Tom Rhoads

New tools and platforms can help pharmacists to support patients.

 lifestyle article featuring technology solutions for the mundane tasks of our lives highlighted a digital talking pill bottle with a light-up cap. Its purpose is to remind you when it’s time to take medicine and to order a refill when you run out.

No longer relegated to the inside pages of 

, medication adherence has gone mainstream, front and center, as we pursue the value equation of cost over quality, post health care reform. Medication nonadherence is a big health and cost problem. Half the 3.2 billion annual prescriptions filled in the United States are not taken as prescribed. Fewer patients with chronic health conditions take their medications as prescribed. The price is high—$105.4 billion in avoidable US health care costs as a result of nonadherence.

Adherence is generally defined as taking medicine the way the doctor prescribed it—the right amount, at the right time, and for the length of time prescribed. As awareness of patient nonadherence and its ramifications increase, most of the consumer technology solutions that have emerged have focused on forgetfulness and seek to resolve the problem through behavioral aids via reminders to pick up filled prescriptions, take medicines, and order refills. The reminders come in the form of text messages, e-mails, smartphone apps, interactive voice reminders, and prizes for self-reporting adherence success.

Reminders make sense if we assume that the patient is completely on board with the course of treatment and, from time to time, simply forgets. But reminders alone fail to address (1) the larger issue of why people don’t take their medicines as prescribed and, perhaps more importantly, (2) the goal of having a common understanding of why they were prescribed and, ultimately, what the prescriber is trying to accomplish in partnership with the patient.

One of our pharmacy customers recently shared an example of a patient routinely returning to the emergency department for treatment of anxiety. The pharmacist identified a pattern: the hospital visits consistently fell a few days shy of the refill date on the patient’s Xanax prescription. Our customer, whose pharmacy includes an aggressive adherence and medication management program, reached out to the patient, engaging her in order to understand the problem. The patient couldn’t afford transportation to the pharmacy, so she was trading a handful of Xanax for a ride. The solution was home delivery. The patient hasn’t returned to the hospital since. These patient-centered types of solutions are not resolved through a one-size-fits-all technology.

Why People Don’t Take Their Medications 

Reasons for not taking medications are as complex and individual as each patient. Cost clearly influences adherence, with more people taking medicines when insurers eliminate or reduce prescription co-payments. But eliminating out-of-pocket costs alone is not enough, according to a recent study showing nonadherence rates of up to 40% among patients covered by health plans with no prescription co-payments.

 Other factors influencing a patient’s decision to take medicines as prescribed include religious and cultural beliefs; family dynamics such as a negative outcome for a relative who took a similar medication; health literacy; financial constraints; transportation; geography (where they live); and lack of coordination of care across the patient’s health team.

We know that if patients take their medications, it leads to better health, which ultimately requires less care. Achieving medication adherence means engaging with patients along their journey and aligning pharmacy services and support with their lifestyles. As part of our technology development, we conducted a series of focus groups among individuals aged 30 to 60 years and 60 years and older who either take multiple medicines daily or are caregivers for someone who does. When participants talked about “forgetting” to take their medicines, it was often the result of changing their routines for travel, eating out, or needing to take a pill with food at a time when eating wasn’t convenient.

As important as understanding why people don’t take their medications is the need to understand what motivates some to stick with a treatment plan. When we asked participants why they adhere to their treatment plan, we heard the following reasons: to be independent, to be able to work and continue enjoyable activities, and to be there for others who are important to them. These are among the reasons why pharmacists are seeing considerable success when they incorporate pouch packaging into their adherence programs for patients taking multiple medications. Packaging the medicines by time of day gives patients independence—it’s easier to tuck a pouch into a pocket or purse than to lug a bag filled with pill vials. And patients say it helps reduce the stigma of being viewed as a person with an illness; in fact, it helps them feel less sick and empowers them to get on with their lives. Since patients typically frequent pharmacies more often than any other type of health care facility, the “high-touch” environment of the pharmacy is becoming a popular place for reinforcement and review of medication action plans. What better place to close the touch gap?

