Evolving Your Pharmacy Practice in an Era of Great Change

OCTOBER 19, 2017
Brad Tice
The face of health care is rapidly changing as the entire industry evolves to a value-based care model that pays for quality and performance.

What Does That Mean for Pharmacists? 
It means that pharmacists can finally move ‘beyond the script’ and get paid for more than dispensing medications through opportunities to get paid for providing total care and support for the patient. All of this necessitates a change in how you operate as a pharmacy and pharmacist.

It has been difficult for pharmacies to establish new, sustainable business models that support the entire practice, but now is the time to make that move by transforming from a prescription-centered practice model to a patient-centered practice models.

Health insurance plans and pharmacy benefit managers are narrowing their networks and imposing new standards and fees (ie DIR fees). Some require that practitioners, including pharmacists, demonstrate they meet certain quality care standards, which are not always transparent. This is all in the name of the movement to improve quality and establish value-based care to lower the cost of health care. Therefore, shifting from a focus on the prescription to a focus on the entire patient enables the pharmacist to identify additional care opportunities, meet the total health care needs of the patient, and deliver a better patient experience while providing better quality and lower total health care costs.

As cost pressures and margins on prescriptions continue getting squeezed, new revenue models built off of this patient-centered transformative model can help extend the pharmacy business while also providing more complete care to the patient. We've made some progress, but for the most part, pharmacies haven't created a successful business model separate from dispensing medications. If we don't meet these new requirements, we stand to be forced out.

October is American Pharmacists Month and an opportunity to not only celebrate the pharmacy profession, but also explore and consider what we can do to advance pharmacy practice in this tenuous environment. While the change to a value-based payment model is a big challenge for pharmacists, if we can once and for all get beyond the mindset that we're simply dispensing medications; there are massive opportunities to improve patient care, expand our businesses and practice at the top of our licenses.

Challenges Equal Opportunities
For example, let's look at some of the potential changes and how they could impact your business and practice:
  • Patient-reported outcomes and increased quality measures provide hard evidence that what we do is helping our patients, and offering increased pharmacy revenues by meeting those care requirements.
  • Implementation of a new billing structure for medical claims will allow pharmacists to provide and charge for services beyond dispensing medications, be it preventative care or care around chronic disease, immunizations and flu shots.
  • Achievement of provider status (getting recognition for the patient care services provided by pharmacists so we can be reimbursed by government programs) is a must, and many states already grant pharmacists that status. As we pursue this initiative nationwide, you're presented with the opportunity to practice at the top of your license and use your full training and skill in support of patients.
  • Increased patient connectivity, which allows for more hands-on interaction with the customer, and the ability to promote and offer other pharmacy services like the aforementioned immunizations.
How Pharmacies Can Start Making These Changes
While this may sound overwhelming, the fact is these changes to your business can and should be made in a step-by-step fashion rather than a complete and immediate overhaul. The time to start is now.

First, consider implementing some basic medical care practices like immunization programs. These are well-established in our industry and provide a clear path to start improving your business. 

Medication synchronization programs are another relatively easy implementation that can really help create convenience for the patient by limiting how often they must visit the pharmacy, while also giving you a distinct opportunity to interact with that customer about their health and medication routine. By identifying these needs and small wins as you evolve your practice, you'll also begin expanding customer perception and expectations about your services, earning trust as you add more and more programs.

In fact, one pharmacy I've worked with recently added 14 new services over the course of a couple years. With these programs, the pharmacy had great success in measuring positive care outcomes and getting paid for that value. The key for them, however, is that they view this practice change as a new way to treat patients, not just as a way to add programs in order to get paid.

You Aren't Alone
The good news in all of these dramatic changes is that you don't have to go at it alone. At the ground level, 48 states and Washington, D.C. allow for various types of collaborative practice agreements with physicians that give pharmacists the ability to offer additional medical and preventive services. This delivers patients more and better access to care, and establishes both value and quality measures in the care model for pharmacists.

Moreover, as the incoming president-elect of the American Pharmacists Association (APhA), know that we are working on national initiatives to make this transition easier on you. First, we've made great strides on provider status nationwide, with bills in both the House and the Senate garnering massive bipartisan support. We're helping representatives work through this legislation and anticipate it could be passed as early as the spring of 2018. This would make an immediate impact nationwide on setting up pharmacies for this successful transition and a right to play in a new value-based environment. 

Additionally, we're working on infrastructure that not only helps pharmacists show up on the radar of the health plans, but also allows us to readily get paid for providing value-based services.

We are undergoing a sea change in how health care is provided and paid for, and while this evolution can be daunting for pharmacists, it also presents an ideal opportunity for us to get started on this path.

A move from a prescription-centered view to a patient-centered view will enable the transition from fee-for-service to value-based care and provide you not only a reason to move beyond a business model that is currently squeezed by cost and margin pressures, but an incentive to expand the pharmacy business, practice at the top of your license and provide more and better care for your customers.

Brad Tice is the Director of Product Strategy and Commercialization at Cardinal Health, incoming president-elect of the American Pharmacists Association.

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