Healthier Patients and a Healthier Bottom Line: Improving Your Pharmacy Practice Through Prescription Adherence Management

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Charles Lyons
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1 Healthier Patients and a Healthier Bottom Line: Improving Your Pharmacy Practice Through Prescription Adherence Management John Sykora, RPh, MBA Owner, Abrams and Clark Pharmacy Long Beach, CA October 2009 Learning Objectives Describe how prescription refill management can improve patient outcomes. Outline staffing and workflow modifications that are important to the patient centric model. Discuss how patient adherence management can be incorporated into just-in-time inventory and affect turns. 1

prescription refill management can improve patient outcomes.

2 Outline Pharmacy Profile Case Management Business Model Program Benefits Patient Centric Model (PCM) Program Target Patient Population Program Overview Pharmacist Responsibility Program Operations Future Plans Panelist Discussions Conclusion Pharmacy Profile Location: Long Beach, CA Products/Services Offered Prescriptions DME Medical Supplies Delivery Personnel Hours of Operation Mon. Fri. 9:30 6 2

3 Case Management Business Model Workload efficiencies Minimize phone calls Proactive orders Prioritize work flow Delegate routine activities to technician Hours of operation Adjust to new workflow Case Management Business Model Inventory control Just-in-time (order to fill not to replace) Increased turnover (37 times a year) Reduced inventory Improve bottom line Increase gross margin Decrease expenses Increase turnover Increase efficiencies Increase cash flow Increase patient retention Book of business created 3

(order to fill not to replace) Increased turnover (37 times a year) Reduced inventory Improve bottom line Increase gross margin

4 Program Benefits Patients Improve health care management Improve medication adherence Decrease gap therapy Reduce stress due to running out of medications Reduce stress due to waiting for orders Increased opportunity to discuss complete drug therapy with pharmacist Reduce prescription costs: selection of most cost effective drug therapy Coordination of supply orders with prescriptions Reduced trips to the pharmacy Service is free of charge Program Benefits Pharmacists Better time management Increased interaction with patients Proactive approach to managing work load More time for professional services Less stress to pharmacy staff More time to help patients with drug therapy and overall costs Increased career satisfaction Increased retention of patients 4

prescriptions Reduced trips to the pharmacy Service is free of charge Program Benefits Pharmacists Better time management Increased interaction with patients Proactive approach to managing

5 Program Benefits How it All Adds up Better Patient Adherence leads to: Less hospital visits Less physician visits Improved continuity of care Less drug treatment failures Detection of gap therapy Improved disease state management Early detection of medication problems Selection of most cost-effective medication therapy Patient Centric Model (PCM) Model Patient Improved: Communication Patient adherence Quality of care Workflow/efficiencies Inventory management Overall healthcare costs Started in 1996 Recognized need with medical supplies Expanded to include prescriptions Currently 250 patients enrolled Free of charge Pharmacist Physician 5

Patient Centric Model (PCM) Model Patient Improved: Communication Patient adherence Quality of care Workflow/efficiencies Inventory management Overall healthcare

6 Target Patient Population Opt-In Program Inform patients of service when they call or pick-up Target populations Multiple maintenance medications Require refill reminders, last-minute callers Going on extended vacations Mental health programs with refills Senior housing Under conservator care Program Overview Heart of the program Synchronization of fills All refills to one date Household members Patients in facility One-time process Most costly medication serves as anchor Partial fills of others may be required 6

refills Senior housing Under conservator care Program Overview Heart of the program Synchronization of fills All refills to one

7 Pharmacist Responsibilities Patient Enrollment Explain benefits of program and need for partial fills Review current medication therapy Resolve any therapy issues Synchronization: Verify medication therapy with MD and patient Explain adherence program and synchronization Create script for remaining quantity required Create second prescription for regular monthly fills Adjust new Rx to PSP date Program Operations Dedicated staff member Organized, great communicator Anticipates problems and works to resolve them quickly Set-up and Supplies: Master spreadsheet with patient list Accordion File with slots 1-31 For each patient: Assign appointment date Assign identification number Create medication list (verification request form) 7

monthly fills Adjust new Rx to PSP date Program Operations Dedicated staff member Organized, great communicator Anticipates problems and works to resolve them quickly Set-up and

8 Program Operations Week prior to appointment date: Pull verification request forms Call patient to review medication list Inquire about any recent visits to physicians office or hospital Verify which refills are needed, any changes or discontinuations If necessary, contact physician for refill authorizations or verify any changes noted by the patient Generate labels for filling Complete request form Program Operations Day before appointment date: Any previous issues are resolved Prescriptions are ready to be filled Ensure adequate inventory on hand or place appropriate order Appointment date: Prescriptions scheduled are filled and verified Patient receives monthly order 8

by the patient Generate labels for filling Complete request form Program Operations Day before appointment date: Any previous issues are resolved Prescriptions are ready

