FinalDraft
CommunityPharmacyFoundationProject
CommunityPharmacyChangePackage
IntegratingComprehensiveMedicationManagementServices
IntoCommunityPharmacyPractice
KrogerPharmacyJ-909CareProHealthServices
MeyerPharmacyTowncrestPharmacyAppleDiscountDrugsGoodrichPharmacyHealthPartners
SUPERVALUPharmaciesWalgreens
CareSouthCarolina
CohortLearningCoach:JoshFeldmann,PharmD
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IntentTransformation:Thisdocumentisaworkingdesignofhowcommunitypharmacyorganizationscanstepbeyondthemedicationdispensingroletobecomeprovidersofeffectiveclinicalpharmacyservices.Thecommunitypharmacistwouldbecomepartofanintegrateddeliverysystem.Theywouldprovideintegratedmedicationmanagementserviceswithinateamaccountableforthepatienthealthstatusbeingatgoal.Leadershiprole:Thecommunitypharmacistisplayingaleadershiprolebyenvisioningthisnewdeliverysystem,bycallingitintoexistence,andbysecuringcommitmentsandagreementsfromothernecessaryplayers.Thisdocumentwillcapturetheevolutionaryprocessbydistinguishingthreetypesofprogress.
• Creatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive(context)• Bestpracticesthataredefiningpartsofaneffectiveandsustainableintegrateddeliverysystem(blueprint)• Opportunitiestofurtherdevelopandadvancethedeliverysystemmodel(challengestoaddress)
Opportunity:Communitypharmacistsrepresentaspecialassetinthecommunity’shealthcaresystem.Theyhaveauniqueandpersonalrelationshipwiththepatient.Theyhavefrequentencounterswiththepatient.Theyhavetheprofessionaltrainingtooptimizemedicationtherapy.Theyarepositionedtoplayaproviderrolethatcandramaticallyimprovequalityandlowercosts.Objective:Prepareanddisseminateanexperiencedbasedguide-ChangePackage-forcommunitypharmacists.Itshowsthemhowtobecomepartofadeliverysystemthatassureshighriskpatientshavetheirhealthstatusatgoal.Framework:TheworkisorganizedaroundfivestrategiesthattheAIMMexperienceshowsarenecessaryandsufficienttorealizethegoal.
1. LeadershipCommitment:Developorganizationalcultureandrelationshipsthatpromotesafemedicationusesystemsandoptimalhealthoutcomes.
2. DemonstrateMeasurableImprovement-Achievechangeusingthevalueandpowerofdata-drivenimprovements.Communitypharmacist’sacknowledgeroleandinachievinghealthoutcomes.
3. IntegratedCareDelivery-Buildanintegratedhealthcaresystemacrossprovidersandsettingsthatproducesafetyandoptimalhealthoutcomes.Create“systempartnerships”withcommunityprovidersthatpromotedevelopmentofacommunityintegratedcaredelivery.
4. SafeMedicationUseSystems:Developandoperatebysafemedication-usepractice5. ComprehensivePatientCenteredCare:Buildapatient-centeredmedication-usesystem(integratedcomprehensivemedication
managementsystem).
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Design:Thisdocumentisorganizedasthreetables:
• Table1istheBlueprintforaServiceDeliverySystem–thistableincludespracticestrategiesemployedbycommunitypharmaciesthatdefinethenatureoftheintegrateddeliverysystemtheyenvision.Eachstrategyissupportedbyabestpracticeandexamplesfromvarioussiteperspectives.
• Table2istheContextwithinwhichtheServiceDeliverySystemmustoperate–thistableincludestheconditionsnecessaryandconceptsonhowtocreatethemtopromotesuccessoftheservicedeliverysystem.Eachconditionissupportedbyexamplesfromthecohortparticipants.
• Table3istheSummaryofChallengesthatcanbeaddressedthroughaQualityImprovementProcess–thistable
highlightsmajoropportunitiesthatcanimprovethemodeldeliverysystem.Itdescribespotentialsolutionsandthoughtsandinsightsfromthecohortparticipants.
Theauthorshopethatcommunitypharmacistsfindtheinformationcontainedbelowhelpfulinbringinghigh-riskpatientsintheirpracticetogoalineachoftheirhealthconditions.
