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This is the second part of a two-part series outlining six things every pharmacist should know about CPESN networks. In ComputerTalk‘s July-August issue, we covered three out of the six in part one. Read it now or listen to the audio file or podcast.

Read Part I

 

Troy Trygstad, Pharm.D., M.B.A., Ph.D., executive director of CPESN USA
Troy Trygstad

In 2016, a major new effort was announced at the NCPA Annual Convention, called the Community Pharmacy Enhanced Services Networks, or CPESN. The goal of the program, according to Troy Trygstad, Pharm.D., M.B.A., Ph.D., executive director of CPESN USA, is to organize pharmacies that provide enhanced care services into a coordinated network that will enable them to get paid for providing these services.

EngageRx: The Latest And Boldest Step in The Maturation of CPESN USA


EngageRx
Example EngageRx Materials

FOUR: EngageRx is the latest and boldest step yet in the maturation of CPESN USA. Launched this summer, the program pulls all the elements of the program together. It provides local networks with the training and marketing materials they need to more successfully contract with payers.

Trygstad says, “EngageRx is the ‘next big thing’ for CPESN networks.”

The professionally produced brochure and inserts outline a variety of enhanced care programs. The inserts describe how a particular pharmacist-provided service benefits patients, prescribers, and payers in measurable ways. Trygstad says that EngageRx provides CPESN participating pharmacies with the ability to present a program that is branded for each specific enhanced care service. For example, the program provides a specific “sell” sheet for services such as care synchronization or diabetes management.

CPESN USA Payer Update Map
CPESN USA Payer Map

Trygstad emphasizes that EngageRx is more than flyers and brochures. Participating pharmacists using the materials must first take a 10-hour training course that provides them with technical information and sales skills training. And, he adds, a PowerPoint presentation and digitized version of the materials are also available to facilitate formal presentations and effective follow-up. All of this is supported with a customer relationship management (CRM) software package that helps network leaders track the progress of each potential new client.

Trygstad believes this is the most sophisticated and comprehensive sales and marketing program ever provided to community-based pharmacy owners and managers.

Members of Local Networks Provide a Core Set of Enhanced Services

FIVE: To be a member of a local network, pharmacies must demonstrate they can provide a core set of enhanced services. According to Trygstad this requirement is central to the idea of a clinically integrated network. This means that when a payer contracts for services it can be assured every pharmacy in the network can provide them.

The CPESN website, www.cpesn.com, provides a list and explanation of what these core services are. Trygstad says that some of these may seem pretty basic, but when you are competing with mail-order pharmacy sometimes things that seem basic are actually pretty important.

“For example,” Trygstad says, “as simple as it sounds, the first requirement is that the pharmacist be available for face-to-face consultation.” Next, the program calls for participating pharmacies to review all medications a patient takes and take action to prevent medication-related complications.

Other enhanced care services include monitoring a patient’s immunization record and offering to provide vaccines when needed. If the pharmacy cannot provide the immunization, the pharmacist is to refer the patient to a facility where it can be provided. Medication synchronization is also on the list.

Every participating pharmacy must have a private consultation area as well. The key takeaway: While all of these services are valuable, they are not out of reach for the average pharmacy and are far superior to what mail-order pharmacies provide.

Every CPESN Pharmacy Actively Uses A Pharmacy eCare Plan


SIX: One novel requirement is that every CPESN pharmacy must be capable of, and actively use, a pharmacy eCare plan. According to Trygstad, eCare plans are kind of like the glue that holds all the different elements of the program together.

An eCare, or electronic care, plan is a place to create, organize, and document all the interventions and services the pharmacy provides to patients receiving enhanced care. Since an eCare plan is so important, CPESN USA has worked with system vendors and arranged for many of them to build a plan into the pharmacy management system. Other technology companies, such as STRAND (now part of OmniSYS), PrescribeWellness, and AZOVA, have developed eCare functionality that integrates with pharmacy management systems. As of the time of this writing, 15 companies are certified by CPESN USA as having met their eCare standard.

Robyn_Amberg
Robyn Amberg

According to Robyn Amberg, senior business development manager with PrescribeWellness, a TRHC company, eCare plans are an essential “next step” for the profession. Amberg says that every time she visits a physician, the doctor documents her diagnosis, recommendations, and prescriptions into an electronic health record (EHR). She says that if pharmacists want to be paid for providing cognitive services, they must learn not only to provide them, but to document them as well.

The format for storing and sharing eCare plans has been coordinated with the Pharmacy Health Information Technology (HIT) Collaborative. CPESN USA-approved eCare plan templates meet all industry standards for functionality, interoperability, and HIPAA regulations. The ability to provide eCare plan functionality for pharmacies serves as a perfect example of the need for pharmacy system vendors and other technology providers to support and develop interfaces.

Recorded on an eCare plan are clinical assessments, treatment recommendations, lab results, counseling provided, identified drug therapy problems, and actions taken to remedy them. Then, once in digital format, these reports can be shared electronically with providers, and the providers can respond electronically.

With the aid of eCare plans CPESN networks are now able to capture the data and produce the documentation necessary to support billing payers — not PBMs — for services rendered. And none of this would happen as well or as rapidly without the network, or be as valuable on an individual pharmacy basis rather than as the total value of the combined network. This is, according to Trygstad, “a big deal.”

Conclusion


Yogi Berra, the late, great New York Yankees baseball player and erstwhile philosopher, is sometimes credited with the saying, “The future ain’t what it used to be.”

For generations the goal of retail pharmacy has been to fill more prescriptions. It is now obvious this is no longer the primary determinant of success. The time has come for pharmacies to provide, document, and bill for services that lower healthcare costs and help patients live healthier lives. CPESN networks seem to me to be the profession’s best hope for accomplishing that task. Here’s hoping, no matter what your practice setting, that you’ll take time to investigate and support the movement. CT



Bruce Kneeland is an industry expert who focuses on helping pharmacists find new and better ways to serve patients. He can be reached at BFKneeland@gmail.com. 

CPESN USA is jointly — and equally — owned by Community Care of North Carolina, a 501c3 organization, and the National Community Pharmacists Association (NCPA). Learn more about the organization at www.cpesn.com.

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