Tip of the Week: A Business Model for Advanced Pharmacy Services

Business planning includes many components, not just merely generating an idea and hoping it will succeed.

Value-added services are more likely to succeed with the use of business planning tenets. This includes scanning the environment, identifying target markets, developing a plan and timelines, delineating appropriate markers for success, and evaluating the program against those markers you’ve established. This is the case in any setting or situation, and might be especially prudent when examining business opportunities among emerging care models, such as is the case in a patient-centered medical home.

An article in the Journal of the American Pharmacists Association detailed this process with a description of such a model. The authors’ primary objective was to develop a sustainable business model for pharmacist-provided comprehensive medication management (CMM) services in a patient-centered medical home (PCMH). A secondary objective was to evaluate the impact the pharmacist had on clinical and economic outcomes. The authors describe how the interdisciplinary team undertook SWOT analyses and took stock of the greatest needs of patients in developing a model that would work, be accountable to the PCMH, and thrive in a semi-capitated environment.

The practice employed 5 physicians and 2 nurse practitioners, and served more than 20,000 patients. The pharmacist targeted patients with diabetes, lipid disorders, hypertension, congestive heart failure, obesity, polypharmacy, and treatment nonadherence for CMM services. The pharmacist was available for immediate consultation or referrals by appointment 5 days a week. Services provided by the pharmacist were billed as “incident to” physician evaluation and management services codes. Number of patients seen per day, revenue collected from services rendered by the pharmacist, physician productivity and payment, cost avoidance, and health quality metrics were measured to determine the financial sustainability and clinical impact of the project.

The pharmacist was able to see an average of 11 patients per day, which was 72% of capacity. The practice collected approximately $7400 per month for services rendered by the pharmacist. Over 70% of uncontrolled patients showed an improvement in clinical outcomes such as A1C, LDL, and blood pressure.

The project detailed by the authors was successful following careful planning. It included an extensive array of benchmarks for success that could be monitored for improvement, such as the case where the capacity analysis demonstrated the pharmacist could be even better integrated into the process, thereby indicating that workflow and marketing would need to be improved for even greater success.

Business planning includes many components, not just merely generating an idea and hoping it will succeed.

Additional information about medication therapy management and management functions can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. You or your institution can subscribe to AccessPharmacy to access the textbook.

Shane P. Desselle, RPh, PhD, FAPhA, Professor of Social/Behavioral Pharmacy at Touro University California.

REFERENCE

Fabel PH, Wagner T, Ziegler B, et al. A sustainable business model for comprehensive medication management in a patient centered medical home. J Am Pharm Assoc. 2019;59(2):285-290.