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Table1.BlueprintforServiceDeliverySystemBestPracticethatdefineahighperformingintegrateddeliverysystemwithcommunitypharmacistsdeliveringmedicationtherapymanagementservices.
PracticeStrategiesThatDefineTheNatureoftheIntegratedDeliverySystemEnvisionedbyCommunityPharmacy
BestPractice:(Definingelementsandperformanceprinciples) LeadingSitesDemonstratingtheBestPractice
1. LeveragethepersonalrelationshipsdevelopedbetweentheCommunityPharmacists&Patients/Family
MovePharmacistsfromdispensingroletoprovidingeducationinteractionwithcustomer/patient.Encouragepharmacist’sengagementofeachpatientandprovidetoolstofurtherdevelopmotivationalinterviewingskills.(Meyer)
Wehavegoodrelationshipswithourpatientsandusepatient“CommunicationSlips”tocommunicatedosechanges,questions,clarifications,andspecificconsultnotes.Wealsodocumentday-to-dayinterventionselectronicallyinourdispensingsystem,althoughdonothaveagoodwaytoquantifytheinterventionsyet.(MeyerPharmacy)Wehavepharmacistsremovedfromworkflowdedicatedtocompletingeducationalsessionswithpatients.Beyondourpersonalpatientcarestandardsweutilizeourdispensingteamtorecruitforourappointmentbasesservices.(SUPERVALU)EncourageDSMEclassattendeestoinvitefamilymembersandclosefriendswhoarepartoftheirsupportsystemtotheclasses.(AppleDiscountDrugs)
2. FreeupPharmaciststimetobestutilizeskillsandeducation
FocusPharmacistsworkon:1)achievingtherapeuticoutcomes;2)safetherapy&3)effectivetherapy.Furthertrainandintegratetheuseoftechnicianssothatpharmacist’swillhavemoretimetofocusonclinicalinterventionandreview.(Meyer)
Useroboticsinthepharmacytohelpstreamlineworkflowandtraintechnicianstafftopracticeatthetopoftheirlicense.(SUPERVALU)
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Table1.BlueprintforServiceDeliverySystemBestPracticethatdefineahighperformingintegrateddeliverysystemwithcommunitypharmacistsdeliveringmedicationtherapymanagementservices.
PracticeStrategiesThatDefineTheNatureoftheIntegratedDeliverySystemEnvisionedbyCommunityPharmacy
BestPractice:(Definingelementsandperformanceprinciples) LeadingSitesDemonstratingtheBestPractice
3. Createmechanismfornaturaldocumentationofinterventionsaccessiblebyhealthcareteam
Documentinterventionsinsharedelectronicmedicalrecords Pharmacycommunicateswiththerestofthe
healthcareteamthroughtheelectronicmedicalrecord.Inadditiontousingthismeanstoclarifyprescriptionsandmakerecommendations,pharmacistsdocumentassessmentsofpatients’diabetesmanagement.(HealthPartners)WehaveanintegratedsystemtodocumentDTPsandfacilitatecommunicationwithlocalproviders.Further,weprovideproviderswithasummarytheirpatientsappointment-basedservices.(SUPERVALU-)
4. Reviewonthetherapeuticendpointssothatallpharmacistscanfeelupdatedwithnewguidelines
ReviewJNC8andADAendpointssoastoensurepharmacistsfeelconfidentaboutthetherapymanagementandinterventionsneeded
WepurchasedtheACCPTherapeuticsReviewCEforeachofourpharmaciststostayupdatedonnewguidelinesandrecommendations.(MeyerPharmacy)
5.Createrelationshipswithproviderstodemonstratevalue
Providesoundrecommendationsthatmattertopatientandprovideroutcomesandvalues
Communicatewithlocalproviders.Conductprovideroutreach.Utilizestudentdeveloped,residenteditednewslettertoprovideclinicalupdatestotheproviders.(SUPERVALU)Bi-annualnewslettersenttoprovidershighlightingoutcomes,servicesprovided,andrecentresearchofinterestonpharmacybeinganactivememberofthepatientcarecontinuum.(AppleDiscountDrugs)
6.Developingrelationshipswithprovidersinthecommunity
Reachouttolocalclinicgroupsexplainingwhatpharmacycandotohelpthemoutandhowthey
Wehavemetwithsomeoftheprimarypracticesinourcommunitytosharemoreaboutthe
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Table1.BlueprintforServiceDeliverySystemBestPracticethatdefineahighperformingintegrateddeliverysystemwithcommunitypharmacistsdeliveringmedicationtherapymanagementservices.
