Big data and analytics are everywhere—including in independent pharmacy. But is the collected information being used to help with documentation, care planning, and reimbursement?
Pharmacies have come a long way over the past 3 decades in their use of data analytics, according to Heidi Polek, RPh, a pharmacist and strategic program manager at DrFirst, a provider of innovative technology solutions that works with 67,000 pharmacies nationwide. “We’ve grown from doing our own simple paper-and-pencil calculations to being able to choose from a host of vendors and consultants that offer detailed analytics on things that community pharmacies can have a direct impact on, such as prescription abandonment,” said Polek. “With insights into trends like these, pharmacists can more effectively intervene to improve medication adherence.”
Pharmacy expert Lindsay Dymowski, CEO of Centennial Pharmacy Services in Philadelphia, Pennsylvania, noted that data collection is common in pharmacies, as it is with most health care organizations in the digital age. Pharmacies have always had access to huge volumes of data from various sources, including patient, prescription, insurance, and medication supply chain and pricing data.
“Historically, independent pharmacies haven’t used the data collected to their advantage,” Dymowski said. “Most pharmacy data have been collected by large organizations—PBMs [pharmacy benefit managers], insurance companies, wholesalers, [and so on]—and used to help these organizations make decisions on things like drug pricing and formularies. When pharmacies did look at their data, they mainly looked at prescription volume and reimbursements.”
That is changing, as the COVID-19 pandemic has propelled independent pharmacies into taking a more analytic approach. “Providers collaborated with pharmacists to get patients counseled on disease states and medications to people who were too scared or too sick to visit an office. And when the country needed a resource to quickly administer millions of lifesaving vaccinations, independent community pharmacies were the ones who stepped up,” Dymowski said.
Joe Moose, PharmD, owner of Moose Pharmacy, with 8 locations across North Carolina, said that when he first started working as a pharmacist, computers were just coming into the profession—where they served as nothing more than glorified word processors. Through the years, the pharmacy has evolved to use data to make a greater difference in the lives of customers.
“Over the last 5 years, using data has gone from operations and business-side management to changing patient outcomes,” he said. “We input our data knowing we can mine this information to give the patient a better outcome.”
Documentation Made Easier
Through data analytics, pharmacies can identify claims with a high potential for audits and ensure that all requirements are in place to prevent a financial challenge from the payer. They can also analyze postaudit results to identify areas where they were most penalized and put measures in place to avoid penalties in the future. And, Dymowski pointed out, data insights have only served to help prescription and patient documentation as well.
“In robust pharmacy systems in states that allow for electronic record keeping, pharmacists have the ability to receive electronic prescriptions directly from prescribers with patient demographics, clear prescription information, and even notes written by the prescribing team,” she said. “Those prescriptions can then be annotated on the pharmacy level with information such as calculations for ‘days’ supply,’ which helps with pharmacy audits.”
With all prescriptions and prescribing data being kept electronically, pharmacies can easily access information for events such as drug recalls. They also can notify the affected patients quickly.
Aysha Ahmed, PharmD, chief medical director, president, and cofounder of Vasa HealthIV, a mobile infusion therapy company, noted that independent pharmacists utilize medication therapy management. This allows them to see if some patients are regularly picking up their prescribed medications and taking them as they should.
“It also shows if they have multiple disease states and if they are being monitored for drug interactions as well as dose-appropriate alterations,” she said. “This information is sent to insurance companies regularly to ensure that the patient avoids any risk of hospitalization along with providing evidence of much-needed pharmaceutical intervention conducted daily by the pharmacist.”
Better Care Planning
Some pharmacies participate in collaborative practice agreements, disease state management, or other clinical programs that require care planning. These pharmacies now have the opportunity to develop and manage care plans through a pharmacy management system in most major health systems.
“With this, pharmacies are able to create customized care plans for patients based on their data: their medications, their disease states, and their demographics are controlling what happens with their health,” Dymowski explained. “Care plans can include quantitative information such as test results, labs, vitals, and prescribing data, or more qualitative data such as observations, questionnaires, counseling [or] coaching notes, and other socioeconomic and environmental factors that can impact patient health.”
Care plans also allow pharmacies to set specific goals. This enables them to identify high-risk patients, then set up these patients for success based on targets they can achieve.
