Health-system-owned community pharmacies are a vital but too-often untapped resource for optimizing patient care — and it's up to the profession to change that, said Kristel Geyer, clinical coordinator and program director for the postgraduate year 1 community-based residency program at Cleveland Clinic Specialty Pharmacy in Cleveland, Ohio.
Geyer was the lead speaker at the Dec. 10 educational session Jackpot Strategies: Winning Big With Clinical Service Expansion in Health System Community Pharmacies at the Midyear Clinical Meeting & Exhibition in Las Vegas, Nevada.
“Community pharmacies are uniquely positioned at the crossroads of accessibility and continuity [of care]. And the time has come for us to really target that potential,” Geyer said.
Geyer said the overall landscape of community pharmacy is shifting, with less emphasis on dispensing-related revenues and more on the provisions of clinical services, such as vaccination. But obstacles to clinical care expansion remain, including inadequate reimbursement and corporate pressures that cause “dissonance between what we want to do and what we have time to do,” she said.
Co-presenter Bri Robinson, home delivery pharmacy manager for The Cleveland Clinic Foundation, said any plan to expand community pharmacy services should be built on data that describe a problem that the services can solve, such as improving prior authorization approval rates and making the approval process more efficient.
“Metrics tell the story,” Robinson said. With solid metrics, she said, “you don’t have to beg for resources every revenue cycle.”
She urged the audience to build financial sustainability into proposed clinical services from the start by ensuring that they align with health-system priorities. The services should include appropriate billing and reimbursement workflows and integrate into the organization’s electronic health record (EHR) and communication systems. Knowing what metrics capture these elements is an essential part of planning, she emphasized.
“Don’t wait until the pilot is over to decide what to measure,” Robinson said.
Robinson said her health system used metrics related to the prior authorization process to justify an EHR integration project that gave the organization’s community pharmacists access to key patient care data.
She said sustaining any clinical service expansion requires continued attention to metrics. Ideally, she said, the data should describe a measurable clinical impact, demonstrate revenue generation or cost savings, and not result in disruption of pharmacy staffing or workflows.
Robinson recommended the SWOT analysis — strengths, weaknesses, opportunities, and threats — to keep the clinical expansion strategy grounded and adaptable. She walked the audience through a SWOT analysis of a heart failure adherence pilot program implemented at her organization. The program included pharmacist-led medication management and coordination of medication refills, secure messaging follow-up in the EHR, and a partnership with a population health team to target high-risk patients.
The clinical expertise and accessibility of the community pharmacy team was a strength of the program. Weaknesses included reimbursement barriers and workforce shortages. The ability to align the program with the organization’s value-based care and public health priorities was an opportunity. Threats included inadequate reimbursement and competition from retail pharmacies.
Ultimately, Robinson said, the heart failure adherence program met its predefined goal of increasing medication adherence by at least 10% in three months. She credited the program with a 5% reduction in readmission rates for program participants and large improvements in patient engagement and population health program integration. Overall patient satisfaction with the program was 92%, she said.
Ryan Petronis, assistant director of community pharmacy at the University of Rochester Medical Center in New York, said his health system has embedded community pharmacists into primary care teams to fill gaps in the care process that impede access to medications. In addition to working with patients, the pharmacists interact with a central care adherence team and other healthcare team members to eliminate some of the “back and forth” that delays prescription filling, Petronis said.
Access to the integrated EHR system is a key element of success for programs like this, he said. The presenters urged session attendees to leverage their own integrated records to develop services that improve access and continuity of care.
The speakers also encouraged attendees to see themselves as innovators and to advocate for policy changes that support the expansion of community pharmacy services.
“The future is ours to shape,” Geyer said.