Understanding patients and their health care goals, beliefs, and challenges expands how we define and view nonadherence. “Adherence implies mutual engagement on the part of the provider, the patient, and their caregiver that results in consensus regarding the patient’s treatment regimen.”

 Shifting our thinking to center on the patient and how community pharmacists can enable and support self-management of health and illness calls for technology that positions pharmacists to discuss the goals and fears of patients and how pharmacists can best align their services and support to achieve maximum wellness. Programs that have made adherence a priority, including Geisinger Health System and Group Health Cooperative, leverage information technology and patient-level data to understand patients’ attributes and then tailor interventions to those attributes.

Health Information Exchanges: Sharing Information

For decades, community pharmacists have been patients’ trusted advisors and easily accessible without an appointment. Now, technology must elevate the pharmacist’s role among health care providers by connecting pharmacists to health information exchanges for fast, secure communication of vital medical information. Key information tracked at the pharmacy, such as a patient’s refill record, medication possession ratio, or patient interaction notes, should be shared with the rest of the care team. Technology must leverage that accessibility and become an extension of the pharmacist’s clinical thinking, enabling medication synchronization, prompting intervention for at-risk patients, and plugging into other providers’ patient scheduling capabilities.

Today, we have dispensing automation technology that aims at driving efficiencies behind the counter to allow pharmacists to be out in front, counseling patients to promote positive health outcomes. Emerging medication therapy management workflows and telepharmacy solutions will extend the pharmacist’s reach to patients—including those who never set foot in the pharmacy&mdash;to provide remote counseling and medication therapy management. Pharmacy dispensing processes are beginning to evolve from a drug-oriented process (each bottle filled on its own&mdash;independent, for all intents and purposes, of the others) to a more patient-oriented process with batched monthly fills, often scheduled in accordance with the patient’s desires and touch points, with a concurrent review to ensure that the whole regimen makes sense for the patient. Now available are adherence solutions that incorporate pouch packaging and dispensing to support patients in maintaining active, independent lives while managing their wellness and illness. And we have technology platforms that can identify and prioritize patients, schedule fill times and patient meetings, and even assist with tracking patient care.

In addition to changing the way medications are distributed, the associated medication management services and the manner in which those adjunctive services are delivered are being driven by more sophisticated analytics. By leveraging technology and predictive modeling to identify patients at the greatest risk for nonadherence and downstream medical events, pharmacists can target those patients for counseling and follow up for a strong value proposed to payers.

 Engaging with those patients to understand their health goals and obstacles to adherence offers the greatest return on patient outcomes, population health, and overall health care costs.

As nearly 10,000 US adults turn 65 years of age daily, aging with independence at home will increasingly be a lifestyle of choice—and of financial necessity. In-home monitoring solutions are seeing explosive increased demand. Imagine in-home medication management technology that serves as the 2-way connection between the patient and the pharmacist as the touch point for the larger health care team. What if that technology lets the pharmacist know in real time that a critical medication was taken in the morning, but skipped at noon?

That information could trigger real-time engagement with the patient—was it nausea? Maybe he was feeling better and decided to skip a dose. There’s the opportunity for the pharmacist to talk with the doctor, perhaps suggesting another option. Or it might create the opportunity for the pharmacist to help the patient understand what he is taking and why, what might be making him feel too sick to eat lunch, and what he can expect to have happen if he continues to skip doses. These types of solutions are not too far off from becoming mainstream, scalable, and affordable modalities of in-home monitoring.

We’re not there yet, but community pharmacists are on the right path in leveraging technology to support patient engagement. Every patient is on a journey, and the challenge is for pharmacists and all members of the health care team to collaboratively understand and engage them in the self-management of their medications and health. 

Tom Rhoads is chief executive officer of Parata Systems, a leading provider of technology solutions to support coordinated care, better health outcomes, and lower medical costs, empowering pharmacists to grow their businesses. Over the last year, Rhoads has convened a number of regional Innovation Summits, facilitating an industry dialogue among pharmacists and other health care providers focusing on the role of pharmacists and technology solutions in a value-based health care system.

