Michele Belcher, president of the National Community Pharmacists Association, and pharmacist and pharmacy owner at Grants Pass Pharmacy, discusses ways of transforming the pharmacy profession’s current challenges into opportunities for positive change for the profession.
Pharmacy Times interviewed Michele Belcher, president of National Community Pharmacists Association (NCPA), and pharmacist and pharmacy owner at Grants Pass Pharmacy in Grants Pass, Oregon, on ways of transforming the pharmacy profession’s current challenges, which are largely driven by the COVID-19 pandemic, into opportunities for positive change for the profession.
Alana Hippensteele: So, Michelle, what are some of the greatest challenges pharmacists are facing today?
Michele Belcher: I would say that, certainly, first and foremost, the reimbursement challenges that every pharmacy has faced, even pre-pandemic, existed—whether it's the [direct and indirect remuneration] fees, certain states have additional taxes, Oregon has undergone what's called a [corporate activity tax] that is based on your revenues, and that has certainly led to some significant regional chain pharmacy closures that we can discuss further later.
But I think that what we have seen during the pandemic is the staffing burdens that are happening across the country universally, and this is especially significant in the availability of adequately trained technicians. So, what we're seeing is a tremendous shortage of technicians, and in many states along the West Coast where we have a higher minimum wage, that has really skewed the technician wages, and we're having to pay so much more than I think we ever have before to be able to find good staff.
Alana Hippensteele: Yeah, absolutely. I can imagine those challenges are causing some problems. Nearly every pharmacy that participated in COVID-19 vaccinations, COVID-19 testing, or other COVID-19 related services adopted a scheduling system to coordinate vaccinations. Is that a significant evolution for pharmacy practice and workflow or just a flash in the pan related to the pandemic response?
Michele Belcher: Many colleagues were using some type of a scheduling platform hire that I would say most of us have embraced that as a necessity during the pandemic if you were vaccinating. What I think that we have seen is that our patients loved having that ability to be able to come in at a set time and were thoroughly impressed when you were running—just like any medical office—on time and were respectful of their time that they had allotted.
So, I absolutely see this is something that we will continue to have not only for vaccinations, but we're using that for our smoking cessation and other clinical services that that we are doing. I think that we will always try to offer a walk-in ability for our patients as well. But it's trying to balance that, and I think that having an appointment-based model really allows that flexibility.
Alana Hippensteele: Right, that makes sense. The Federal Retail Pharmacy Partnership led to the CDC attempting to roll out a national registry for immunization administrations for the first time. What happened to this rollout and was it successful?
Michele Belcher: Unfortunately, it was not successful. I don't know where that fell down, unfortunately, at the CDC level, but I think that it's something that we would like to see in the future. The benefits, I think we can all say, would be tremendous, but at this point what occurred was that each of us in each of our respective states were entering into our own state’s systems.
Alana Hippensteele: Right. Has COVID-19 lead to more information sharing among care team members?
Michele Belcher: Absolutely. I think that it gave opportunities for pharmacists to engage with colleagues, whether it was public health, whether it was your other prescriber partners, and have that opportunity to be a resource for them on what was happening at the pharmacy level.
So, I know that I continue to be on weekly calls, whether it's with public health or physician partners, that want to have that input on a continued basis on what's happening at the pharmacy level. So, I think that that was a tremendous opportunity.
Public health especially—I think what was realized is that, in the independent pharmacy realm, we were used to being problem solvers and we could help solve the problems, whether it was to get a particular population their vaccine quickly—and that was one of my first engagements with public health further back when the vaccine first was rolled out—and to be nimble enough to be able to make that not only the answer, but solve the problem and deliver it to the patient level within days. So, that's something that has been recognized in communities, states, and federally in ways that we never had anticipated.
Alana Hippensteele: Right. What are 1 or 2 technologies that are essential for community pharmacy practice and sustainability that was not the case before COVID-19?
Michele Belcher: So, I think, as we talked about before, I would say some type of a scheduling platform and integration with being able to put your own forms and information pieces that you want accessible to your patients, so I see that as continuing and evolving into what we specifically want that to be and how that best integrates with our pharmacy management systems.
Second, is an EHR, or electronic health record—I absolutely think is going to be a necessity for any pharmacy that wants to have the ability to bill on the medical side and be paid like other providers.
