How Integrated Community Pharmacy Networks Enhance Patient Care

December 28, 2020

Cody Clifton, PharmD, CPESN USA, discusses the organization's pharmacy integration network and the pharmacists' role amid the coronavirus pandemic.


Drug Topics®: So our topic today is the COVID-19 pandemic, of course, and the role of CPESN and independent community pharmacists during this time. How has CPESN’s services help meet the demands of the COVID-19 pandemic?

Clifton: CPESN USA is a clinically integrated network. And one aspect of a clinically integrated network is having 50% of resources dedicated to best practices and quality assurance. With that thought in mind, CPESN USA has been following a model of Flip the Pharmacy.

Flip the Pharmacy is a practice transformation effort in which we are helping pharmacies across the country really transform their practices. And it's really ushering in a new level of services. And we know that community pharmacies are super valuable in the community, payers recognize the localness, but there's still some need out there for practice transformation to get us to where we're going in the future, where we do have that touchpoint with the patient by dispensing the medication, but true value comes around all the services surrounded by the dispensing model.

So Flip the Pharmacy is focused on best practices. So what we're doing is sharing across the country, what CPESN pharmacies are doing in practice, so that it is helping others transform at the same time. And so CPESN USA through the COVID-19 pandemic, has been able to share what's happening at Duvall family drugs, what's happening at Lou’s Pharmacy, what's happening at Town Cress Pharmacy in Iowa. So just think about 3 different pharmacies across the country that are geographically totally different. But what's so amazing about this and where pharmacies do not need to continue recreating the wheel is with these best practices, we're now able to share within our provider-led network and across the spectrum, what pharmacies are doing to transform their practices.

So if Randy McDonough at Town Cress Pharmacy is doing something spectacular to meet the demands of the healthcare system, we're able to share that across CPESN pharmacies and the pharmacies then don't have to recreate a model that already exists. So we're growing together as one.

And we're able to transform our practices together, we get to go through the ups and downs together. But at the end of the day, what it's all about is transforming the patient care experience. And so, we're leveraging that experience that we have in the community pharmacy setting and those relationships to really drive our outcome which is improving the patient's healthcare. And that's truly where the value of CPESN comes into play is whenever we can come together and share these best practices for the greater good. And so that we're not all working in a silo any longer, we're working together as a team to get the ultimate goal.

Drug Topics®: And CPESN was also recently named a federal pharmacy partner for the CDC COVID-19 vaccination program. What does that program entail?

Clifton: The CDC COVID-19 vaccination program is really going to usher in our country to getting back to some level of normal. I think we're all struggling to find what that normal looks like right now. I'm hoping right now is not the new normal. And so as I lead the federal pharmacy program partnership that CPESN USA has with the CDC, that is my end goal.

So I know all of the work that we're putting into this as a federal pharmacy partner is going to allow, for instance, my parents in Walnut, Mississippi to receive the vaccine. So it is a true honor, that CPESN USA is named a federal pharmacy partner so that our loved ones get the vaccine that is currently being produced. So the role of CPESN USA as the federal pharmacy partner with CDC for the COVID-19 vaccine means that we are providing access to the vaccine to those community pharmacies across the country that may not have had another option to have vaccine access.

So there's many federal pharmacy partners across the country. You had to have a certain number of pharmacies, so that you could be considered a federal pharmacy partner and get that agreement with the CDC. And so CPESN USA, as an organization with, at the time 2600, CPESN pharmacies, we had a huge group of pharmacies already to go to CDC to say these pharmacies, we're not sure if they have access to the vaccine based on their current partnerships and within their current business model - and many of them probably do, however, we want to at least be a backstop as everyone is trying to figure out who is their vaccine allotment partners essentially. And so that's where CPESN USA is able to play that role of vaccine access.