Rhoads’ previous experience in the health care industry includes Baxter Healthcare and Cardinal Health Corporation. He is a graduate of Duke University, and holds an MBA from The Citadel. He serves on the Pharmacy Times advisory board, is a member of the North Carolina Technology Association, and the Chief Marketing Officer Council, and is an Iron Duke alumnus of Duke University. He also represents Parata with numerous pharmacy industry organizations, including the National Association of Chain Drug Stores and the National Community Pharmacists Association. Parata and Pharmacy Times are partners in the Next-Generation Pharmacist

 Awards, the national program recognizing pharmacy innovation and leadership, which entered its fifth year in 2014.

		Avoidable costs in US healthcare: the $200 billion opportunity from using medications more responsibly. IMS Institute for Healthcare Informatics. July 2013.

		Cutler DM, Everett W. Thinking outside the pillbox—medication adherence as a priority for health care reform. 

		Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: its importance in cardiovascular outcomes. 

		Williams AB. Issue brief: medication adherence and health IT. The Office for the National Coordinator for Health Information Technology. January 9, 2014.

Articles

New tools and platforms can help pharmacists to support patients. 


Using Technology for Patient  Engagement: Are We There Yet?

Big changes in pharmacy technology will affect the ways that pharmacists communicate with patients and health care providers.

Meet Dave. He has hypertension. His doctor monitors his adherence with information transmitted by an ingestible sensor in his medication.

The sensor, about the size of a grain of sand, transmits a signal to a patch on Dave’s stomach. The patch contains another sensor that monitors his heart rate, body position, and activity level. It communicates data from both sensors to his smartphone via Bluetooth. The information also goes to a pharmaceutical company to help researchers better understand how Dave takes his medication and how his body responds to it.This product just secured approval by the FDA and is one of many innovations under development that would support health care providers in their efforts to improve health outcomes and lower medical costs. It also forecasts big changes for pharmacy technology in a coordinated care health system.

Here’s a look at key functions pharmacy fulfillment systems must incorporate to support high-tech, high-touch health care delivery.

 For decades, community pharmacists have been accessible members of a patient’s health care team. Now, technology must elevate the pharmacist’s role to the level of other health care providers by connecting them to health information exchanges (HIEs) for fast, secure communication of vital medical information, such as continuity-of-care documents. Key information tracked at the pharmacy, including refill records, medication possession ratio, and patient interaction notes, should be pushed to other providers involved in a patient’s care via HIEs.

 Pharmacists have a key ingredient that motivates patients to make good choices: trust. They are second only to nurses in Gallup’s annual poll that ranks the most trusted professionals in the country. And unlike doctors’ offices, where patients work around physician availability, pharmacists work on patient timelines. Technology must leverage that accessibility and become an extension of the pharmacist’s clinical thinking, enabling medication synchronization and multi-dose packaging of medications the way people take them: by date and time of day, prompting intervention for at-risk patients and plugging into other provider-patient scheduling capabilities. Additionally, innovations in telemedicine can create a lifeline between pharmacists and patients to provide remote counseling and critical medication therapy management. It also brings the added benefit of balancing workloads across multiple pharmacy locations to maximize labor efficiency.

 For decades, pharmacy technology has automated the “count, pour, lick, and stick” process and eased verification to free time for pharmacists to counsel patients. Now, it must ensure that pharmacists have the time and the tools to communicate with other health care providers and provide high-touch, high-value patient services that promote positive health outcomes. The integration of robust pharmacy robotic systems with information technology platforms is enabling pharmacists to strengthen their patient value proposition while anticipating emerging technology, such as Dave’s ingestible sensor.

To get there, pharmacy technology innovators might think of the pharmacist as the conductor in the symphony of a patient’s medication management regimen. Technology systems must empower pharmacists in that role—connecting them to each of the health care providers who work with them&mdash;and easing the exchange of vital, relevant medication information with patients to support outcomes-based care.

Tom Rhoads is chief executive officer of Parata Systems, a leading provider of technology solutions to support coordinated care, better health outcomes, and lower medical costs, empowering pharmacists to grow their businesses. He recently convened Parata’s inaugural Innovation Summit, a 2-day industry leadership idea exchange on pharmacy, technology, and evolving health care partnerships.

