Specializing in information technology has opened the doors for both of us to attend meetings held by every discipline and specialty in healthcare. Bill just returned from a health benefit managers’ business coalition meeting where national leaders were telling attendees that employers need to control healthcare costs going forward. We know that employers — including the government — pay all the bills with increasing help from employees, who are being charged a growing amount for their care in deductibles that can total $12,000 per family per year. We think that this can be an opportunity for pharmacy to make a difference and to find patients more receptive to doing things that improve their health status through self-care management.
We have written previously about population health, but we are concerned that pharmacists are slow to prepare for a time when employers will sign up with accountable care organizations that will agree to provide care for an entire workforce for a fixed amount of money per year. We are dealing with health systems that are fully prepared to make these kinds of deals today. They know they need to act like insurance companies, and they need to have tight affiliations or ownership of every provider throughout the continuum of care. Pharmacy has to be either affiliated or owned, or it may be left out. We keep saying that if you’re not at the table, you may be on the menu. What follows is a briefing of what employers talked about in multiple presentations at the meeting referenced above.
Population health is not just taking care of people who come into your pharmacy. What evidence can you produce that you are making a difference in the lives of the workforce family that does not take prescription medication? Can you impact other patients who don’t have chronic diseases with preventive measures that improve their sense of well-being? We would like to recommend a mobile app called LARK that has been an encouraging health coach to Bill for the last 90 days. In that time, he has increased his activity level and lost 26 pounds. It is a free app and will chime with a message that says, “Bill, I’m saying this in love, but you haven’t moved in the last two hours. Would this be a good time to take a short walk?” It logs other activity, outcome measures, meals, and whether the food is healthy neutral or unhealthy, and it looks at trending data.
How much is successful medication regimen adherence a matter of remembering to take a medicine, remembering that you have taken a medicine, dealing with the complexity of a regimen, and being reminded of the need for refills? Remembering to take important measures like weight, blood sugar, and blood pressure can also be difficult. The fact that most of your patients are carrying a smartphone that will either run an app or use the native components of the device to get reminders seems like something that could be taken advantage of, from our perspective. Most people are enjoying text messaging more than other channels of communication. Are you employing this in your practice yet?
Beyond Facebook, have you considered looking at the work being done in websites like PatientsLikeMe.com? This website not only gives terrific information from experts and includes information in video form on how to perform self-care management behaviors, but it also partners patients with other patients who have the same diagnosis so that they can receive encouragement and gain motivation from people who are going through the same challenges that they are.
One health system we are working with has made a heavy commitment to Doctor on Demand, where patients can pay a fee to get a face-to-face consultation with a physician. In many instances, people can receive help while they are on the job, and if a prescription is required, a local pharmacy can have the medication that addresses the symptoms delivered to the workplace. How much could you accomplish in your practice by telecommunication that could be done more efficiently than face-to-face interactions?
Self-Management Tools and Educational Resources
Transition of care is a hot topic in healthcare right now. We continue to be impressed that every prescription can be accompanied by knowledge on how to get the best success with the medication being prescribed. If you go to YouTube and search for “nebulizer,” you will see how to assemble, clean, operate, and troubleshoot a nebulizer in language that is designed for patients. When you Google a question, how many resources to answer your questions have you come up with that contain little or no information? The bigger problem is sorting through and determining which of the information is the most appropriate for you to answer your question. Are you in a position to anticipate the self-care management needs of your patients and to supply them with the resources that reduce their uncertainty in their decision-making?
Links to Community Resources
In a population health environment, someone needs to do care coordination between providers. The access that people have to pharmacy is second to none. There are many resources on the Internet that describe the kind of care that would be desirable for any age of patient with any number of conditions. Who would be best on the healthcare team to coordinate the care throughout the continuum?
Mobile Health and Remote Monitoring
We have been watching how pharmacists embraced drug information resources on their devices going back to the PalmPilot days. Today, decision support for patients in the form of health apps has exploded. Whether you are talking about lifestyles, chronic disease management, recreation, or medication regimen adherence, there are thousands of apps that can be matched to patient needs. The same devices that hold the apps can serve as a terminal to present valuable data between episodes of care. As we showed in the beginning of this, patients have some pretty strong financial motivation to get more involved in their health. Do you have a vision for this area?
On Site/Near Site
On this last category, we wondered when your pharmacy last participated in a workplace-specific health screening, flu shot clinic, or other health-based activity. This and every other category listed above were all being packaged by employers as a means of moving from a workplace benefit mentality into something called an employee experience. Studies have found that there are many benefits when a sense of well-being exists in the workplace. The benefits to a company when employees are happy include: 33% higher profitability (Gallup), 43% more productivity (Hay Group), 37% higher sales (Shawn Achor), 300% more innovation (Harvard Business Review), 51% lower turnover (Gallup), 66% decrease in sick leave (Forbes), and 125% less burnout (Harvard Business Review). It sounds like every pharmacy manager needs to work on employee happiness as well.
We would be interested in hearing your questions or comments. CT
Bill G. Felkey, M.S., is professor emeritus, and Brent I. Fox, Pharm.D.,
Ph.D., is an associate professor, in the Department of Health Outcomes
Research and Policy, Harrison School of Pharmacy, Auburn University.
They can be reached at firstname.lastname@example.org and email@example.com.