Program Aims to ‘Flip the Pharmacy’ Experience for Pharmacists, Patients
| Gone are the days when your local pharmacy just dispensed prescriptions.
Community pharmacists get to know their patients in a way that helps them recognize and act on health problems and medication issues that result in improving their health outcomes. And they believe those services deserve to be compensated by insurance companies.
Sixteen Arkansas community pharmacies are engaging in a national, two-year program called Flip the Pharmacy to do more for patients to improve their health outcomes while moving to a new business model.
The program has the potential to change greatly how almost every American experiences their local, independent pharmacy. It also could prove to health insurance companies and other payers that the new and existing services community pharmacies provide are a valuable role in providing health care.
The program will guide pharmacists to incorporate changes to shift focus from the current model of “prescription-level” care provided in a moment of time to “patient-level” care provided over a lifetime.
Pharmacists will document the patient care provided within the community pharmacy setting. Documentation of such services could then be used to prove the new and existing services community pharmacists improve health outcomes while lowering overall health care costs.
Community pharmacists hope a revamped, sustainable business model resulting from Flip the Pharmacy will enhance the existing, traditional prescription-based model that is being challenged by the changing economics of health care.
FAMILIAR FACES
Perhaps no other health care professional sees an individual patient more than their pharmacist.
The average Medicare patient sees their physician or a nurse practitioner a few times a year while seeing their pharmacist 20 to 30 times annually, said Brandon Achor, Pharm.D., co-owner of Achor Family Pharmacy in Maumelle and a program participant.
Achor knows many of his regular customers well. One older customer was so frequently at his pharmacy that friends knew they could reach her there. He and his employees saw her enough to notice a change in her mental state. When she called Achor at work one day to complain about people in her yard, he was able to determine she was hallucinating. He picked her up and drove her to the Emergency Department at a local hospital and was able to give the doctors and nurses there a detailed, in-depth history of the patient.
“I thought when I was leaving, ‘there were another 30 people going to go through dementia without having their pharmacist with them,’” Achor said. “It made me realize we have so much to offer fellow health care professionals. They need our data collection from our firsthand experience with a patient. The emergency medical professionals are seeing them for the first time. I’m seeing them for 4,000th time.”
‘FLIP THE PHARMACY’
In 2017, Arkansas community pharmacists came together with the Arkansas Pharmacists Association to form the Arkansas Community Pharmacy Enhanced Services Network (CPESN). It is part of the national CPESN USA.
Megan Smith, Pharm.D., assistant professor in the UAMS College of Pharmacy Department of Pharmacy Practice, helped facilitate that effort and advise the group.
“In thinking about Flip the Pharmacy and what UAMS is doing, it is right in line with UAMS’ continued support, but also the excitement and seeing the value in community practice,” Smith said. “We as a college recognize that and are working in multiple ways to support that through whatever means we have. We are redefining what we can do between the college and community pharmacy.”
The goal of the pharmacy network is to improve the quality of care and patient outcomes related to medication and other health care resources, leading to a reduction in the total cost of care for that patient. It also can involve pharmacists providing important health screenings and monitoring of a patient’s health.
This August, the Arkansas CPESN received a two-year $77,600 grant from the Community Pharmacy Foundation to participate in the Flip the Pharmacy Program with 24 other states. The funding will pay for coaches who will help implement and test the new business model as well as an intern.
Achor, left, receives a box of Flip the Pharmacy materials from Smith at his Maumelle pharmacy.
UAMS College of Pharmacy is providing in-kind support like Smith’s time. Smith Drug Company is a sponsoring partner providing funds as well as in-kind support. Additional partners providing in-kind support are PioneerRx and the Arkansas Pharmacists Association. The network’s participants want to show how effective pharmacists already are at keeping their patients healthy, improve on those health outcomes with new services and earn reimbursement from pharmacy benefit managers, insurers and other payers.
OLD VS. NEW BUSINESS MODELS
“I feel very strongly that we need to find avenues outside of prescription revenue to sustain our businesses,” said Victoria Hennessey, owner of Community Pharmacy of Springdale. “We’ve been trying to do that, but unfortunately, the real world wasn’t ready for that. The market wasn’t ready for it. These are the first steps to move in that direction.”
Hennessey said her pharmacy already has begun moving to an appointment-based model that will create time for her and her staff to advise patients on the best ways to manage their medications, make sure they are taking them properly and assist with the management of chronic diseases such as diabetes and high blood pressure.
Pharmacists are performing interventions throughout the day that are meaningful to patients, other health care providers and payers. This can include counseling a patient with diabetes on the importance of taking their statin daily to prevent cardiovascular disease or recognizing that same patient hasn’t had their pneumonia vaccine and administering it while they are at the pharmacy,
“These interventions positively impact our patients and lower overall health care costs, Hennessey said. “Therefore, pharmacists deserve to be compensated for not just the product we dispense, but the services we provide. However, to prove our worth to payers and negotiate contracts with them, we need a systematic process to perform and document these interventions consistently within the community pharmacy setting. It is my hope that Flip the Pharmacy will guide me and my staff, in a stepwise approach, to do so.”
TRANSITIONS
Economics and pharmacists’ ambition to do more for patients are driving the change.
“The business margin has been the difference between what you purchase the medication for and what insurance will reimburse you for,” Achor said. “That’s supposed to not just cover all the business costs but also all the clinical knowledge and interactions with a patient. That’s not a reliable model anymore.”
From October 2020 to September 2022, the program will implement changes in pharmacy work flow, time management, staffing and capture data and outcomes. In the beginning and for the first six months, each pharmacy in the program will implement a new “domain,” Smith said. The first is the appointment-based model, and the third month is developing new roles for pharmacy support staff.
To have time for a store’s pharmacist to meet with patients by appointment, other staff will need to help fill prescriptions and maintain the more traditional business of a community pharmacy.
Some stores have opted to identify their own coach familiar with their pharmacy, Hennessey said. She has chosen to have an outside Flip the Pharmacy coach come in to help make changes. Hennessey is reluctant to ask her staff of more than 20 to work any harder, but eager to work with a coach to figure out how to shift to a new business model without burdening them.
Geoff Curran, Ph.D., is a professor in the UAMS College of Pharmacy’s Department of Pharmacy Practice and director of the UAMS Center for Implementation Research. He said the center will advise Smith and through her will advise pharmacies on implementation strategies and how to document those changes.
The program will ask them to write care plans for patients, document a patient intervention and its outcome, Curran explained. There likely will be goals for the number of completed care plans along with data collection and documentation benchmarks.
“I firmly believe we in our College of Pharmacy are really trying to change things through initiatives like Flip the Pharmacy,” Curran said. “The everyday experience of what happens in a pharmacy in 20 years will be significantly different than it is now. This is going to happen more and more.”