Examining the case for direct contracting: A multistakeholder case study.

BACKGROUND: Employers and pharmacies are challenged by a complex system for prescription payment. Cost plus direct contracts for prescriptions and bundled services may yield benefits. OBJECTIVES: This study aimed to (1) explore direct contracting using multistakeholder interviews, (2) compare employer costs and employee copays for 6 months of prescription charges under their pharmacy benefit manager (PBM) with projected costs under a pharmacy direct contract, (3) project pharmacy revenue, costs, and net profit had these prescriptions been processed through the direct contract, and (4) assess employee satisfaction under the direct contract. METHODS: Semistructured stakeholder interviews were recorded transcribed and analyzed to identify different perspectives on direct contracting. Employer PBM invoices for 412 employee prescriptions over 6 months were analyzed to calculate employer and employee costs and reanalyzed for the invoice cost plus $12 professional fee direct contract. For the pharmacy financial analysis projection, invoice costs and a $9.82 cost of dispensing were subtracted from total revenue to yield an estimated profit had the parties been under the arrangement. A 34-item satisfaction survey was mailed using a 4-contact design with cash incentives to the 20 employees serviced by the direct contract that were analyzed descriptively. RESULTS: Eight stakeholder interviews described the benefits and potential challenges of such direct contracts. The financial analysis suggested the employer costs would be $5664 lower and employee copays would have been $1918 lower had all prescriptions been paid using the direct contract. The estimated profit for the pharmacy was projected at $899. Survey respondents were generally satisfied with the direct contract, but few used the bundled services. CONCLUSION: The direct contract may be financially beneficial for all parties. It also may offer more transparent pricing that may be desirable for the employer and pharmacy. Greater uptake of bundled services may increase the value to the employer.

Use of a fall risk evaluation in a community-based pharmacy.

BACKGROUND: Falls in older adults are a serious public health concern. They increase health care expenditure and account for more than $30 billion in direct medical costs. Medication-related problems can contribute to fall risk, and community-based pharmacists are well positioned to intervene, given their role in monitoring ongoing medications. OBJECTIVES: To evaluate the integration of a fall risk screening assessment (i.e., Stopping Elderly Accidents, Deaths, and Injuries [STEADI]) into community pharmacy practice and to report on the targeted medication management interventions that pharmacists made for patients aged 50 years or older with a fall risk potential. PRACTICE DESCRIPTION: A service-oriented independent pharmacy in the Midwest United States that uses an in-house clinical software program to perform a prospective drug utilization review and document clinical interventions. PRACTICE INNOVATION: A 3-item STEADI fall risk screening assessment was administered from October 15, 2018, to January 31, 2019, to 311 pharmacy patrons aged 50 years or older taking high-risk medications. EVALUATION: For those with a positive screen for fall risk, the 12-item STEADI fall risk assessment was administered. A pharmacist performed a comprehensive medication review (CMR) for these patients. Education and medication recommendations were provided. RESULTS: Fifty-three patients (17%) responded "Yes" to at least 1 prescreening question. The mean total STEADI fall risk score was 5.7 out of 12. The most commonly reported STEADI item was a worry regarding falling (75.5%) and sometimes feeling unsteady when walking (67.9%). Education regarding falls was provided to all the patients who received the study CMR, but only 6 medication changes were made to the prescribers, of which 4 were accepted. CONCLUSION: The STEADI assessment was useful in identifying patients who were potentially at a risk of falls. More work pertaining to deprescribing high-risk medications for at-risk patients seems to be needed.

Scaling Community Pharmacy Transformation with the 'Flip the Pharmacy' Implementation Model: Program Origins.

The rising costs of healthcare, increased chronic illnesses, and healthcare provider burnout has led to an environment desperate for scalable solutions to ease practice burdens. With a projected shortage in the number of primary healthcare providers available to provide team-based care, community-based pharmacy practitioners are accessible and eager to assist. In order to provide enhanced patient care services to aid their clinician colleagues, community-based pharmacists will have to transform their practices to support the provision of enhanced services and medication optimization in value-based payment models. The purpose of this article is to define how multiple factors in pharmacy, healthcare, technology and payment models aligned to create an opportunity for the Community Pharmacy Foundation and CPESN® USA to implement a nationwide community pharmacy practice model called 'Flip the Pharmacy'. This new model aims to scale community pharmacy practice transformation and move beyond filling prescriptions at a moment-in-time to caring for patients over time through a 24-month step-wise program paired with in-person pharmacist coaching. Preliminary observations from the first six months of the program highlight community pharmacy as a site of care with community-based pharmacist practitioners providing and documenting targeted patient care interventions.

Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization.

OBJECTIVES: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified. METHODS: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified. RESULTS: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not. CONCLUSIONS: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.

Development of a medication therapy management superbill for ambulatory care/community pharmacy practice.

OBJECTIVES: To explain the purpose of superbills, suggest strategies for incorporating superbills into pharmacy practice, and propose a model superbill for consideration by practitioners. PRACTICE DESCRIPTION: Ambulatory pharmacies in the United States. PRACTICE INNOVATION: Superbills have been used by physicians and other health care providers for many years as a way of efficiently communicating to the office staff, the patient, and even the insurer the types of services that have been provided at the point of care. The profession of pharmacy has not routinely used superbills in the past; however, given the recognition of pharmacists as providers of medication therapy management (MTM) services, immunizations, disease management, and other specialty preventive health services, the time has come for pharmacists to begin using superbills. MAIN OUTCOME MEASURES: Not applicable. RESULTS: A sample superbill, suitable for adaptation by individual providers of medication therapy management and other clinical pharmacy services, is provided in this article. CONCLUSION: Superbills may or may not improve the pharmacist's overall ability to receive insurance remuneration, but the authors believe that greater recognition by patients of the nondispensing activities of pharmacists can be achieved by using a superbill and that this may lead to more opportunities for payment for MTM in the future. Research is needed to assess whether incorporating superbills into a variety of pharmacy practice settings improves patient perceptions of the pharmacist and to discover how superbills effect practice efficiency.

Improving communication skills of pharmacy students through effective precepting.

Pharmacy students should be given opportunities to learn and practice interpersonal communication skills during their community advanced pharmacy practice experience (APPE). Preceptors have the responsibility of setting the stage for the pharmacy students during their initial encounter. During this orientation to the site, students should become familiar with the history of the practice, the types of services provided, and the staff members. Once the orientation is completed, preceptors can develop strategies for incorporating the students into the practice's patient care activities. Students should participate in patient counseling, interviewing, and educational sessions. Also, students should participate in collaborative work with other health care providers. To ensure the development of communication skills in pharmacy students, preceptors can incorporate the teaching process "see one, do one, teach one" into their teaching activities. By following these strategies, preceptors can effectively and positively impact the communication skills of their students.

An evaluation of managing and educating patients on the risk of glucocorticoid-induced osteoporosis.

OBJECTIVE: To assess the impact of risk management activities on patient risk of glucocorticoid-induced osteoporosis. METHODS: Ninety-six adult patients taking chronic glucocorticoid therapy in 15 community pharmacies. Patients in the control group received usual and customary care. Patients in the treatment pharmacies received education and an educational pamphlet about the risks of glucocorticoid-induced osteoporosis. In addition, the treatment group pharmacists monitored the patients' drug therapy, to identify and address drug-related problems. Data including the glucocorticoid taken by the patient, medications, and osteoporosis risk factors were collected at baseline and after 9 months of monitoring, via Web-based survey completed in the pharmacy. Using an intent to treat approach, the pre-post frequency changes were compared with contrasts for presence of bisphosphonate therapy, presence of estrogen therapy, presence of calcium supplement, discussion of glucocorticoid-induced osteoporosis risk, discussion of bone density test, presence of bone mineral density test, reported inactivity, and reported low calcium diet. RESULTS: The contrast was significant in favor of the treatment pharmacies for the frequency of patients taking a calcium supplement (Control [-6.9%] vs. Treatment [17.1%], P < 0.05). No other contrast was significant. CONCLUSIONS: Community pharmacists are capable of increasing calcium supplementation among patients at risk for glucocorticoid-induced osteoporosis. Pharmacists who educate at-risk patients can impact the self-care of these patients.