Brad Tice

Challenges such as overwrought performance goals that create insurmountable stress, a lack of control coupled with a flood of new graduates willing to work for low wages to pay off student debt, and dismally low reimbursement are all driving toward one result: pharmacist burnout.

The danger of attempting to deliver patient care in such taxing conditions has quickly become more concerning than rampant workplace dissatisfaction. But, with adverse drug reactions (ADR) representing the 

 in the United States and Canada behind heart disease, cancer, and stroke. the value of the pharmacist has never been more apparent. Why the juxtaposition?

Mounting Pressure with Little Relief in Sight

Facing performance metrics, such as prescription fill and immunization quotas, along with the pressure of counseling patients, and phoning physicians and insurance companies, it’s no wonder many pharmacists feel it’s more difficult than ever to perform their jobs to the peak of their license.

Pharmacy services is an industry ripe for disruption. The pivot from product-based care to service-based care won’t happen overnight; however, the tides are beginning to turn thanks in part to new models designed to enable pharmacists to take control of their careers and practice quality patient-centric care.

By focusing squarely on the patient and delivering clinical services without the business distractions, pharmacists are beginning to recall the reason they chose this profession in the first place.

As a pharmacist myself and someone who has been at the forefront of driving practice change, I wholeheartedly understand the pursuit of achieving provider status, yet also am aware of the challenges of such a pursuit. New services such as immunizations and medication therapy management within the pharmacy setting has often times added additional layers of complexity as pharmacists juggle the delicate balance of integrating clinical services into traditional dispensing environments, while being forced into performance metrics set forth by corporate entities.

A New Way of Delivering Care, From Anywhere

As society shifts to cope with the global pandemic, previously existing models that drove adoption of personal delivery of care outside of pharmacies are taking shape. Opportunities for pharmacists to work with patients must also evolve to account for remote deliveries of care and telehealth models. And consumer demand has arrived.

McKinsey & Company COVID-19 consumer survey

, consumer adoption of telehealth has skyrocketed from 11% of US consumers using telehealth in 2019 to 46% of consumers now using telehealth to replace canceled health care visits.

McKinsey’s survey also found that approximately 76% of consumers are highly or moderately likely to use telehealth in the future. Seventy-four percent of people who had used telehealth reported high satisfaction.

Beyond simply meeting patient demand, pharmacists are identifying alternative models of care delivery that bring them closer to patients whether they are associated with a brick and mortar location or not, choosing to adopt an individual practitioner approach to delivering care. For this precise reason, emerging models of telehealth that enhance the pharmacist-patient relationship and create longitudinal relationships are needed more than ever before. 

For patients with complex and chronic conditions taking multiple medications, one-on-one conversations with their pharmacist are critical for ensuring medication understanding and adherence.

It is through these longitudinal relationships that consistency of care and awareness of the patient’s socioeconomic conditions can be established. It is only then that potential barriers to care are likely to be identified, and the pharmacist can treat the patient to drive the most favorable patient outcomes.

What if patients could be intelligently matched with clinical pharmacists based on a multitude of key social and clinical factors? With the right technology, they can. Matching patients to pharmacists based on condition-specific expertise, for example, can increase the likelihood for patient adherence and successful medication management.

By furthering the use of new technology and increasing the use of data mining we can identify both ideal matches for patients and their pharmacists—as well as their responses to those clinicians who drive quality of care over time to build the best relationships and patient loyalty and affinity toward their health plan.  

For the first time, care and outcomes will be measured at the clinician level. Today, pharmacists work behind another brand. Now, pharmacists can cultivate their own brand and deliver care as a provider, driving quality and improved outcomes.

As these new models emerge, pharmacists are now able to establish their own panel of patients that they manage over time, acting as a consumer-focused health care provider who provides more value than simply dispensing medication. Now and in the future, pharmacists will be recognized for the care and value they are delivering.

Deviating from quotas tied to dispensing and vaccinations, they’ll evolve into becoming advocates for their patients, improving medication use and driving adherence while creating longitudinal relationships that evolve over time.

By working directly with patients in patient-care environments, pharmacists will continue to establish their own professional practices, ultimately deciding when and from where they want to work. From notable brands such as Facebook and Slack, we have already seen dramatic shifts toward remote-based work, and pharmacy is no different.

As long as pharmacists can remain accessible and connected to their patients, they can reside wherever they choose, working the days and times that suit them and their families. The pandemic has proven that flexible work schedules are needed and if they are not achieved, many professionals have left the workforce in droves.

, of the 1.1 million people who left the job market in September, more than 860,000 were women

. We see the same demand for flexibility here at Aspen RxHealth, which is what drove us to create the largest community of pharmacists in the nation.

By allowing our pharmacists to “step away from the counter,” maintain autonomy over their careers, set their own practice hours, and determine from where they wish to work, we see significant satisfaction level.

As someone who has dedicated my professional life to driving change in pharmacy, I could not be more optimistic. The technology has finally arrived that allows pharmacists to achieve provider-like status and has opened the gates for clinical pharmacists to drive clinical improvements across the health care continuum.

https://www.nytimes.com/2020/01/31/health/pharmacists-medication-errors.html

https://wisconsinexaminer.com/2020/10/05/big-fight-over-drug-pricing-heads-to-the-supreme-court/

https://www.fiercehealthcare.com/tech/telehealth-could-grow-to-a-250b-revenue-opportunity-post-covid-mckinsey-reports#:~:text=During%20the%20COVID%2D19%20pandemic,consumer%20survey%20conducted%20in%20April

https://www.npr.org/2020/10/20/925944351/why-women-are-leaving-the-workforce

Articles

Pharmacists must juggle the delicate balance of integrating clinical services into traditional dispensing environments, while being forced into performance metrics set forth by corporate entities.

Pharmacist Burnout: A Cry for a Transformative Approach to Traditional Pharmacy Practice

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.

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.

 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.

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.

(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.

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.

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 

 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.

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

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.