Rhoads’ previous experience in the health care industry includes Baxter Healthcare and Cardinal Health Corporation. He is a graduate of Duke University, with an MBA from The Citadel. He serves on the

Advisory Board, is a member of the North Carolina Technology Association, and the Chief Marketing Officer Council, and is an Iron Duke alumnus of Duke University. He also represents Parata with numerous pharmacy industry organizations, including the National Association of Chain Drug Stores and the National Community Pharmacists Association. Parata and

 are partners in the Next-Generation Pharmacist

 Awards, the national program recognizing pharmacy innovation and leadership, which is entering its fifth year in 2014.

Not Your Parents' Pharmacy Fill System: High-Tech, High-Touch

Pharmacists can drive results related to adherence by offering patients new services and solutions.

Pharmacists are among the most trusted professionals in the country, but until the recent focus on adherence they haven’t been getting paid for it. Gallup regularly polls Americans on how they rate the honesty and ethical standards of people who work in various professions, and pharmacists consistently take one of the top 2 positions.

Pharmacists have long been patients’ trusted advisors, a virtual “information desk” on all matters related to drug therapies, nutrition, and wellness. They are easily accessible, don’t require an appointment, and patients know that they care about health outcomes. Yet pharmacists were conspicuously absent in shaping the Affordable Care Act (ACA) that is transforming how we do business in health care.

It is a dynamic we’ve seen before. Ten years ago, American politicians debated making drugs more affordable for consumers, and some encouraged patients to travel to Canada—even busing them across the border to get them to pharmacies there. Many patients brought home drugs with the same name as the one their doctor prescribed, but manufactured with different strengths or used to treat other conditions. American pharmacists picked up the pieces, counseling patients on drugs they didn’t dispense.

And pharmacists, for all their long hours and hard-won victories on the front lines of patient care, seemed to take all of this in stride. So as health care providers apply the provisions of the ACA and shift their focus to adherence as a key driver of patient health, it’s no surprise that people are turning, once again, to the trusted professionals in white coats behind the pharmacy counter to help make things better.

Independent pharmacists are uniquely positioned to drive results related to adherence. Their intense focus on personal relationships with patients comes naturally. It is their passion for helping people that inspired them to pursue pharmacy. That focus is also the key to driving patient outcomes with adherence programs.

When we founded Parata 12 years ago, our early customers were independent pharmacists who were eager to adopt technology that would change the way they did business and allow them to spend more time with patients. Today is no different, only now we work with thousands of pharmacies across all market segments—national and regional pharmacy chains, military, institutional, hospital, and community pharmacies.

So it hasn’t been surprising to us that independent pharmacists are the ones quickly stepping up to adopt technology that will enable them to impact adherence. As we work with them, we offer this advice for growing their businesses with adherence programs:

Look at your product and service offering.

 The health care game is changing. It’s time to develop a smart strategy. Independent pharmacists already provide great service; it’s their sweet spot. But when they turn a complex problem like a bag of prescription vials into a simple solution, like a strip package with a patient’ s daily medications collated by date, time, and dose—now that's a game changer.

Entrepreneur and author Seth Godin calls such a product the “purple cow in a field of brown cows.” It’s a product that can make a pharmacy stand out in a crowd of other excellent pharmacies because it’ s remarkable and worth talking about.

Another high-value offering is medication therapy management (MTM). Recent US House and Senate bills would increase the number of Medicare Part D beneficiaries who qualify for one-on-one counseling sessions with a licensed pharmacist to include any patient with a chronic condition. So MTM is about to get more profitable for pharmacies who have the time to provide it.

 For most pharmacies, 10% of their patients account for about 50% of their revenue. They are the chronically ill patients who take more than 5 medications a day. They’re also the patients payers are targeting for fast savings. It’ s critical for independent pharmacists to retain those high-value patients with adherence products and services that make it harder for them to walk out of their pharmacy and into another one down the street.

