Listen to the content...
ELEVATING THE LEVEL OF CARE
GRX Holdings owns and operates 20 Medicap Pharmacy locations in Iowa and has focused over the last year on enhancing the level of care for patients. “We’ve been building on our involvement in CPESN Iowa, “says Cheri Schmit, Medicap Pharmacy director of clinical pharmacy. “We’ve been working to set ourselves apart and be part of the value-based healthcare movement providing clinical services and helping patients improve their outcomes, and also collaborating more with providers to help solve some of their needs in the value-based healthcare arena.”
Medicap Pharmacy is using MedWise from Tabula Rasa Healthcare in all 20 retail locations, as well as in its long-term care pharmacy, to review complex multidrug medication regimens. While not yet interfaced to the pharmacy management system, this is a web-based platform that pulls in patient medication lists using cutting-edge interoperability standards such as SMART on FHIR and CDS Hooks. “We’ve been using MedWise for about 18 months,” says Schmit. “And it’s a big piece of how we’re helping provide enhanced clinical services and improved patient outcomes for our patients at all of those locations.”
Once the staff at a Medicap Pharmacy has identified a patient who is eligible for a service with MedWise, they first take a look at the MedWise risk score. “That gives us an immediate gauge of how much risk that patient is at for an adverse drug event,” explains Schmit. “If that risk is high, we can go a step further and see that the patient is at risk of a fall or at risk of sedation or at risk of anticholinergic effects or a cardiac effect. We can quickly dial in a little bit and see exactly why the patient’s risk score is high.”
From there the next step, according to Schmit, is a full medication reconciliation. “So if a prescription says once a day,” says Schmit, “what does that mean to that patient? Is it 8:00 a.m., or does the time vary? Are they taking it with or without food? We are gathering information that we can use with the tools in MedWise to look at the metabolic pathways and find out if there is any medication that may need to be taken at a different time of day so that it’s separated from something that may be impairing metabolism of that product and helping to create a side effect. Honestly, I think it helps us to just think more clinically and holistically about the patient.”
Check out this interview with interview with Tabula Rasa HealthCare’s Tom Wilson…
MULTIDRUG INTERACTION REVIEW BRINGS BIG WINS
While pharmacies have long per formed DUR (drug utilization review), that process has typically been limited to pairs of medications and doesn’t address the real complexities of clinical decision-making. “We’re looking at all the medications taken together and how they interact together — and looking specifically at metabolic pathways and competitive inhibition,” explains Schmit. “It could be, though, that a drug is 30% cleared through one pathway and 40% through a different one. And that’s just one of the pieces you’re looking at. If the patient is taking six different meds, we want to know what the potential interactions are for all of those meds together and what the optimal timing is for taking them.”
“MedWIse has improved our ability to identify issues and make well-thought-through recommendations,” says Cheri Schmit. “We’ve had a number of prescribers who turn out to have been trying to figure out a patient for a long time, and we were able to solve this problem for them. Ideally, we’ll be able to say to more prescribers that we want to collaborate with them on caring for their most difficult cases.” The goal would be to develop a cost-sharing program in which Medicap Pharmacy would earn a fee for services that improve prescriber metrics, such as HEDIS measures or whatever that may be. “I think that’s where the future is,” says Schmit.
Schmit offers an example case that she considers a big win. A Medicap Pharmacy had a patient who was taking three different medications for reflux: a PPI (proton pump inhibitor), an H2 blocker, and Tums. Yet she still was experiencing some heartburn. Further review showed that the patient was also taking alendronate. “We looked at that and thought, that’s not really the best choice,” says Schmit. “We talked to her and her provider about switching over to a Prolia injection. And it was like a light bulb went on.” Schmit reports that the patient is doing much better because the pharmacy used MedWise to support an approach of asking important questions such as: Why are patients taking medications the way they are taking them? Is this the most appropriate combination of medications? This mindset of asking the right questions and digging into a patient’s med list highlights what Schmit believes is an important aspect of using technology like MedWise.” As pharmacists we absolutely need a tool like this,” she says. “But we can’t just expect it to serve up the answer. We are looking at therapy guidelines and gaps in care and everything that we’re trained to do to help that patient.This tool combined with our knowledge and relationship with the patient and prescriber ultimately helps us find the solution and improve patient outcomes.”
