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Stacey Irving

Eyad Farah

In this interview, McKesson Patient Relationship Solutions (MPRS) Vice President of Strategic Marketing Stacey Irving and McKesson Vice President of Business Development and Strategy Eyad Farah talk with 
ComputerTalk’s Will Lockwood about the results of a study commissioned to look at the emerging trends in patient adherence.

For more information on the study and MPRS, please visit www.mckesson.com/mprs

ComputerTalk: Stacey and Eyad, let’s begin with some background on the study.

Irving: The study was commissioned by MPRS, and is actually a follow-up to one that we did in 2011. The goal was to look at emerging trends in medication adherence, use of co-pay cards, and attitudes toward different healthcare providers. We looked at both pharmacists and physicians, because they’re both important providers of patient care.

We interviewed 450 different patients taking medications across six therapeutic classes, including cardiovascular, oncology, diabetes, respiratory, dermatology, and obesity. The goal was to understand their drivers to medication adherence. What ends up being really interesting is the ability to compare the results from 2014 with those from 2011.

CT: What kinds of drivers of adherence did you look at?

Irving: We looked at financial drivers, as well as an area that we spend a lot of time thinking about, which is the behavioral aspects of medication adherence. What we wanted to understand is, where do patients want to receive additional support? How do they prefer to receive incremental resources and education that will drive adherence?

CT: So the study touches on both technology and how personal interactions work toward improving outcomes. Can you go into more detail on what patients and pharmacies are looking for in order to balance out the technological and the personal?

Irving: I’ll walk you through a couple of themes that we saw in the research. Then we can tie that into what pharmacies are really expecting, because I think pharmacies and physicians practices, but most notably pharmacies, are changing so quickly. I think a lot of this change is aligned with the expectations that patients have and their areas of focus.

For example, when we look at how concerned patients are about their condition and compare 2011 to 2014, we find that patients are increasingly concerned about their condition and that they’re increasingly committed to working to remain healthy, but that on the other hand they seem to have less of a grasp of the real aspects of understanding their condition and how to manage it.

CT: What explains this? 

Irving: Although cost has remained at the top of the list of factors determining medication decisions, patients are also really identifying education, and a need to understand the medication, as a major factor. We found that patients are looking for someone to help them work through the task of becoming better informed about how to effectively manage their conditions. That’s very validating from my perspective for pharmacy. I really was excited to see how receptive patients are, and how much they’re looking for what pharmacy is already working hard to provide.

CT: What other insights does the study provide?
Another key insight is that patients’ expectations of their interactions with healthcare providers are changing. They are still tremendously interested in prescription reminders and refill reminders, which is where you typically see technology involved. But 86% of the patients in our study said they also want live phone support, and 83% of them are really open to face-to-face pharmacist coaching. That’s a tall order for our healthcare system to fill, but the good news is that patients are very open and receptive to these types of services to help support them as they manage their conditions.

Additionally, patients are increasingly satisfied with pharmacy. Ninety-four percent indicated that they were satisfied. I would expect that a lot of that has to do with the fact that pharmacy has really stepped up in terms of looking at innovative ways to help fill in the gaps that exist in healthcare today. Pharmacy does so much to make sure that patients have access to their medications and that they remember to take them. Pharmacy really helps patients keep on track. So there are a lot of good things happening there as well.

CT: Stacey, you mentioned that financial considerations still top the list when it comes to adherence barriers. Tell us more about what the study found here.
This is another highlight area of the results. The study found that patients are very open to receiving co-pay assistance at the pharmacy. Obviously, physicians still remain the primary way of accessing it, but when we see that patients are open to accessing this assistance at the pharmacy we see another innovative channel for service, and a gap we are working to fill in the pharmacy to support adherence, with the recent launch of LoyaltyScript@Retail. Designed to provide pharmacists with a timely, convenient means of providing patient savings and enhanced care at the point of dispensing, LoyaltyScript@Retail provides pharmacists with easy, in-store, online access to co-pay savings offers for a growing list of medications across a range of therapeutic classes.

CT: And then what about the role technology can play?
Certainly it’s going to be a matter of finding the balance of bringing the right technology to bear, which McKesson is very focused on. The goal is to provide technology designed to free up pharmacists’ time to spend more time with patients. We certainly can’t create more hours in the day, but we can make some of the administrative tasks around delivering face-to-face coaching and other types of patient education or support much easier.
We’ve done a lot of work around delivering tools and resources to pharmacies that will help them grow their skill set to help patients make positive changes in their behavior. Ultimately, the role for technology is about enabling the pharmacy to have a very efficient conversation with a patient — maybe just five minutes — and get the most out of that time with the patient and help them change behavior and remain adherent.