Considering that almost half of consumers use more than 1 pharmacy, and strip packaging aggregates prescriptions, pharmacists who use it can grow their business and have a greater impact on patient wellness with increased visibility. They also can create a built-in refill program and pick up an extra fill a year, since most patients don’t refill on time.

Simply follow the money to identify the providers who make the best partners; they are the ones who have the most to lose on hospital readmissions. They are ACA’s target to bring health care costs under control. One in 5 Medicare patients are readmitted to the hospital within 30 days, costing taxpayers $17 billion a year. On average, half of those patients do not take their medications as prescribed.

Hospitals place high value on health care providers who help them prevent readmissions and bring costs down. Physicians started half of the Medicare-approved accountable care organizations (ACOs), which are provider partnerships that tie reimbursements to patient health outcomes and successful cost reduction measures.

Smart pharmacists are working with insurance companies, physicians, employers, and home health care agencies to target entire patient populations, like a virtual ACO. When a pharmacy provides a service or product that makes it easier for patients to adhere to medication regimens, the pharmacy becomes a valuable partner for other health care providers seeking to contain costs. We’ve heard from several of our customers who were delighted when insurance companies called them to report that their dispensing fees would increase because they were using strip packaging.

The pharmacies that can account for measurable impacts on patient health outcomes will emerge as industry leaders in the next 36 months. Many schools of pharmacy are interested in partnering with health care providers to measure the impact of medication therapy changes. Bob Lomenick, owner of Tyson Drug Company in Holly Springs, Mississippi, is a Parata customer who uses strip packaging as the cornerstone of his adherence program. He’s working with a research team at the University of Mississippi School of Pharmacy to track outcomes, with great results. Bob not only secured his patient base, he doubled his prescription volume within 1 year of offering the product. Now, he’s engaged with an insurance company to prove outcomes and capture thousands of patients.

Health care is changing fast. At Parata, we’ve seen these changes on the horizon and made big changes of our own to respond to them by preparing our team to become consultants to pharmacists who want to grow their businesses and succeed in the next generation of health care. We’ve brought on a team of industrial engineers who are Six Sigma Lean certified in health care to help pharmacies optimize their labor and work flow processes and get more for their automation investment. We’ve also raised the bar on technical support training, so we can help busy pharmacies resolve issues in minutes over the phone, for maximum uptime.

It’s our passion. We want to see pharmacists get paid for keeping patients healthy. It’s what has inspired them since pharmacy school. No wonder they are among the nation’s most trusted health care professionals.

Tom Rhoads is chief executive officer of Parata Systems, one of the nation’s leading pharmacy automation providers. For more information, visit www.parata.com. Parata has partnered with

 awards program, now in its fourth year. For more information, visit www.nextgenerationpharmacist.com.

Adherence: A New Strategy for New Times

Saving time and improving safety benefit the pharmacy and the patient alike.

It’s easy to get caught up in the excitement surrounding new technology. From electric cars to 3-D televisions, yesterday’s science fiction is popping up faster than ever in our living rooms, driveways, and offices.

For years now we’ve heard the buzz about robots in the pharmacy—which is promising, to be sure. But in the real world, promising is not quite enough to pay for the privilege of changing the way you operate. Just as with any business decision, there has to be a solid case for investing in pharmacy automation. These aren’t the kinds of “shiny objects” that you purchase on a whim.

In fact, the most important factor in determining the value of a robotic system isn’t the system itself. It’s the valuable byproducts it can create—time and safety.

This is why we challenge our pharmacy partners to look past the technology investment and answer these 3 questions:

		What percentage of total prescription dispensing can be lifted from your staff?

		How much “touch time” is required to maintain performance?

		What can you do with the time saved to improve profitability?

It’s best to start at the end and work backward. If a pharmacy’s leadership doesn’t have a strategy for growth, there won’t be enough incentive, or focus, to develop good answers to the first 2 questions.

From my perspective as a pharmacy automation developer, I saw firsthand how the early days of automation were rife with big excitement and wild claims. As an industry, we have to acknowledge that we didn’t always live up to the hype. Automation had a lot of potential. But without a big picture understanding of how to integrate this tool into the overall pharmacy work flow—or how to help employees make the transition&mdash;automation remained an idea that was a little ahead of its time.

