Five big ideas for chronic care management
As part of its annual Industry Issues Conference in December, Drug Store News assembled a first-class panel of retail pharmacy and supplier executives for an exclusive, in-depth discussion on emerging best practices for improving care among patients with chronic conditions.
Click here for the complete transcript.
For the 12th year, Hamacher Resource Group VP and co-owner Dave Wendland served as DSN’s special guest moderator. “As I was preparing for this year’s session, a group in the United Kingdom ... had just published a report about dealing with chronic conditions and aging populations,” Wendland noted, setting the stage for the day’s discussion. “The first [was] 8-in-10 patients, according to U.K. physicians, are not taking their medications as prescribed; the second was that 92% of U.K. physicians said, ‘I wish community pharmacy would get more active and more engaged with our patients because we feel they play an important role;’ and the third was that [U.K. physicians believe that] the specialized knowledge pharmacists bring and their accessibility really completes the holistic care that these patients are seeking. The chain and independent pharmacy trade associations came together under one group called Pharmacy Voice to do that study.”
What follows here are five of the biggest ideas to come out of the panel.
1. Pharmacist: Moving from dispenser to adviser
If you had said to me when I graduated pharmacy school in 1976 that I would ever give an immunization to someone, I would have told you that you were out of your mind. Now it’s absolutely commonplace. In the state of Oregon, pharmacists [are] prescribing birth control pills in a collaborative agreement with the state.
... I think the real challenge is to figure out how it all works, and at the end of the day, ... how we can become compensated for these [activities], and how we can use those new funding models to offset some of the losses on the other side of the equation. That’s the challenge. — Mike Mastromonica, assistant VP pharmacy services, Costco
About two years ago, we realized we had to get away from a dispensing model and get into a patient care-centered model. So we started working with ... MTM .... What we found is that once we spread the MTM across the store — we made everybody responsible: technicians, pharmacy interns and the pharmacists — we started to identify immunizations that we could do. I think it was about ... 88% of our CMRs that we do through MTM, we do 48% for free; it ends up we get an [immunization] out of it.
So that went further, ... and we just kept adding what we had to work with. Currently, every CMR ... in every ... MTM ... that we do ends up with med synchronization now. So we find out that after maybe about three touch points customers [are] engaged again, and all of a sudden [it goes from], ‘my pharmacist hasn’t really talked to me for a couple of years’ [to] ‘my pharmacist has an interest in my health care.’ — John DeJames, manager clinical programs and special projects, Giant Eagle
Health care has dynamically changed over the last three years. We have seen our model begin the shift from fee-for-service to value-based reimbursement. One of the catalysts has been the Medicare Part D Star Ratings Program. The impact it has had on access and payment in our most common patient population has changed how we approach our members and their corresponding actions.
Over the last three years, we’ve taken a very deliberate journey with them, and it first started with an awareness campaign. As an independent pharmacist you wear a lot of hats, which makes staying on [top] of what’s changing in the marketplace very tough. We shared with our members how clinical performance was being defined. Who’s measuring? Who are the stakeholders? How do you understand where you stand today? ...
In year two we moved from awareness to adoption ... such as how you use the MTM interventions ... to have more deliberate conversations with patients; how to approach every conversation with a behavioral-based model for identifying patient gaps in care ... .
Finally, we dug deeper to help shift the workflow model. If you go into most pharmacies and you ask them about their day, they respond with how many prescriptions they’ve filled. We’re trying to transition to, how many patients have you seen? How many conversations have you had? How many lives have you touched? — Tony Willoughby, chief pharmacist, Health Mart
2. Coordinated care, transitions in care — the pharmacist in the middle
Well Transitions is ... an adherence-focused partnership between Walgreens pharmacists and a hospital system to help patients at discharge to make the transition back home. We target high-risk, chronically ill patients that we feel have a high readmission risk, and a Walgreens pharmacist [visits] them in their hospital room and talks to them about their disease, their medication, the importance of compliance and any other questions they may have.
Walgreens is becoming very patient-focused. We’re seeing very good response rates because they’re getting educated, they’re getting their questions answered and there’s that empathetic interaction at bedside. Also, hospitals and payers love it because it is improving healthcare outcomes and decreasing 30-day readmissions, which is the goal of the program. We [have] published white papers [on the program, and] it is working very well — 30-day unplanned readmissions are down 46% through the program. — Michael Wolf, DMM/director advanced care, Walgreens
[Another] area that we’ve learned is an obstacle — that was a surprise — is formulary management. We experienced one patient that was on a branded bladder control medication and a branded high blood-pressure medication; they went into the health system and those medications were not on the formulary. The hospital placed the patient on other, therapeutically equivalent products that were on the hospital formulary. Meanwhile, our pharmacy had already taken this particular patient through step therapy on these products previously, [and they] had not worked. The pharmacist explained the need to continue the original medications as the patient was experiencing bladder control issues and increased blood pressure ... .
... In addition, there is always the potential risk that patients are discharged and start taking a new medication, plus a duplicate medication they already have at home.
So, there’s a lot of coordination needed, but this is definitely an area of opportunity. — Dan Miller, SVP regulatory affairs, Rite Aid
I think transitions in care is a huge opportunity for the entire market, and I include the wholesalers and the suppliers and everyone in that — [including] all the technology providers. ... I mentioned [before] that I see our industry in general in a shift from a product-based focus into more of a s