We don't need to reinvent the wheel—providers have been billing. So, if we're wanting to be recognized as providers, we need to document and bill to payers in that same fashion.
Alana Hippensteele: What are some other technologies that could potentially be implemented, maybe off in the future, that would help pharmacists save time and better coordinate care?
Michele Belcher: Choosing your technology partners is going to be crucial—the right technology partners. When I'm looking at a partner that will connect with EHR and goes beyond just medication management—I think that that's important. When we look at population health and the management of those patients, I think that's going to be integral in how that connects our payers, and that really is going to happen through that electronic health record.
So, I would say then the last piece would just be that we need databases that are going to continue to help us show and support the value-based care model.
Alana Hippensteele: Right, absolutely. What are some new clinical services that could be initiated to generate alternative revenue streams for pharmacies?
Michele Belcher: So, Grants Pass Pharmacy has really looked at expanding our clinical services and taking the opportunity to bill as the provider. We have made sure that myself and my other pharmacists are out in the community working with the payers to be able to set up any opportunity that we have.
We’re providing COVID-19 tests, the COVID-19 vaccines, and we've also worked on tobacco cessation, prescribing of hormonal contraceptives, and then really looking at vaccine assessment as a way to also build something that we've all been doing, but not billing for that on the medical side.
So, things that we talked about with one of our [coordinated care organization (CCO)] partners here in our community is where we want to move towards in disease state management, whether it's diabetes or high blood pressure, and I think that we have a real opportunity in these, working with that same payer, that's a CCO here in the state, but based in our community, I've become the first credential pharmacists that's in-network with them.
So, it certainly leads to my hope that those pharmacists are going to look at the necessity, like other providers, to become credential within different payer networks. So, it's been an exciting time here at our pharmacy.
Alana Hippensteele: Absolutely, what are some strategies that could help to shift pharmacy workflow practices from reactive to proactive workflow models?
Michele Belcher: I think that first and foremost, and we've seen this here at our own store, is that synchronization has got to be maximized. To be able to make an effective workflow, with especially the shortage of technicians, we need to make sure that the time that is spent in each aspect of workflow is being the most efficient that it can be. So that's where we really had to—and are continuing to—evaluate that workflow, and making sure that our synchronization is maximized, making sure that each step along the process is being as efficient as possible, because that's what frees up the time to be able to provide the clinical services and the expanded responsibilities that your technician and your team is taking on to provide those services.
So, I think that making sure, again, that you're choosing, in our case, a documentation platform that would enable us to capture all the data that we wanted, to make sure that we're being paid at the maximum amount possible—so that's where we, in our case, we felt that we did need to go outside of just a care plan, and the SNOMED codes to go into a true EHR where we're looking at the [current procedural terminology] and [evaluation and management] codes.
Alana Hippensteele: Right. What are your hopes for the future of the pharmacy profession following the struggles of the COVID-19 pandemic?
Michele Belcher: I think that my biggest hope for our future is that we take the opportunity to embrace the recognition and the acknowledgement by not just our communities, but the public health, in the services that we are able to provide, and how independent community pharmacy, again, is able to be so nimble and change and provide services that may be unique to certain populations or to certain communities.
I hope that within that, it's going to give us the opportunity to potentially provide further clinical services that will allow us to be paid on that medical side, and these are services that many times we have been providing, certainly within the vaccination, consultation, assessment, and delivery. This is something now that we can make sure, if you are choosing your partners correctly, that you can build and be paid for.
So, my hope is that we embrace this and there's a lot of changes that happen. In fact, I just got off of a [Community Pharmacy Enhanced Services Network] call just before this, and where we're talking about that it is a change in workflow, it is a change in where the time is spent, but the value that will come out of this, in terms of, I think, the rewards as a pharmacist, the rewards financially to be able to sustain your pharmacy are immense.
So, that's one of my biggest hopes and I think that as we move towards provider status, not just state to state right now is what we're seeing, but if we eventually are able to achieve the provider status at the national level as well, we have tremendous opportunities then, also for reimbursement.
I think that pharmacists need to start looking and thinking about credentialing if they aren't aware of what they need to do to become credentialed with the payers in their state or communities. They need to start educating themselves on that, because I think that's going to be an important part as well.