I had the privilege a few years ago to be the program director for a Centers for Medicare & Medicaid Services demonstration project that sought to pay pharmacies for incorporating care management functions into pharmacy workflow in coordination with primary care across hundreds of pharmacies for a per-member, per-month payment. These days, such types of programs and arrangements with payers are commonplace with medical providers but are only now reaching the shores of community pharmacy practice.

Value-based contracting puts pharmacy providers at risk and reward for screening patients, getting patients to therapeutic goals, and reducing the overall cost of care. It is the future of health care and the only viable path to sustainable community-based pharmacy practice.

One day, I received a call from a pharmacy owner who said, “I get this. It makes sense. I want to do it, and I believe it is the direction we need to go in, but I just do not have the time.”

I responded, “Tell me where you feel like you are spending most of your time.”

He said, “Well, when I call these patients to check in on them—”

I stopped him right there and said, “Time out. You are calling the patient? You need to train one of your staff to do that and then triage to you when they need you.”

PHYSICIAN PRACTICE TRANSFORMATION = PHARMACY PRACTICE TRANSFORMATION
I spent the first 15 years of my career building pharmacy supports around the patient-centered medical home (PCMH) concept, and what I, and the physicians, learned is that clinicians cannot and should not do it all. Pharmacies must have a strong support staff that optimizes pharmacists’ time. Physicians do not reach out to patients to get them scheduled or generally call patients to report an unremarkable lab finding. Nor do they take a medication history or room the patient, and they do not deal with services billing. Why would pharmacists take on these roles?

FLIPPING THE PHARMACY
I have also had the privilege over the past year of directing the Community Pharmacy Foundation– supported Flip the Pharmacy effort, which is intended to be a practice transformation effort akin to the PCMH movement in primary care.The overall goal is to move business and work processes and the skills that go with them from moment-in-time, prescription-level processes to an emphasis on longitudinal, patient-level processes over multiple points in time. One of the 6 domains of emphasis is training and using staff members in a different manner and having different expectations about their daily work.

Pharmacies should ban the term and title pharmacy technician. Technicians put pills in bottles. A pharmacy’s staff requires much more. The term is also unbecoming and misrepresents their value to the pharmacy. At Community Care of North Carolina, we had pharmacy program assistants, formerly called techs, help take medication histories and coordinate communications between care team members for care management functions. Other pharmacies should pivot too.

NEW ROLES
There are plenty of important and new roles a “pharmacist extender” staff member can train in and employ in a pharmacy.
These include the following:
  • Community health worker/social needs expert: Is the pharmacy’s delivery driver being used effectively?
  • Data analyst: runs reports in the pharmacy management system on opioid use and outliers or patients without recorded blood pressure
  • Health screening program manager: ensures that all touch points can be parlayed into improving value-based contracting measures, such as glycated hemoglobin screenings, noninfluenza vaccinations, and even colonoscopy reminders
  • Medication synchronization coordinator: Pharmacies that do not have one may have programs that do not work.
  • Patient engagement expert: calls patients with low adherence and asks what their barriers are
  • Point-of-care-testing coordinator: builds out and reports to the pharmacy manager on, for example, coronavirus disease 2019 testing

Just like physicians, pharmacists cannot and should not do it all. “Techs” want to help. What is good for the goose should be good for the gander.
 
TROY TRYGSTAD, PHARMD, PHD, MBA, is vice president for pharmacy provider partnerships for Community Care of North Carolina, which works collaboratively with more than 1800 medical practices to serve more than 1.6 million Medicaid, Medicare, commercially insured, and uninsured patients. He received his PharmD and MBA degrees from Drake University in Des Moines, Iowa, and a PhD in pharmaceutical outcomes and policy from the University of North Carolina at Chapel Hill. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance

REFERENCE

Flip the pharmacy. Flip the Pharmacy. Accessed July 28, 2020. https://www.flipthepharmacy.com/