9 Program Satisfaction Pharmacists Better time management allows for development or expansion of professional services (e.g. MTM) Increased interaction with patients builds trust and loyalty Patients/Caregivers Service is free of charge Reduced trips to the pharmacy Coordination of supply orders with prescriptions Improved quality of care Future Plans Disease State Management for HMO, employer groups, insurance patients Hypertension Hyperlipidemia Anti-coagulation Diabetes CHF Mental health Outcome studies 9

pharmacy Coordination of supply orders with prescriptions Improved quality of care Future Plans Disease State Management for

10 Conclusion Program improves patient adherence and promotes better medication management Pharmacist can gain better control of: Workload, workflow Inventory costs and turnover Overall practice Considerations: Staffing, employee buy-in Pharmacy space Business model Charleston Pharmacy Owner: Twila Boyd, RPh Located: South Charleston, OH Program patients: ages 48 and over Program started: June 2009 Number of patients enrolled: 26 Number of scripts managed:

buy-in Pharmacy space Business model Charleston Pharmacy Owner: Twila Boyd, RPh Located: South Charleston, OH

11 Charleston Pharmacy Marketing: word of mouth we market to the kids in their 60 s picking up for mom or dad who are in their 80 s. They think it s a great idea. Impact on the pharmacy: Makes filling much easier: can fill medications during downtime instead of trying to fill 10 refills 5 minutes before closing Closer eye on inventory Yale Drug Pharmacist: Kacee Blackwell, PharmD Located: Yale, OK Program patients: rural, Medicaid, Medicare, or uninsured Program started: May 2009 Number of patients enrolled: 24 Number of scripts managed: 225 (including a family of 6 with 38 Rx's 4 patients in program with 20 or more Rx's) 11

Impact on the pharmacy: Makes filling much easier: can fill medications during downtime instead of trying to fill 10 refills 5 minutes before closing Closer

12 Yale Drug Identifying key personnel: Entire pharmacy team is key. Everyone must be aware of the patients in program and what to do when new Rx comes in or if refill called early. Technician involved with organization must understand purpose of program and be able to communicate well with patients. Marketing: We usually bring it up when someone makes a comment about having to come in so many times to get all their refills (refill too soon, etc). Windsor Gardens Pharmacy Owner: Nancy Gallegos, PharmD Located: Denver, CO Program patients: seniors in retirement communities, assisted living facilities Program started: July 2009 Number of patients enrolled: 60+ Number of scripts managed:

Technician involved with organization must understand purpose of program and be able to communicate well with patients.

13 Windsor Gardens Pharmacy Impact on the Pharmacy, increased: inventory turns revenues patient compliance staff hours by adding 1 part-time pharmacist and 1 part-time pharmacy technician Marketing: Flyer, newspaper ad, fax coversheet and medication review for MD s Windsor Gardens Pharmacy Challenge: training tech for synchronization Nancy, in her own words: The pharmacy inventory is easier to control, customer satisfaction has increased, productivity is smoother our prescription count has also increased! This is an excellent opportunity for any community pharmacy to implement this prescription adherence management program 13

for synchronization Nancy, in her own words: The pharmacy inventory is easier to control, customer satisfaction has increased, productivity is smoother our

14 Marketing Example Sample Faxes to Physicians Our mutual patient has enrolled in our Patient Centric System. This is an efficient system designed to synchronize medications to one fill date of the month. In order to achieve this, we are asking for a short-fill of the following medication(s): Our mutual patient, has joined our Patient Centric System (PCS). This is an efficient system designed to synchronize patient s medications to one day of the month. In order to achieve this, we are asking for a full review of the above patient s medications. Please review this list. If there are any medication changes, please fax us a new prescription. 14

In order to achieve this, we are asking for a short-fill of the following medication(s): Our mutual patient, has joined our Patient Centric System (PCS).

15 Patient Centric Model Information Background In 2008 the National Alliance of State Pharmacy Associations (NASPA) began working with NCPA and state pharmacy associations in order to implement a patient centric model The goal is to improve patient outcomes Program received a lot of interest in first recruitment phase 15

associations in order to implement a patient centric model The goal is to

16 Program So Far Over 50 pharmacies have agreed to participate Have begun to enroll approximately patients per pharmacy (goal of 15-20% of total patients) Beginning to collect baseline data Will evaluate baseline, mid-term, and year end persistency Goals for the Future Enrollment ends in December 2009 Goal of approximately 150 pharmacies Goal of approximately 3000 patients Data collection ends December 2010 Final data analysis Spring

mid-term, and year end persistency Goals for the Future Enrollment ends in December 2009 Goal of approximately

17 Support During Program Current Support Available /phone support as needed with project manager One-on-one scheduled phone support from project manager Free data exchange with NASPA to determine progress throughout the pilot Bi-weekly PCM newsletter (updates, advice from colleagues, etc.) Future Plans Social networking group for participating pharmacies Contact Information For More Information Please Contact: PCM Project Manager (804) ext

18 Audience Questions Thank You You have successfully completed the educational portion of our activity. To receive credit for your participation in this educational activity, please proceed to the Post-Test/Evaluation. Upon successful completion of the Post-Test/Evaluation you will be granted immediate access to print your own CE certificate. Thank you for your participation! 18

To receive credit for your participation in this educational activity, please proceed to the

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