Many pharmacists remained unconvinced about the value of automation. Pharmacist Abe Hutto, the owner of LAB Discount Drugs in Waynesboro, Mississippi, is emblematic of the mindset, saying: “I looked at robotic dispensing solutions for about 4 years” before taking the plunge. He’s also a perfect example of the many pharmacists who discovered the wait was worth it. In the intervening years, the technology has improved dramatically and the business case can now be supported by predictable, validated outcomes.

		In a pilot program recently undertaken by Rite Aid, the retailer implemented next-generation automation and achieved an incremental labor savings of 11% within the first 90 days. At United Supermarkets in Lubbock, Texas, an upgrade to next-generation robotics at 2 of its 43 stores achieved utilization rates near 50%.

		Some independent pharmacy owners are reporting that customer wait times dropped from 15 minutes to 5 minutes. They are cutting back on restocking and replenishing, no longer having to submit the same order every couple of days.

Clearly, the chatter around automation is changing. Always pushing forward, pharmacists set the bar high for their expectations of automation providers. And it took a few years—and a few hard knocks&mdash;to catch up and deliver consistently on the promise. Today, our conversations have moved beyond “What can it do?” and “Will it work?” to focus on the real heart of the issue: “How much time will you save, and what can you do with that time?”

With staff time savings running up to 50 to 60 hours a week, or more, options abound.

Abe Hutto’s answer: “We do home IV infusion, so now 1 technician can be dedicated entirely to that service. We’re going to focus a little more on medication therapy management, and get into things like weight control and healthy lifestyle programs, now that we have the time to do so.”

Wiley’s Pharmacy in Strasburg, Pennsylvania, works with a lot of assisted-living facilities, and automation has strengthened that business. “We were finding that accrediting organizations were pushing long-term care facilities to move to a more organized and distinctive system,” Stephen Wiley says. “Our strip packaging automation gives customers a safer, more effective distribution method.” Wiley also noted, “We won’t need to add additional staff as we grow, and we won’t have to replace anyone.”

From larger players like Rite Aid and United Supermarkets to smaller independents, the focus is on customer service and basket size. But in an era of thinning margins, pharmacists don’t have the opportunity to add resources to accomplish more—they have to find ways to do more with less. So, pharmacy leaders at all levels are pursuing competitive advantages anywhere they can find them, whether by diversifying, differentiating, or streamlining. All of these strategies share 1 common requirement&mdash;time. Staff time to dedicate to higher-level, higher-value activities, to support sales, or to simply do more with the resources available.

One concern pharmacists shared is how staff will react to automation. When things go well, automation is often a technician’s best friend. In surveys of team members before and after the United Supermarkets launch, for example, satisfaction scores went up dramatically, including a 72% increase in the perceived value to daily pharmacy operations.

Abe Hutto is even more direct: “My staff would quit if I got rid of automation! It just takes away the burden and removes the drudgery and busywork. It makes life much easier.”

Time for What Matters Most: Customer Care 

What it ultimately comes down to is being able to offer better service. For many pharmacies, “face time” with customers is how they distinguish themselves, and how they grow. Automation gives them more time to focus on patients.

Cary Fischer, certified pharmacy technician at Lock Drug in Bastrop, Texas, has seen what a difference the personal touch can make. “I just got a thank-you card for helping my customer with a prescription she’d been working on for a year; she was almost in tears. I couldn’t provide that kind of service if I handled all our prescriptions.”

So, has the time finally come for pharmacy automation? Based on what we’re seeing, pharmacy’s answer is an emphatic “Yes!” I hear regularly from pharmacists who recognize that to be competitive over the coming years, they’ll have to have robotics—and they’re telling their peers to get on board. Abe Hutto also advises others to act soon. He says, “If a pharmacy is doing 175 scripts or more a day, it’s time to look at automation.”

Tom Rhoads is chief executive officer of Parata Systems, a Durham, North Carolina—based pharmacy automation provider and partner with 

Saving time and improving safety benefit the pharmacy and the patient alike. 