PracticeStrategiesThatDefineTheNatureoftheIntegratedDeliverySystemEnvisionedbyCommunityPharmacy
BestPractice:(Definingelementsandperformanceprinciples) LeadingSitesDemonstratingtheBestPractice
arealreadyhelpingimprovethehealthoftheirpatients.
servicesthatwecurrentlyoffertoimproveourpatient’scareandtheclinicalprogramwehopetogrowmovingforward.(MeyerPharmacy)Pharmacists-in-Chargeattendclinicprovidermeetingstostayupdatedonclinicinitiativeandexplaintoproviderswhatpharmacycanoffer.(HealthPartners)Communicatewithlocalproviders.Conductprovideroutreach.Utilizestudentdeveloped,residenteditednewslettertoprovideclinicalupdatestotheproviders.(SUPERVALU)
7.Definedservicewithdefinedgoals-geteveryoneinthepharmacyonboardwiththeplan
Ensurethateveryonethattalkstopatientsinthepharmacyknowswhatservicesthepharmacycanofferandwhomightbenefitfromtheseservices.
8.Createanenvironmentwithinthecommunitypharmacythatemphasizesqualityserviceandpromotesclinicalinterventiontoimprovepatientoutcomes.
Providecontinuingeducation,training,andreviewworkshopstobuildastrongfoundationforstafftofurtherengagepatientsandprovidequalityclinicalservice.Activelyinvolvepharmacystaffandshareorganizationalgoalstoreinforcethevitalrolethatcommunitypharmacistsandtechnicianscanplayinimprovingclinicaloutcomes.
WepurchasedtheACCPTherapeuticsReviewCEforeachofourpharmaciststostayupdatedonnewguidelinesandrecommendations.(MeyerPharmacy)
9.Creatinganewparadigmwithinthecommunitypharmacy
1.Changingjobdescriptions2.Changingresponsibilities
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Table1.BlueprintforServiceDeliverySystemBestPracticethatdefineahighperformingintegrateddeliverysystemwithcommunitypharmacistsdeliveringmedicationtherapymanagementservices.
PracticeStrategiesThatDefineTheNatureoftheIntegratedDeliverySystemEnvisionedbyCommunityPharmacy
BestPractice:(Definingelementsandperformanceprinciples) LeadingSitesDemonstratingtheBestPractice
practicewithstaffengagementtomovetoanewmodelofpatientcare
3.Redesigningthepharmacytosupportpatientcare
10.Deliveringadifferentmodelofpatientcarewithinthecommunitypharmacy
1.Changingworkflow2.Techniciandrivendispensingprocess3.Pharmacistsprovidingcontinuousmedicationmonitoring(prospectiveDUR)services
4.Pharmacistdocumentingtheircare.
Wearecurrentlydecidinghowtorestructureourworkflowprocesstofreeupforpharmacisttimeforclinicalreviewandinterventionsbuthavenotimplementedanythingyet.(MeyerPharmacy)Currentlydocumentsignificantinterventionsinrealtimeaspartofthepatientprofileinaspecific“MTM”fieldthatwillflagifnotcompletedorfollowupisneeded.Alsoabletodocumentlabvaluesthathavebeenreportedandcanbefollowedtoidentifytrends.(MeyerPharmacy)NowincludingdepressionandsleepapneascreeningsintoDSMEtofacilitateidentificationofhighriskpatientstoachievebetteroutcomesandtotalpatienthealth.(AppleDiscountDrugs)
11.Marketingthe“newtype”ofpracticetopatientsandkeystakeholders
1.Patientdiscussions/counselingsessions.2.Sendingfaxestophysicianswithclinicalinterventions/recommendations
3.Meetingwithphysicians/prescriberstodiscussthechangesoccurringinthepharmacy
Developedastandardformtocommunicateinterventionsanddrugtherapyproblemstoprovidersbyfax.Developedastandardizedformtorequestspecificlabvaluesbyfax.(MeyerPharmacy)
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Table1.BlueprintforServiceDeliverySystemBestPracticethatdefineahighperformingintegrateddeliverysystemwithcommunitypharmacistsdeliveringmedicationtherapymanagementservices.
