There Has Never Been a Better Time To Be a Pharmacy Leader
Service opportunities and increasing demand for a highly skilled workforce as driving innovation.
PANDEMIC-RELATED OPPORTUNITIES ABOUND
COVID-19 booster shots are here, and along with them are administration opportunities for influenza, pneumococcal, and other vaccines. Testing is back in full force, with a need to cover COVID-19 as well as influenza and strep as we near the "cough and cold" season. At least 1 state (Arkansas) has now authorized pharmacists to prescribe and administer monoclonal antibodies to treat COVID-19 early in the community, and this can be added to the ever-growing "test and treat" services, with authorizations percolating across the country.
Beyond the pandemic but related to the public's new realization of pharmacy as an untapped access point for screenings, referrals, and medication therapy management services, there are hemoglobin A1C, mm Hg, and other clinical measure-related, value-based contracting opportunities sprouting everywhere.
SERVICE DELIVERY REQUIRES ADDING ROLES TO THE COMMUNITY PHARMACY PRACTICES
Community pharmacy generates billions of prescriptions each year, and the mechanics of the supply chain movement, prescribing, and filling of medications is remarkably efficient. However, therapies for patients often remain ill coordinated and suboptimal regarding the proper selection of drugs for various conditions, potential drug-drug interactions, and the administration of the drug by a health care professional or the patient. With the advent of new services—including delivery models for optimizing medication use as well as screening, testing, and vaccinating—pharmacies are accessible and willing service providers but often have not made the infrastructure changes necessary to accommodate such developments.
Services generally require that appointments are both efficient and effective, and call for different documentation for both billing and effective longitudinal care delivery. New services also require workflows and processes that dispensing does not, and challenges can include different billing requirements and more prevalent no-shows. These services also tend to require more preparation to be ready to serve the patient.
Additionally, services such as dispensing require nonpharmacist staff to engage the patient prior to the visit, prepare for the visit itself, and communicate follow-up instructions. In the instance of vaccinations and testing, nonpharmacist staff also frequently provide the actual service delivery under a pharmacist's supervision. These are all tasks that pharmacy learners (students, fellows, residents, and others) can learn while developing or improving the pharmacy's overall efficient and effective delivery.
To run a successful services-based pharmacy, observing a physician practice can be instructive. First, all practices have a practice management system where patients are scheduled, prereened, and billed for medical services. Pharmacies are beginning to adopt physician-like practice technology solutions, such as online scheduling, booking staff devoted to service delivery alongside those schedules, and learning the ins and outs of non-dispensing-related services billing. Nearly every physician practice has an office manager for a reason.
As with dispensing, interactive voice response and other outreach and follow-up technologies have been adopted in physician clinics. Yet pharmacy has even greater opportunities to engage the patient since they are the most frequented setting of care. Having a screening system both in the pharmacy and with delivery or courier services is a next-level pharmacy capability. Which patients are at risk for low adherence? Which patients screened for high blood pressure do not have a primary care physician? Which patients need depression screening? Which patients have been discharged recently and need medication reconciliation? Which patients need home delivery? Video look-ins for the pharmacist when patients are at home also present many opportunities. Finally, when patients are identified for all these services, who is responsible for the patient experience, scripting of messaging, and coaching of staff?
Effective and efficient services are impossible without the appointment-based model, even if those services are based on screening and acute intervention. The walk-up model of pharmacy workflow remains necessary but is outmoded by new dual "front of house" and "back of house" workflows. Front of house workflows cater to the transient patient who makes an unplanned visit or has little fidelity or patronage to the pharmacy. Back of house workflows cater to the patient with a longtime relationship with the pharmacy who now has the ability to walk in for services when needed but also has access to scheduling and dispensing services, in addition to specific pharmacist practitioners as a "patient of the practice." Who is responsible for setting up and making improvements to this "back of house" workflow? Has the pharmacy synchronized medications yet? Can they add more patients to the synchronizing services? Are those appointments connected to the online scheduler and public website? What additional services is the patient eligible for, served by, and billed for when they pick up their medications?
BECOMING A "POSITIVE DEVIANT"—GOOD FOR YOUR RESUME, EVEN BETTER FOR THE SOUL
Today's pharmacy learners have the chance to see and participate in multiple settings of care and multiple versions of those settings. In the thousands of community pharmacies across the country, the pandemic has catalyzed and amplified the adoption of services and workflows previously left to the leaders and luminaries of the profession. Now these services are workflows are becoming more mainstream. However, most pharmacy personnel have yet to participate in such activities and workflows. This gives pharmacy learners the opportunity to be that "positive deviant"—learning established practice staples necessary for safe, efficient, and effective dispensing, while also helping to implement new best practices related to service delivery.
Troy Trygstad, PharmD, PhD, MBA, is vice president of pharmacy and provider partnerships for Community Care of North Carolina, which works collaboratively with more than 2000 medical practices to serve more than 1.6 million patients who are on Medicaid, Medicare, commercially insured, or uninsured. He received his PharmD and MBA degrees from Drake University and a PhD in pharmaceutical outcomes and policy from the University of North Carolina. He also serves on the board of directors for the American Pharmacists Association Foundation and the Pharmacy Quality Alliance.