And with vaccine access also comes compliance components. CPESN USA, as a clinically integrated network, we're very familiar with compliance as part of our mission so that we're saying that we are who we say we are. And so, the CDC has set for requirements for pharmacies, and CPESN USA has to make sure these pharmacies uphold those requirements.

And so in that role, we are wearing a compliance hat. And with that, there's a lot of requirements that pharmacies across the country are now going to have to shift into very much similar to the Flip the Pharmacy initiative where we're transforming pharmacy practice. So it's ushering in appointment-based models like we had never seen, and many pharmacists, and including myself until about a year ago, had not recognized what an appointment based model even looks like.

And now, in order for us to deliver on this vaccine, we've got a couple options for the appointment-based model. We could write on cards, how we're going to schedule this, and that's very archaic, and it's going to be very, very hard to keep up with. But now we're able to get into software platforms outside of our pharmacy management system and start scheduling appointments for patients in the near future, so that they are coming into the pharmacy to get their vaccine at a certain time, or maybe it's at a flu clinic or something similar to a flu clinic, where they're signing up for that clinic, and come in to get their vaccine.

But then some of these vaccines are multidose, so we've got to keep up with that also. So as we think about the requirements, the challenges keep building, right. And so it makes it hard for a pharmacy owner or pharmacist in the community pharmacy setting to say, Wow, there are 21 requirements that I have to attest to under this pharmacy agreement with CPSA USA, and likewise with the CDC. How am I going to get that done?

And so it's really, as I looked at the agreements, I had to put on my practicing pharmacist hat. And I had to look at that from the lens of how is Cody going to implement this Duvall Family Drugs with everything else that we have going on. And there's 21 things that I've got to make sure that I have the capabilities of doing. and so where CPESN USA is coming in is there are 21 requirements: let's be just like the CDC in that we're being very mindful of we're trying to improve the health of our population in the United States. There are certain requirements that have to be met to be able to do that. And there's legal agreements to make sure those happen.

However, there's a little bit of time we have to work with here so that we can help these pharmacies meet those 21 requirements. And so that was CPESN’s main goal is to make sure that there was access, it's just like access to care within the health care system. If you're in rural place, and you don't have access to the health care that you need, then you're at a disadvantage from the very beginning.

And so we want to make sure, with the COVID-19 vaccine, that pharmacies had access to the vaccine, so that at least the access is in check. And so if the access isn't there, then how do we get our communities back to normal? So that was the main role of CPESN USA is to provide that access point. And our deadline for signing up with CPESN USA was November 21. And through that, we were coaching these pharmacies, now over 3000 pharmacies that are with CPESN USA, almost 1500 that are a part of the CPESN USA partnership with the CDC as the vaccine allocation efforts here.

And with that, we had to help these pharmacies understand, yes, there are commitments to the CDC application. Here are all of those commitments, here's your agreement, you've got to read through this and sign it. And you have to be committed to this vaccine program. But with these 21 requirements, you just have to make this prior to us going into phase 2 or 3 of the vaccine rollout with the CDC. And that's where the CDC is really leveraging federal pharmacy partners, is for the phase 2 and 3 role outs. As far as federal pharmacy partnerships, it's looking like community pharmacies will be distributing the vaccine - administering the vaccine, rather, in the communities in mid to late of quarter 1 of 2021.

With that in mind, these pharmacies have a month and a half to 2 months to really get these requirements met prior to being able to order the vaccine.

As we looked at the 21 requirements for the agreement, we wanted to help pharmacies understand how this would be attainable for them. We went through the 21 requirements that they had to read through and sign off on their agreement. But beside each one of those agreements, in a separate document, we listed out the pharmacy considerations: here are the things that you need to think about when you're saying I think I can meet this, or I will be able to meet this by the time the vaccine is rolled out. And so it was going through those 21 requirements and helping them get that understanding that was so valuable, that I think made it a lot more feasible for these pharmacies to say, yes, I want to get my community back to normal and yes, I do feel like it's attainable, because I have a month or 2 to get these requirements met.