PracticeStrategiesThatDefineTheNatureoftheIntegratedDeliverySystemEnvisionedbyCommunityPharmacy
BestPractice:(Definingelementsandperformanceprinciples) LeadingSitesDemonstratingtheBestPractice
4.Meetingwithotherkeystakeholders(e.g.healthsystems,ACOs,long-termcareorganizations,visitingnurses,etc.)todiscussthechangesoccurringinthepharmacy
Havemetwithlocalproviderstomakeawareofourgoaltoimproveourpatient’soutcomesbytakingamoreactiveroleintheircareanddiscusssomeoftheinitiativesofourclinicalfocusedprogram.(MeyerPharmacy)Useourmedsynchronizationprogramasasellingpointtopatientsandthenpromoteanddiscussthemoreindepthmonitoringandclinicalserviceweareabletoofferthemaspartofthat.ThesyncprocesscreatesvalueforthepatientbecauseittakessomeoftherefillresponsibilityfromthemandgivesusanopportunitytocompleteaCMRandmedreviewtogetstarted.(MeyerPharmacy)
Utilizingourpharmacystafftopromoteserviceslocallyandutilizingourclinicalleadershipteamtomarketservicesanddevelop/expandclinicalserviceswithothercommunityleaders.(SUPERVALU)
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Table2.ContextCreatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive
Conditionsthatmustbeinplaceforthenewservicedeliverysystemtoform
Howthoseconditionsarecreated Sitedemonstratingthestrategytocreatetherequiredconditions
1. Partnershipswithothercommunityorganizations
Identifycommongoalsandaimsandassertivelysolicitotherorganizationstojoininachievingthem.Createvaluebyfocusingontheuniquepositionthatcommunitypharmacyholdstoengagepatientsandevaluateadherencedata,akeypiecetosuccessfuloutcomes.
Wehaveusedourdispensingsoftware’sabilitytocreatean“AdherenceReportCard”thatevaluatesrefilldataandMedicationPossessionRatioasatalkingpointinourmeetingswithpotentialpartners.(MeyerPharmacy)
Communityoutreachutilizingpharmacyteamstocollaborateanddevelopopportunitiestoeducatecommunitiesandincreasecompetenciestopreventmedicationerrorsandpromotingproactivehealthcare.Findcommonground,commit,andexecute.(SUPERVALU)Workwiththelocalschoolofpharmacyaswellasmultiplelocalcharitablehealthcareorganizationswithinthecommunity.(AppleDiscountDrugs)
2. Supportandengagementfrompharmacyteam
Encourageinputfromallstaffonthedesignandworkflowofservices
Staffprovidedinputontheprocessofflaggingourpatientswithasthmaduringworkflow.Pharmacistswereshowedhowtoextractinformationoutofthemedicalrecord(ACTscores&asthmamanagementplans)touseasacounselingtoolatthewindow.(HealthPartners)Trainandsolicitfeedbackfromallstaffmembers.(SUPERVALU)
3. Technologicalsupportataninter-storelevel
CreatingastandardexcelsheetorotherprogramwhichcanbeaccessedatthestoreanddoesnotneedWi-Fi(Internetservice)toaccess.
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Table2.ContextCreatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive
Conditionsthatmustbeinplaceforthenewservicedeliverysystemtoform
Howthoseconditionsarecreated Sitedemonstratingthestrategytocreatetherequiredconditions
4. Buildprojectintostandardofcareincorporatinggoalsandobjectivesoftheprojectasoutlinedabove
Staffshouldhaveobjectivesinstandardofcaregiventoallpatientstoensureitiscompletedinaconsistentfashion.
5. Leveragetechnologyandinnovationtofreepharmacisttime
Automateddispensing,tech-check-tech Weusecentralfillandmedicationsynchronizationtoattempttostreamlineourprocessinthepharmacy.(HealthPartners)BlockingoffclinicalpharmacisttimeformeetingwithpatientsinthecontextofMTM,DSME,etc.(AppleDiscountDrugs)
6. Supportfrompharmacymanagement
Discussimportanceofservicewithmanagement.Securepaymentforservicesthatshowsthevalue.
