New tools and technology applications abound as many industry-wide shifts are taking place in pharmacy.
It can seem as though pharmacy is sometimes treated as the underdog of the healthcare community, given industry-wide challenges such as direct and indirect reimbursement (DIR) reimbursements and the struggle for fair compensation when negotiating value-based contracts.
However, after the COVID-19 pandemic showed how critical pharmacists are to keeping people healthy, we are starting to see a noticeable shift in 3 areas:
- The role of pharmacy as a gatekeeper for health.
- How pharmacists are perceived by their care partners, especially payers and physicians.
- How pharmacists are viewed by their patients.
Research suggests that more pharmacists are now operating at the top of their license than ever before, and it is clear that pharmacies are empowered to shape health outcomes in new ways, impact reimbursement, and drive new revenue.
But these additional opportunities bring additional responsibilities, such as the need to navigate new financial and collaborative practices with care partners or the need to play a more direct role in disease management and the overall care experience.
They also raise a big question: What is the best way for pharmacies to move forward, given their growing importance in value-based care?
Competing for the biggest slice of the pie
To remain successful in any industry, organizations must always consider how broader changes, such as incentive programs or new regulations, will affect day-to-day operations. This is especially true for pharmacies feeling the impact of numerous industry-wide shifts in 2022. One of the biggest of these? Shifting to value-based care models that align financial incentives with patient experience as well as outcomes.
Consider it CAHPS metrics related to member experience now account for nearly 40% of a health plan’s CMS Star rating. As pharmacies are a lifeline to health plan success, the degree to which patients have a positive experience with their respective pharmacies affects all stakeholders in the healthcare ecosystem.
Although pharmacies are not the only point of contact for patients, they are responsible for ensuring that patients are clear about their health conditions, medications and expectations, and often have more patient contact throughout the year.
Medication adherence is also particularly important to pharmacies, and understandably so: Up to 50% of all Americans do not take their medications correctly, which contributes to a an estimated 275,000 deaths per yeardue to non-optimized drug therapy. It is a central part of the Pharmacy Quality Alliance (PQA) aims around it pharmacy performance measures.
Of course, simply dispensing medications or verifying prescriptions with providers is no longer sufficient. Pharmacies must do more and collaborate more closely with their health plan and provider partners to ensure patient adherence.
Alas, collaboration is not a task that comes naturally or easily to care for partners competing for the biggest piece of the pie – or the biggest share of the compensation. As clinical manager of pharmacy programs at Blue Cross Blue Shield of North Carolina he noted in a the last interview“there’s often an adversarial relationship when you first start…because we’re used to putting our heads down.”
Touching technology
Given the broader industry changes underway, now is the time for pharmacies to adopt tools that reshape their communications with payers and other care partners, as well as future-proof their organizations.
Here are 3 areas that pharmacies should focus on when evaluating potential technology investments:
1. Cooperation
We hear a lot about the sophistication of tools to support pharmacy workflows and improve the prescription filling process. However, a pharmacy management platform should go one step further by providing an integrated solution that enables complete visibility into everything from clinical opportunities to payer-funded clinical interventions.
2. Support for patient engagement
The average patient visits their pharmacist 12 times more often than their primary care provider. Community pharmacies are in a unique position to take an increased role in primary and preventive care with the right tools to support engagement. These may include, for example, apps that send messages, educational campaigns, and reminders at predetermined times based on a given individual’s medication refill history.
3. Enabling and supporting growth
As technology evolves and new regulations materialize, pharmacies will be expected to remain flexible, so they will need technology that can support them as they grow. For example, if pharmacies want to offer ancillary revenue services, such as urinalysis, bone density scans, or even chronic care management via telehealth, they will need tools to help them with coding. , documenting services and sharing information with care partners across the country. continuity.
As pharmacy’s role in patient care evolves, now is the time to review processes, people and technology—but especially the latter. Adopting the right solutions to foster better collaboration is a key aspect of moving forward and setting up care pharmacies for continued success.
About the Author
Anna Hall is the Chief Compliance Officer for Transaction data systems, the leader in pharmacy software solutions. Its portfolio of products and services included Rx30, Computer-Rx, KloudScript, PrescibeWellness and Enhanced Medicine Services.