“By measuring this outcome and following along with each patient using metrics, pharmacists can identify patients who are at risk of developing a poor prognosis and get to them before any hospital-related events come up,” Ahmed said. “Putting raw pharmacy data into metrics can help pool patients into certain groups that can be targeted early on and followed… to ensure the best possible health outcome.”
With the growth of direct patient care programs offered by community pharmacies, such as chronic care management and medication therapy management, there are numerous opportunities for data analytics to inform care. Many pharmacy information systems have modules that can provide pharmacies with this type of information.
“For example, pharmacists can use insights into adherence patterns to plan interventions with high-risk and vulnerable patients, such as seniors with multiple chronic health conditions, including diabetes, high blood pressure, high cholesterol, and congestive heart failure,” Polek said. “[Findings from] numerous studies have shown how pharmacists can help patients avoid adverse events and hospital readmissions. Now these programs can use data analytics to target interventions for the best results.”
Reimbursement is another key area where pharmacies can benefit from data analytics.
“Pharmacies need to pay particular attention to DIR [direct and indirect remuneration] fee patterns and ensure they take all possible precautions to reduce these clawbacks as much as possible,” Polek explained. “In extreme cases, a pharmacy may choose not to participate with an insurer that has a history of poor reimbursements and high DIR fees. However, with a deep understanding of prescription drug plans and their reimbursement patterns, pharmacists can share coverage and co-pay information to help patients choose a plan that provides the highest level of coverage for their current medications while also fairly reimbursing pharmacies.”
This benefits both patients and pharmacies. Historically, pharmacies have been reimbursed for dispensing medication, which still accounts for the majority of revenue made by independent community pharmacies. But potential exists for reimbursements above and beyond dispensing medication, because the pharmacist is recognized as a holistic health care provider.
“Along with the opportunity for different types of reimbursements, most pharmacy contracts have data-driven goals built in that provide higher reimbursement or some type of alternative or higher payment to pharmacies that achieve greater quality metrics,” Dymowski said. “Pharmacy is no longer about dispensing a prescription; it’s about supporting your patients’ medication regimens and increasing their health outcomes through prescriptions.”
Around the Pharmacy
Analytics can improve things for the independent pharmacist in a number of other ways. Data insights can be used across all facets of health care to improve quality of care in the industry, and they can change the way independent pharmacies operate for the better.
For example, data analytics within patient engagement programs can help improve medication adherence and outcomes. “Some patient engagement technology can analyze prescription abandonment trends and send patients pick-up reminders that include tailored information about prescription costs, financial savings, and educational materials, which helps improve adherence,” Polek said.
Dymowski noted that pharmacies can use the information collected to better collaborate with community providers. Additionally, they can use prescribing information to meet specific metrics set out by payers and document via care plans to get different types of reimbursements.
“Pharmacy organizations are increasingly pushing for pharmacists to be given provider status in all 50 states, especially since pharmacies played such a huge role during the vaccine rollout,” she said. “For pharmacists to receive that status, pharmacies need to start incorporating data collection, care planning, and other outcome-related analytics into their daily workflows to prove to the health care community that pharmacists can make positive impacts on patient health.”
Relying on Data
Today’s pharmacists are busier than ever as they care for an aging population that takes more and more prescription medications. Thus, with the avalanche of patient data now available to pharmacists, it makes sense to use fast, efficient data analytics tools to do what would otherwise take hundreds of work-hours—find the patients who need help the most.
“More pharmacists are recognizing the importance of data analytics and becoming experts in its use, including working at—or starting—companies that can help community pharmacies benefit from this technology,” Polek said. “I love the idea of pharmacists building tools to benefit other pharmacists and their patients. That is how health care can and should work.”
Data and analytics, therefore, are the future. Payers are structuring contracts on quality metrics, and integrated health systems are collaborating with community pharmacies that are attending to and bettering those metrics. Further, millions of people went to bed last night knowing how many steps they took.
“As the population wearing technology ages, more providers are going to rely on that technology to better care for their patients,” Dymowski said. “Pharmacists need to be prepared to combine their pharmaceutical and clinical expertise with databased care plans that increase patient health and have the data to prove it if they want to be seen and respected as a health care provider.”