So this leads us into change packages, or you may think of these as implementation guides or toolkits, that really helped the pharmacies think through how they're going to implement and meet the requirements over the next month to 2 months prior to when they're able to order the vaccine.

So yes, they do have to get the appointment-based model set up, whether that's on a piece of paper, which I don't recommend, I can't imagine doing that in my pharmacy, or if it's looking through a scheduling platform that exists out there, and helping the pharmacies understand what are their options with the with the vaccine scheduling platforms out there.

We're currently collecting information to provide a chart to the pharmacies to say here is what we know in the marketplace that exists based on a survey that we had sent out to the local CPSN leaders in the country. And so that's where CPESN USA can truly shine and helping the pharmacies and doing a lot of hand holding on the best practices aspect.

As we are able to do this, this gives pharmacies a little bit more comfort in their day to day life of, okay, I have resources out there, I've got a sign up for the vaccine finder, I have no clue where to start. I'm caring for this patient right now on the bench. But I've got to be able to find some time to get this implemented. And if we can provide a step-by-step guide, essentially, for each one of these requirements being met, that's going to make this so much more attainable for these pharmacies, and then likewise, really usher in this new normal that we've been longing for in our in our country for almost a year now.

It's really incredible to see the community pharmacies across the country step up to the plate, willing to essentially go to war with the COVID-19 pandemic, so that we can get our country back to normal and enjoy those things in life that are meaningful to us and get back to a quality of life that we're used to.

Drug Topics®: So outside of the pandemic, how do you see CPESN supporting pharmacies in the year ahead?

Clifton: As we look forward to CPESN USA, being a partner to pharmacies in the future, the opportunity is just now being exemplified. Within CPESN USA, we're all about the sustainability of community pharmacy and also us leveraging our local relationships with our patients in our community and other health care team members because that goes a very long way.

What CPESN USA is able to do is to help connect the dots on so many opportunities and how does it actually roll out into the pharmacies to make it something that we can weave into our workflow, or maybe we need to think about our business model a little bit differently and say okay, dispensing is super important, right? Like it's our touch points with the patients, we're never going to get away from dispensing if we're in the community pharmacy setting. But how do we leverage that, as we move forward, to usher in other possibilities for reimbursement?

And the CDC COVID-19 vaccination program is helping to exemplify those efforts of what CPESN USA is providing the opportunity for. CPESN USA is not in the business to be a source of vaccine distribution. We're in the business of services. And that's really, as we move forward, where we're going to leverage those opportunities for pharmacies is the business of services.

As pharmacies have access to the vaccine, and they're following along with CPESN USA and Flip the Pharmacy, then what pharmacies are going to realize is, hey, I could partner with anybody to get this vaccine to my pharmacy.

However, I think, as we have these leaders across the country in this provider led network sharing these best practices, what's going to be realized is that pharmacies across the country, they know what they're doing, they're up for the challenge. And they're ready to take the bull by the horns and make things work at their pharmacies.

But the challenge is, how is that working across other pharmacies? And how do we come together to show our value in this massive marketplace? Where, yes, we have 3000 pharmacies, but yes, payers are super interested in how they can provide services to their mutual members, or patients at the pharmacy.

This is only going to be exemplified as we move forward, how CPESN pharmacies are viewed as a whole. The clinically integrated network term is something that's fairly foreign to people right now, but I imagine in years to come, it's going to be something that is recognized very easily, as you have these pharmacies coming together collectively to produce an opportunity that's going to be much better for the healthcare system and the patients in the healthcare system.

So we're going to continue to help decrease total cost of care which is one of our goals within CPESN USA, and then also improve patient satisfaction, provider satisfaction, all of those aspects. It's something that CPESN USA is working toward right now. And providing that sustainability of community-based pharmacy in the years to come, which I think will only be recognized a little bit more through the CPESN COVID-19 best practices.