CT: The study highlights the significance of access to healthcare providers, and pharmacy, I think, is widely recognized as perhaps the most accessible healthcare provider. What’s the trend there for patients, and how does this tie into a bigger clinical role for pharmacy that pharmacies are trying to leverage?
Eyad Farah:
If you look at what’s traditionally been important for patients when searching for a pharmacy, cost and convenience are the key factors. We want to help independent pharmacies level the playing field in these areas and continue to grow their business. For example, if you look at what chains are doing, they’re leveraging much more digital and mobile technology that offers active points of convenience to both the pharmacy and patients. McKesson is investing heavily in helping independent pharmacies have these capabilities through a tool called Your Pharmacy Online, which is an online and mobile offering for independent pharmacies and Health Marts. It really helps pharmacies market themselves to patients and be more accessible to them. 

With the proliferation of narrow networks, more patients are willing to go to the “preferred” pharmacies to realize lower co-pays and save money. Within the narrow network, though, a patient can still go to one pharmacy or the other, and that’s where we need to continue to invest in marketing our outreach capabilities and technology, like Your Pharmacy Online, which really help the patient connect with their independent pharmacy and help bring more patients to their pharmacy.

CT: And this has an impact on the new, clinical role pharmacies need to be looking toward, right?
Yes, clinical performance is rapidly increasing in importance, and star ratings are the focus area today for health plans and PBMs. This creates an opportunity for independent pharmacies to leverage their relationship with their patients and their accessibility to help drive better care for their patients. This is a shift in the way pharmacies do business today. To continue to be successful in the future, they need to start providing other services besides dispensing medications, such as medication synchronization and MTM to be able to help patients understand gaps in care and the importance of adherence. What we’re doing is providing access to the right technology and continuing to invest in technologies that support this new role.
In addition to shifting their business to be more clinically oriented, there’s the need for independent pharmacies to focus more on strengthening the relationship with the physicians. This plays a major role in the efforts around improving clinical care. For example, when we talk about closing gaps in care, this really requires a tighter relationship between the pharmacist and the provider or the prescriber. So we’re investing in this, from an educational perspective as well as providing the pharmacist with the tools to help impact the quality of care by working together with the prescriber.

CT: Is there a good example you can point to where pharmacies are having success with these efforts to connect better with patients and prescribers?
There’s one example that I can give you about what our community pharmacies are actually doing in the market today. It’s called the Pharmacy Intervention Program, and it has about 4,000 community pharmacists involved, both chain and independent. It’s a face-to-face behavioral coaching program sponsored by the manufacturers. It’s a perfect example of using technology to meet the patient’s need for personal interaction with the pharmacist. We have a proprietary technology infrastructure that handles all of the administrative aspects and allows the extra time pharmacists need to deliver an intervention. It puts it all right in their hands during the prescription adjudication process. Another key aspect of this program is the extensive work we do in training the pharmacist on how to be effective.
The program’s been in market about six years. We worked in a variety of different disease states, and across the board you see these outstanding results. Just five to seven minutes of coaching leads to a 30% increase in patient adherence, and that impact lasts up to 18 months, which is pretty amazing.
I think it’s a great example of the tremendous impact pharmacy can have on outcomes when you combine technology with the right training and the right program design. There’s so much research now tying that adherence impact to long-term healthcare savings, that we can then work to apply these findings to the payer space and address some of the requirements around clinical performance for these narrow networks. I think McKesson pharmacies, in particular, are really set up to be leaders in this area, because we can bring that technology and health behavior change expertise together.

CT: That really helps support the rationale for why community pharmacy really needs to be involved in patient care and be part of that process, I think.
Absolutely. Community pharmacies are accessible, they’re trusted, and they’re in the right place at the right time. Because patients often leave the doctor’s office and, as you saw in the study, don’t understand what they were prescribed, don’t understand the importance or the impact on their healthcare, the pharmacist has such a critical opportunity. And with continuing patients, we see that people’s priorities change over time, as costs or other issues arise. The pharmacist is ideally positioned to help these patients as well. Whether it’s a phone-based or face-to-face interaction, pharmacists can address those barriers head-on.

CT: If you want to highlight one or two key takeaways, then, what would they be?
I would point to a couple of key takeaways. First, pharmacies need to understand how the industry is changing and how clinical performance is becoming a very important factor in sustaining their future. Second, pharmacies need to have a strategy to take it to the next level and start implementing the right tools for this new healthcare world, whether it’s medication synchronization, refill reminders, or MTM. There are a lot of tools and technologies out there already that can help. Finally, I would say pharmacies need to change the mindset and think about their business not as being centered around the script, but rather being centered around the patient, and start thinking about the patient more holistically. Pharmacies should think about other services that they can provide for their patients to help drive better care. If you start to think about the business as a patient-centered business versus a prescription-centered business, and start building your business toward that, I think that will set you up for the future. CT