantees, like-minded schools of pharmacy and other supporters have focused on innovations in community-based pharmacy practice.
While these innovations have been successful, they could not get to sufficient scale to have widespread pharmacy practice and policy outcomes. Flip the Pharmacy seeks to make a meaningful change in the perceptions of clinical outcomes with pharmacist intervention on a large national scale.”
The picture looks like this:
Implementation Science
The initiative’s change process is designed using successful principles of implementation science — an experiential field, dedicated both to the rigorous study of successful adoption of interventions and to the use of best practices in implementing new interventions. The use of implementation science is growing within the profession, and it can be used in any business.
My colleague Todd Sorensen, Pharm.D., FAPhA, FCCP, identified implementation science as a potential driver of curricular and practice transformation when he was president of the American Association of Colleges of Pharmacy (AACP) in 2019-2020. During his tenure, Sorensen laid out a bold aim for the pharmacy profession: that by the year 2025, half of all primary care practice sites in the United States would have a relationship with a pharmacist. Sorensen has been a huge change agent within the profession and knows that implementation science works. Flip the Pharmacy knows that too.
The initiative’s website says that “scalable pharmacy practice transformation requires changes to workflow, care processes and business modeling in repeatable, consistent, and achievable increments.” Participants are part of practice transformation teams that access “change packages” that prescribe those incremental changes in a logical sequence combined with near real-time feedback from the practice transformation coaches. The coaches “develop close relationships with participating pharmacies, engage in frequent on-site visits, and provide insights on workflow, care processes, and business modeling.”
Reading the network’s brief, and revisiting Flip the Pharmacy’s website, caused me to reflect on the progress that the technology industry and pharmacy profession have made in helping achieve pharmacy’s mission to help patients make the best use of their medicines — a mission coined during the 1989 Pharmacy in the 21st Century gathering.
This was during the profession’s “pharmaceutical care era” from 1980–2009. (See “Towards a Greater Professional Standing: Evolution of Pharmacy Practice and Education, 1920–2020.”) During this time, I graduated from the University of Minnesota and spent the first half of my career working on varying initiatives. I was honored to work on one of the first attempts to study elements of successful pharmaceutical care practice and drive practice change through the “Concept Pharmacy” project in 1996.
The project was an undertaking between the National Wholesale Druggists Association (NWDA) Foundation and the American Pharmacists Association (APhA). The project used a major consulting firm to analyze practice change literature and interview pharmacists who were providing patient care services to learn what they were providing and how, and then created a resource kit and exhibit to help pharmacists understand what was needed to move toward patient care practice and be paid for providing care.
My co-project leaders, Bruce Kneeland (then with the NWDA) and Lucinda Maine, Ph.D. (then with the APhA), and I learned over the course of several years that it would take much more than documenting successful elements of pharmaceutical care implementation to educate and motivate pharmacists to use it to create change. Leaders within the profession continued to move practice initiatives forward, and there have been a number of important contributors to the profession’s journey during the last 25 years:
- The Minnesota Pharmaceutical Care Demonstration Project
- The Asheville Project
- The APhA/Iowa Center for Pharmaceutical Care training collaboration
- Establishment of the Community Pharmacy Foundation
- Passage of Medicare Prescription Drug, Improvement, and Modernization Act in 2003 and the advent of medication therapy management
- Creation of the Pharmacy Quality Alliance
- Expansion of pharmacists’ authority to include immunizations
- Centers for Medicare & Medicaid Services innovation grants
- Creation of Get the Medications Right Institute
- Creation of the CPESN
- Creation of Flip the Pharmacy
This is not meant to be an exhaustive list, and I welcome readers to think of other important contributors that have brought progress to pharmacists’ provision of patient care services. As noted, technology has been an important part of this progress. In 1997, technology recommendations from the Concept Pharmacy project centered on creating a patient care plan and deciding whether to use paper or a computer! The thought of using paper documentation today is unheard of, and the eCare plan numbers from the CPESN update show the benefit of technology’s evolution to support pharmacist patient care initiatives.
We heard more about new and evolving technology and practice initiatives during this fall’s American Society of Automation in Pharmacy (ASAP) midyear meeting in Boston, in September. Some hot topics that were addressed included:
- Medicare Part D and the DIR final rule.
- Provider status and digital pharmacy.
- PDMP recommendations for the next ASAP version.
- Project US@, a unified technical specification for patient address.
Marsha K. Millonig, B.Pharm., M.B.A., is president and CEO of Catalyst Enterprises, LLC, and an associate fellow at the University of Minnesota College of Pharmacy Center for Leading Healthcare Change. The author can be reached at mmillonig@catalystenterprises.net.