Medicap Pharmacy also has Tabula Rasa HealthCare’s PrescribeWellness platform integrated into its pharmacy management system, which provides insights into adherence that complements the data in MedWise. “We can look at the two tools,” says Schmit, “and see if a patient has actually been adhering to a prescription that may be elevating his or her risk score. We can dive into that adherence side too when we do a med review with a patient.”
While the services supported by MedWise are currently billed for as part of enhanced MTM (medication therapy management) for Medicare Part D patients, Schmit would like to see GRX Holdings find ways to extend the benefits to more patients of its Medicap Pharmacies through collaborative agreements with prescribers that include revenue opportunities for GRX Holdings. The point is here that an interface to the pharmacy management system at Medicap would facilitate access to MedWise. According to Schmit, she would like to see an interface for this reason, and reports that this is in the offing.
EFFICIENT ADHERENCE MANAGEMENT
Getting patients on the right combination of medications is critical, but doing your best to ensure that patients are adherent is just as important. Med sync has played a big role in driving adherence in recent years, and Medical Plaza Pharmacy, a Health Mart pharmacy with two locations in Corinth, Miss., has indeed seen great success with its med sync program. But sometimes success can bring a new set of challenges. As Alan Blunt, Pharm.D., who is in charge of the med sync and adherence packaging operations at Medical Plaza, tells it, one such challenge is the time it takes to make the phone calls to patients, a central element of a successful sync program.
“Time is always an issue in pharmacy,” says Blunt, “so we were looking at the time we were spending on these phone calls and trying to figure out what we could do about it.”There’s little doubt, of course, that these patient communications are important, but Blunt still felt there had to be a better way for both pharmacy and patient than tasking a staff member with making 25-plus calls a day, often leaving messages and playing phone tag with patients. The solution for Medical Plaza Pharmacy has come in the form of HIPAA-secure text messaging from Updox. “We can actually use this text messaging feature to let patients know that their medications are coming due for refills and to ask them to contact us if there’s a change or an issue,” says Blunt. “Using texts instead of making phone calls saves a lot of time. We’ve seen a 20% decrease as we’ve been ramping this up since bringing on Updox about a year ago.” Blunt has made it a focus for pharmacy staff to make sure there’s an up-to-date, textable phone number in patients’ files.
Andy Null, R.Ph., pharmacist and pharmacy manager at Medical Plaza, has seen that texting is not just more efficient for the pharmacy, but that you get a quicker response from patients as well. “A lot of times when we’re calling,” says Null, “people don’t pick up or miss our phone call.Then most people don’t actually listen to their voice messages, they just call us back. But they are able to take a quick look at a text message and get back to us.”
Bringing in Updox has also upgraded Medical Plaza Pharmacy’s document management capabilities, notes Andy Null. “We’ve just started using their electronic fax capabilities,” he says. “So now we no longer have a fax machine or even a fax line. Faxes come through Updox and are queued up directly in our Rx30 pharmacy software. We are also sending outbound faxes directly from software, for example when a prescriber needs a patient’s med list. These are great features that have helped us, especially our technicians.”
And then there’s digital marketing, including the pharmacy’s web and social media presence. “We signed on in December, and Updox is updating our web presence and making it more personal,” says Null. “They’re also adding some features like requesting refills from our website. And then they’re helping us with our social media. We’re going to have extensive reporting analytics on how people are using our website and a lot more information about our Facebook ads, which Updox is also helping us create.” Null is expecting to ramp these new marketing efforts up and see actionable feedback within three months.
Blunt notes that Updox has some preset functions as well, which allows him to deploy preset communications for standard parts of the patient contact process.
Texts sent via Updox can be more complete than messages sent other ways, too, notes Null. That’s because of HIPAA-secure features that allow for texting private health information, not just for the sync program but for any need.The feature then allows the patient to send necessary details back securely, too. “We may need insurance information,” says Null, “and with Updox we can send a message and ask the patient to reply with a copy of their insurance card.That saves time, since we can go ahead and get that done proactively rather than waiting for the patient to arrive at our pharmacy and then tell them that we needed their insurance information to input it into the system.”