Lobbyideasandnewopportunitiestotheleadershipteam.Ifit’sagoodidea,they’llsupportitandguideustotheappropriateresources.(SUPERVALU)
7. Creatingadefinedprocesssothateachpharmacist/studentperformingtheserviceisprovidingthesamecomprehensivepatientcare
Definingprotocolsforservices,developingdocumentationtemplates,implementingaqualityimprovementprocesstoensurethateveryoneisfunctioningatthesamehighlevel.
Createserviceoutlinesandtrainstaffaccordingly.(SUPERVALU)Allclinicalservicesaredefinedbywrittenpoliciesandprocedurescompiledonthecompanyweb.(AppleDiscountDrugs)
8. Effectivemeansofcommunicatingbetweenhealthcaresettings.
Developeffectiveandefficientwaysofcommunicatingbetweenhealthsettingsandtransitionsofcare.
Havedevelopedstandardizedfaxformstocommunicatetoprovidersaboutclinicalinterventions.Automaticallyreceivefaxdischargeordersfromthelocalhospital’spharmacydepartmentwhenapatientisreleased.(MeyerPharmacy)
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Table2.ContextCreatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive
Conditionsthatmustbeinplaceforthenewservicedeliverysystemtoform
Howthoseconditionsarecreated Sitedemonstratingthestrategytocreatetherequiredconditions
PharmacycommunicateswiththerestofthehealthcareteamthroughtheelectronicmedicalrecordusingproviderIn-Basketmessages.(HealthPartners)Utilizeservicecustomizedformstofollowupandcommunicatewithothermembersofthepatient’shealthcareteam.(SUPERVALU)
9. Workplaceenvironmentsuitabletomeetingwithpatientsforappointmentsandindepthcounseling.
Createaworkspaceawayfromtheprimarydispensingfunctionswherepharmacistscanreviewprofilesandmeetwithpatientswithoutbeinginterruptedbydailyretailpharmacyactions.Provideasecureandwelcomingenvironmentconducivetocounselingandclinicalreview.(Thischangecanhelpalterthe“patient’sperspective”ofhowretailpharmacyisviewed)
Currentremodelofourpharmacyhascreatedaprivateconsultationroomthatisidealforascheduledmeetingwithpatients.Alsowillallowapatienttofeelmorecomfortablebecausetheyaren’tinthemiddleofthebusypharmacy.(MeyerPharmacy)Manypharmacieshaveprivateconsultationroomstomeetwithpatientsawayfromthepharmacywindow.(HealthPartners)Buildclinicalareasinremodelsandmakedowithwhatyouhavebeforetheremodels.Mostofourpharmaciesutilizeprivacyscreensinlowtrafficareas.(SUPERVALU)
10. Utilizationofsupportstaffwiththegoaltofreeupthepharmacist
1. 1.Techniciandrivendispensing2. Dependingonstatelaw:Tech-check-Tech
dispensingmodels3. Pharmacistsarefreeduptoprovide
prospectiveDURservicesalsocalledcontinuousmedicationmonitoring(CMM)
4. Staffacceptance
Trainanddevelopstafftopracticeatthetopoftheirlicense.Leveragetherelationshiptheteamshavewiththecommunitytoachieveprogramsuccess.(SUPERVALU)
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Table2.ContextCreatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive
Conditionsthatmustbeinplaceforthenewservicedeliverysystemtoform
Howthoseconditionsarecreated Sitedemonstratingthestrategytocreatetherequiredconditions
11. UtilizationofTechnologywiththegoaltofreeupthepharmacist
1. Useofrobotstoprovideautomateddispensingfunctions
2. Staffacceptance
UtilizeaScriptProrobotfordispensing.(MeyerPharmacy)Schedulingtools,schedulingservices,etc.(SUPERVALU)
