Independent community pharmacists found plenty to think about at the recent McKesson ideaShare Conference in San Diego.
The attitude of some pharmacists toward the massive changes in healthcare can be summed up in one word: Meh. “I’ve seen this before,” they say. “This is another weather pattern, another wave in managed care.”
Troy TrygstadThat’s how Troy Trygstad, PharmD, MBA, PhD, describes the dismissive attitudes of fellow pharmacists who figure they can just wait it out. It’s exactly the wrong way to think, said Trygstad, who spoke at the recent McKesson ideaShare conference for independent pharmacists in San Diego. Trygstad is vice president of Pharmacy Programs with Community Care of North Carolina, which provides medical homes for 1.4 million Medicaid recipients. Instead, he said, pharmacists should be focusing on adjusting to new systems that emphasize provision of value to payers and effective care to patients.
Trygstad described fee-for-service, to which pharmacists are accustomed, as a business model that works the way a barbershop’s does; everybody pays the same rate regardless of whether the haircut is any good. In the medical world, “I go to Pharmacy A, which does a great job, or Pharmacy B, which does a bad job, and it’s the same reimbursement,” he said.
The new systems reward efficiency and effectiveness while penalizing waste. This matters, he said, because “the biggest payer in the world is Medicare, and half of all Medicare payments by 2018 will be tied to value.”
According to Trygstad, as things change, the message to keep in mind is a simple one - so simple that he turned it into a mantra at the conference session: “I am an investment, not a cost center.”
Translation: Pharmacists and payers must view pharmacies as places that help patients get better and require less treatment, rather than simply pull money out of coffers.
The good news about reform, Trygstad said, is that “you’ve got an enormous asset.”
“The equivalent of the U.S. population is in the pharmacy every week,” he said. “That’s huge. And what is the lowest common denominator? You. You’re the only lowest common dominator in the equation. You’ve got to be able to speak to payers and say: ‘This is your population, and this is what we’ll do for you.’”
At Community Care of North Carolina, said Trygstad, research based on 2010 statistics suggested that higher utilization of primary care physicians and pharmaceuticals can contribute to major declines in inpatient admissions, preventable admissions, preventable readmissions, and emergency department visits.
Dennis SongDennis Song, BSPharm, CHC, who spoke at the McKesson ideaShare conference with Trygstad, said independent pharmacists should consider wooing Affordable Care Organizations in conjunction with neighboring pharmacies. These organizations are able to reap rewards under Medicare’s shared-saving program for improving the quality of care, and their popularity is expected to rise as the federal government continues to adjust its reimbursement system for doctors.
The message: Pharmacies provide value. “It’s not just about your pharmacy. It’s about the 5-10 pharmacies around you when you go to the affordable care organization and say, ‘This is what we do,’” said Song, owner and head pharmacist at Flower Mound Pharmacy in the North Dallas-Ft. Worth area.
Song likened pharmacy circumstances to what happens in communities when craft breweries begin to appear. “They’re more popular when there are more of them around,” he said. Why? “Because once a consumer goes to a craft brewery, their likelihood of going back to Bud Light or Miller Lite is really low. You’ve changed expectations.”
The same thing goes for pharmacies that can spotlight how they can provide value and convince affordable care organizations to embrace them as the best option, said Song.
Patients are part of the picture too, he said. “We’re the drug experts. We need to convince them that you don’t need to go to a nurse or to your PDR. Call us first concerning clinical matters and third-party issues. We’re the resource.”
Randy Dotingais a medical writer in San Diego, Calif.