Medical Plaza Pharmacy isn’t just getting secure texting from its partnership with Updox, reports Null.There are important paperless document management features and a whole new approach to the pharmacy’s website and social media marketing.
HAPPY PATIENTS MAKE FOR GOOD PHARMACY
Your pharmacy can build great relationships with patients using clinical and adherence tools that help patients be healthy, but don’t forget the patient experience in the pharmacy while you are focused on providing care. For example, if it takes too long to pick up a prescription, then you can lose a patient that you’ve put great effort into keeping.
Dishank Patel, Pharm.D., owner of Express Food & Pharmacy in Atlanta, understands this. His pharmacy was using a traditional will-call system, based on manual sorting and retrieval alphabetized by patient last name. “We are in the heart of Atlanta downtown,” says Patel. “Our patients are using public transportation, and there’s really limited or expensive parking.” Patient wait times at will-call were an obvious issue to him.The pressure to ensure patients could pick up prescriptions as quickly as possible led Patel to look at will-call systems that would give Express Food & Pharmacy a competitive advantage in making patients happy. Ultimately, Patel chose scripClip from PerceptiMed.
Now, instead of a manual process, scripClip organizes will call by reading the prescription barcode printed on vials and paperwork by the pharmacy system. The staff scans these items at the scripClip station and loads them into a hanging bag and then scans the barcode on that bag to tie everything together. The scripClip system verifies that each item is for the same patient. You can then hang the bag anywhere in the will-call rack, since the barcode will identify the correct bag without the need for alphabetization.
This process is critical for eliminating sorting errors at will-call, according to Patel. “In the pharmacy world the real situation is that we have to do things very quickly,” he says. “And with a manual process it sometimes happens that people make mistakes. People can put the wrong prescriptions together, and you can end up giving the wrong prescription to the wrong patient.Those mistakes can be costly.”
According to Dishank Patel, he was looking to move to the BestRx pharmacy management software, but the company had yet to develop the scripClip barcode interface with PerceptiMed. “I spoke to the BestRx team, and I told them,” says Patel, “this is what I have, and if I cannot bring the scripClip with me, guys, then I don’t see any chance of me switching.”
Fortunately, it turned out to be no problem. As Patel tells it, PerceptiMed and BestRx huddled for about a week in the time leading up to his go-live date and got the interface done. “It worked out very well,” says Patel.
When a patient arrives for his or her prescriptions, the staff member at the pickup window enters the patient’s name and date of birth into the scripClip workstation, and the correct bags light up.There’s no need to rummage through bins or bags and no need to double-check to make sure you have everything, notes Patel.
With scripClip, Patel is now confident that his staff can work both quickly and accurately, with the technology keeping an eye on things. “I know that no matter who is doing the bagging for will-call that a mistake is not going to happen with scripClip, that’s for sure,” says Patel.
The benefits from scripClip were so important to Patel, that being able to continue using the technology was a make-or-break part of his move to a new pharmacy management system from BestRx.
TOOLS FOR PHARMACY FINANCIAL HEALTH
Loren Pierce, Pharm.D., is founder and CEO of Pierce Pharmacy Management, which manages 20 stores in Tennessee, Georgia, Florida, and Texas. His team is just as focused on patients’ health as the other pharmacies in this story are, but Pierce also offers an example of using an interface to keep an eye on the pharmacy’s health, too.
Pierce Pharmacy Management operates at a scale of independent pharmacy that requires chain-like back-office tools. Pierce has found one of these in Datarithm‘s inventory management software, which is interfaced with the Liberty Software pharmacy management system in use at all 10 of the group’s Texas locations. “Datarithm gives me data and insights from the group level all the way to drilling down into each store’s operations,” says Pierce. “Effective inventory management is critical in any pharmacy. Inventory that sits unsold or expires puts a real strain on cash flow and our margins.”
Pierce implements Datarithm’s inventory management system on top of the perpetual inventory the pharmacies already use. “We needed a tool that would help us keep a close eye on slow-moving stock and drugs at risk for expiring undispensed, and help us improve our turns,” says Pierce. “You have to have an accurate perpetual inventory, but I’ve seen that Datarithm gives me that bigger picture. I don’t log into each pharmacy to look at the numbers, but instead Datarithm’s interface with Liberty pulls all that data up so I have a dashboard where I can globally see how much inventory in each location is performing and what we can do to do better and be more accurate.”
