Pharmacists implement tech solutions to expand into primary care

Pharmacists receive a lot of accolades from their partners across the care continuum for their ability to engage with patients in the community in a truly unique way. During the COVID-19 pandemic, the applause grew louder as pharmacists bore the brunt of the work around the mass vaccination effort, navigating an unprecedented rush to protect tens of millions of people from the coronavirus. 

But historically, the praise and admiration haven’t been matched with reimbursement structures that make the practice of community pharmacy sustainable under constantly growing demands.   

Despite being trained in many foundational aspects of primary care, pharmacists face state-specific restrictions on their scope of practice that keeps them separate from the rest of the care team. And the losing profit-and-loss equation of the current drug pricing environment means community pharmacists can’t always afford to buy the technologies and hire the staff to maximize revenue from the menu of services they are allowed to deliver. 

The result is underutilization of a valuable clinical resource which is being pushed to the brink of collapse by fixable circumstances, says Chris Schaffner, PharmD, owner of Schaffner Pharmacy in Northwest Washington State.  

“The dollars aren’t there in the traditional pharmacy and prescription drug model,” he told Digital Health Insights. “The staff aren’t available, either.  The old manual workflows just won’t cut it anymore if we want to keep community pharmacy around in the current environment.” 

“We need to rely on technology to make every step of every process extremely efficient and as automated as possible.  If we can start to use data and automation the way that other providers have successfully used it, we can give our teams some of their time back from basic, routine tasks to take on the more advanced clinical services they are qualified to provide. We can give them the space to think in a more global way about their patients so they can augment what’s happening in traditional primary care and enhance what the health system has to offer.”  

Reimagining the role of pharmacists in the primary care ecosystem 

Pharmacists do so much more than just fill up pill bottles. Medication therapy management is among the most important services they provide.  This can include mediation reconciliation, which is especially vital for people experiencing a transition of care, and medication synchronization, which is proven to help polypharmacy patients improve their medication adherence and self-management. 

From a reimbursement perspective, MTM services straddle the line between medical claims and pharmacy claims, explained Tara Pfund, PharmD, a pharmacy policy expert and Product Manager for AssureCare, a healthcare technology company that works with Schaffner Pharmacy. 

“Billing medical insurance payers is very different from submitting typical pharmacy claims,” she said.  “The technology for doing so is different, and most community pharmacies don’t have the infrastructure in place to make it happen.  That means they are leaving dollars on the table for services that they are qualified and able to provide – and that are desperately needed.” 

“Many primary care providers simply do not have the time or the same type of insight into their patients to perform these services in a timely manner, so mistakes get missed.  We know that more than 40 percent of medication errors occur during transitions of care, and we need pharmacists to have the bandwidth and the technology tools to close those gaps for patients.” 

Taking a data-driven, population health management approach to community care 

Schaffner Pharmacy has adopted a comprehensive technical solution for maximizing the skills of pharmacists while taking advantage of reimbursement opportunities for medical claims.   

“We’re on the forefront of clinical service offerings, from travel and vaccine clinics to chronic disease state management and naloxone prescribing. And we now have an EHR and population health platform that has been tailored so we can engage in some of those population health activities while providing all the other services we need to deliver, including medication therapy management, transitions of care management, and the like,” he said.   

“Having tasks and cues to be able to identify patients in the workflow, follow up, and integrate their reimbursement opportunities is rare for pharmacists. With more automation and structure in our information flow, we can move away from being reactive, as many pharmacies are.” 

Schaffer’s pharmacists use their platform to make appointments with patients for medication synchronization and medication reconciliation and document those encounters appropriately. “That creates predictability, reduces complexity for us and for our patients, helps coordinate our billing activities, and allows us to make sure we have the right medications in stock exactly when they’re needed, so patients don’t go home without something important for their care,” he said. 

Integrating pharmacists into the coordinated care team of the future 

If pharmacists are to take on more primacy care tasks, they need to be deeply integrated into the rest of the care team. That requires both robust, interoperable technical connections and strong, trusted relationships with other providers, healthcare payers, and with the community at large. 

Fortunately, pharmacists are among the most trusted healthcare providers, sitting right behind nurses and physicians in the latest Gallup poll about ethical professions. 

“Being in a small community, we’re very well connected in our area,” said Schaffner. “We know our patients and their families. And we know the physicians. We’re all on a first-name basis, and we trust each other to do what’s best for our shared patients.  They know we’re there for them, and vice versa, which makes it a lot easier to have these conversations about how we can help each other relieve burdens and use our collective resources to produce the most good.” 

“It’s still a little bit more challenging on the data side,” he acknowledged.  “At high volumes, those one-off phone calls and drop-ins aren’t going to cut it.  We need a better solution that breaks down the interoperability barriers so that we’re staying aligned and proactive around rising risks, not just immediate needs. If I make a change to someone’s blood pressure mediation dosage, I need their PCP to know about it – and that has to happen through something other than the fax machine.” 

It may take time to develop the data pipelines between pharmacies, providers, and healthcare payers, but the good news is that everyone is on board with pharmacists taking on these new roles, Schaffner continued.  

“There’s such a clear need for more peoplepower to make healthcare work,” he said. “PCPs need support and resources. Payers need these tasks completed to keep their quality high, and we can more easily work with people that they can’t always reach or engage themselves. Patients love having us as part of their community care team. There are enough care gaps to go around, right? This is not a turf war.  There’s enough work to do that we can have all hands on deck without anyone feeling like they’re being shorted out of incentives.”   

“Our goal is to create a pharmacy-centric model that is replicable and scalable so that the health system as a whole can harness our resources and add another layer of insight and another pair of hands to care for the patients who need extra support with their chronic conditions, their polypharmacy, and their self-management. We’re here to help, and we are so eager to collaborate and work as a unified team to move the needle on outcomes for our shared patients.” 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.