One way that community pharmacies can improve how well they care for their patients and their bottom line is to provide enhanced services. These include services that can help keep patients out of the emergency room or hospital and, for which, in some instances, the pharmacist can be reimbursed by a third-party payer or by the patient.
These services can be revenue streams that can help local pharmacies compete with big-box stores and mail-order, and with any inroads from Amazon’s acquisition of PillPack.
There are nine ways that community pharmacies can profitably implement enhanced services, says Bruce Kneeland, a community pharmacy consultant based in Prescott, AZ, who presented at the NCPA 2018 Annual Convention in Boston, October 6. “If you don’t do this, other healthcare providers will,” he notes. Other pharmacies, nursing services, and telephone-based providers are already on board with these things, he adds.
The nine services are:
1. Enhanced delivery
3. Medication therapy management (MTM)
4. Medication synchronization
5. Adherence or convenience packaging
6. Medicare plan selection
7. Point-of-care testing
9. eCare capability
During his talk, Kneeland gave examples of how real pharmacies are providing each of these services. The Community Pharmacy Enhanced Services Network uses a similar list of services it considers enhanced, such as enhanced coordination between the pharmacist and other healthcare providers and additional monitoring of patients.
Many of these services, notably MTM and medication reconciliation, are what most community pharmacists are already doing with many of their patients, Kneeland says. “Most independent pharmacies would qualify without needing to do too much.” Medicare reimburses for MTM, he notes.
Some enhanced patient care services are extensions of programs a community pharmacy may already have in place. For example, enhanced delivery means that not only is the prescription delivered to the patient, but the delivery person speaks with the patient or caregiver to see if there are any issues regarding the prescription, or other problems. The delivery person may even carry a mobile phone or tablet that allows the patient to speak with the pharmacist, Kneeland says. And the car or van used for delivery has the pharmacy logo on the side and serves as a rolling advertisement, he adds.
Immunizations are another area where pharmacies can enhance patient care and their revenue stream, he says. Although one in four vaccinations are now done in a pharmacy, most pharmacies miss 70% of their vaccination revenue, he notes. “Year-round vaccinations could earn your pharmacy an extra $38,000 per year.”
Pharmacies should also consider helping customers with Medicare Part D plan selection. Kneeland says. The pharmacist or pharmacy staff can plug information about the person’s medications into a computer program and the program shows the customer which locally available plan will offer him or her the best coverage, he says. There are 41 million people on a Medicare plan, with the average enrollee having a potentially confusing choice of 26 Part D plans and 16 Advantage plans, he notes. Enrollees often choose a new plan each year, which means they would be repeat customers for this service.
Some pharmacies are already offering point-of-care testing as an enhanced service, including tests for strep throat or the flu. But Kneeland notes that that pharmacogenomics testing is now being offered in pharmacies, as well as saliva tests for hormone levels. Pharmacogenomic testing allows pharmacists to advise physicians on what drugs might not work or carry greater risk of adverse reactions for a given patient.
Almost all pharmacies carry lines of vitamins and dietary supplements, but nutrition is an area where pharmacists can offer greater levels of advice and counseling, especially when it comes to drugs that might deplete levels of certain nutrients, Kneeland says. Pharmacists can become a patient-focused practice rather than product-focused one, he adds, by combining testing, counseling, and clinics for diabetes nutritional advice or for weight loss.
What can help tie all these enhanced services together is pharmacy eCare capability, which can link pharmacists into patients’ electronic health records, he says. Pharmacy eCare can bring in the patient’s information, including prescription records, payer information, medical history, medication therapy problems, care coordination, and the patient’s own goals.