A benefit of running Datarithm is that it helps monitor controlled substances for diversion. “We’re tracking everything we’re buying and everything we’re dispensing, right?” says Loren Pierce. “So if we are buying a controlled substance, but then we’re not seeing it dispensed, that’s a red flag.” This leads to another conversation with the district manager, who is tasked with putting eyes on the stock in question.
Pierce uses Datarithm to track total inventory at each location and see what Datarithm’s algorithms tag as dead. “Then, based on dead inventory,” explains Pierce, “it recommends returning the stock to the wholesaler or transferring it to another store. “ln fact, Pierce is also running Datarithm a ta single Pierce Pharmacy Management location outside ofTexas, and the recommendations for expiring stock to return have made a noticeable impact on his inventory costs there, too.
BE INFORMED AND DELEGATE
Pierce takes this data and tasks his district managers with researching the dead inventory. “So then my conversation with my managers is: Find out if this product is really there. Are you really not selling it? And if you know that’s the case, then we need to take action.” If the bottle is still sealed, the best and easiest path is to return it for credit, according to Pierce.
Pierce is also seeing inventory turns in real time. “You can tell across the board who’s managing their inventory and who’s not,” he says.
GETTING MORE INVENTORY TURNS
Turns are really important, notes Pierce, since turning inventory is what allows you to have cash on hand to pay your bills. “Let’s use a simplified example,” explains Pierce. “We’ll say, hypothetically, that you pay your bills once a month. So what you order in January, you’ve got to pay for in February. In a perfect world, you will have sold all the January inventory before the bill comes due in February. If you do that every month of the year, that’s 12 turns a year. So if we can get 12 turns a year, great. If we can get more, that’s even better. But, it’s pretty difficult to get 12 turns a year when you’re talking about ordering a bottle of 100 and dispense 30. It’s not a perfect world.”
And that’s why you need to keep a close eye on turns and the dead inventory that puts your cash flow at risk. “When you’re running on 2% to 3% net margins max,” says Pierce, “you can’t really afford to let 2% or 3% of inventory get stale on your shelves or go out of date.”
Pierce has successfully moved the needle on Pierce Pharmacy Management’s Texas locations, going from around 10 turns a year to 11 and sometimes 12. “That’s worked out to be a significant amount for us across all 10 stores,” says Pierce. “It’s a mid-six-figures number, and we’re happy about that.”
MORE TOOLS FOR BETTER PHARMACY
The examples here show just a few ways that getting the right tools interfaced with your pharmacy technology platform can be an important part of your strategy for success.
“Our success at GRX Holdings Medicap Pharmacies comes from taking a great relationship we have with our patients,” says Cheri Schmit, “and then building on the information that the patient is giving us when we ask the right questions. We then use that in the clinical decision-making process, with support from the right decision support tools.”
The impact of new technology on patient satisfaction is paramount in Dishank Patel’s mind.There’s no doubt for Patel that the barcode-and light-driven process of using scripClip for will-call is more efficient for his pharmacy staff, but what makes him happiest with his investment is that it makes his patients happy. “l like that patients can see our will-call technology from the pickup window,” he says. “They can see the investment we’ve made and what makes picking up a prescription at our pharmacy much faster and easier. At the end of the day, everything is about our patients’ happiness and how we can earn their business.”
You will find that one good interface can bring other benefits with it as well, as has been the case at Medical Plaza Pharmacy. There’s much more than just secure texting packed into what Updox brings to Andy Null’s operations — so much so that he is taking steps to make sure his key employees understand what they’ve got now. “I’m setting up a training session for several of our employees with Updox so that everybody can understand what we’ve got, how we can use it, and when to be using it,” says Null.
And in the end good interfaces help patients and help pharmacy. That’s because pharmacies in a strong financial position are best able to make the necessary investments in patient care. “When you’re running on 2% to 3% net margins max,” says Loren Pierce, “you need all the tools you can get to ensure the financial health of your pharmacy.”