12. Utilizingdispensingstrategiestocreateefficienciesinthepharmacywiththegoaltofreeupthepharmacist
1. Providingmedicationsynchronizationservices
2. Identifyingandrecruitingpatientswhoaregoodcandidatesformedsync.
3. Staffacceptance
Syncprogramactiveforabout1year.Needtousetechniciansduringthisprocessalittlemore.AlsoofferaMedPackagingservicethatisprettypopular.(MeyerPharmacy)Weusecentralfillandmedicationsynchronizationtoattempttostreamlineourprocessinthepharmacy.(HealthPartners)Automationandcentralfill(SUPERVALU)
13. Efficientdocumentationsystemsthatcommunicatewithdispensingsystems
1. Workingwithvendorsofdispensingsystemstofindbettersolutionsfordocumentingclinicalactivities
2. Attheveryleast,createapaperbasedsystemtodocumentpatientcareactivities
HavecontactedoursoftwarevendortosuggestaSOAPnotebaseddocumentationupdate,butdonothaveanythinglikethatyet.(MeyerPharmacy)
14. Strengthencommunicationbetweeninterdisciplinaryworkerswithinthepharmacy.(I.e.surgical,respiratory,pharmacy,infusion).Interdisciplinaryprofessionalsseepatientswithinthepharmacyforavarietyofhealthneeds.Besurethateffectivecommunicationskillsare
1. Hostinterdisciplinarycontinuingeducationonsite.
2. Communicateappropriateclinicaldatabetweendepartments.
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Table2.ContextCreatingconditionsthatneedtobeinplaceforthenewservicedeliverysystemtoemergeandthrive
Conditionsthatmustbeinplaceforthenewservicedeliverysystemtoform
Howthoseconditionsarecreated Sitedemonstratingthestrategytocreatetherequiredconditions
presenttoensurethatpatientcareiscontinuousbetweendepartments.
Table3.ChallengestoaddressthroughPDSAprocess.Opportunitiestofurtherdevelopandadvancethedeliverysystemmodel
Majoropportunitiesthatwillimprovethemodeldeliverysystem Possiblesolutionstotest. Sitescurrentlypursuingtheopportunityina
systematicwaywithmethodanddiscipline1. Createread/writecapability
withlocalproviderElectronicHealthRecords
Localhospitals,insurancecompanies,primarycarephysicians
Oursystemcanautofaxnotes,butwearenottrulyintegrated.(SUPERVALU-)
2. Expandfocustomorecomprehensivecarefromdisease-specificfocus
Testaddressingcurrentlytargetedpatientsmorecomprehensively.
RatherthanaspecificPoFweareapproachingpatientsthatappeartobehighriskorinneedofadditionalserviceingeneralandmorecomprehensively.Thisallowsustoreachmoreofourpatientpopulationandwetrytodoamorecompletereviewduringourdailyfunctions.Becauseofoursmallercommunityweknowmanyofourpatientsandareabletoidentifywhichonesmaybenefitfromadditionalmonitoring.(MeyerPharmacy)Completecomprehensivereviewsbillablethroughavarietyofplatforms.(SUPERVALU-)
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Table3.ChallengestoaddressthroughPDSAprocess.Opportunitiestofurtherdevelopandadvancethedeliverysystemmodel
Majoropportunitiesthatwillimprovethemodeldeliverysystem Possiblesolutionstotest. Sitescurrentlypursuingtheopportunityina
systematicwaywithmethodanddiscipline3. Abilitytogetpatientsto
adherewithscheduledtimeforservice
Schedulingfunctionalitynotavailable,butwouldbehelpful.Incentivestoensurepatientswouldattendscheduledsessions/appts.(i.e.acontrolgroupwithincentive)
Utilizesupportstaffandautomationtomakepersonalizedremindercalls.We’vestudiedthisanddeterminedthepharmacyteamtobemosteffectiveatreducingtheno-showrate.(SUPERVALU)
4. Timeandadaptationbyotherpharmacists
Createanddevelopamodelwheretheobjectivesareincorporatedindailyfunctionsofstaff,butnomoreworkisrequired.
5. HowtointerestprovidersinbeginningCPSifnotalreadyinplace
• Tailorthe“ask”toproviders’timeandinterestlevel
• Beginprovidingservicestothepatientsofaspecificproviderthenapproachwithactualdata/interventionsofvalue
• Leverageavailableresources(i.e.:QIN-QIO)toseeinwhatarea(s)aproviderneedshelpthenapproachwithinterventionsspecifictotheirneeds
Wehavebeendocumentingourinterventionsthatweoftenmakeonadailybasiswithahopetousethemasanexamplewhenwemeetwithprovidersagain.Initiallywetriedtosetupasystemdirectlywiththephysicianfromthebeginningbuttherewasn’tmuchinterestsowesimplystarteddocumentingandsuggestinginterventionsandwillusethisinformationtofurtherdevelopourprogrammovingforward.
6. Reliablepaymentforservices Providerstatus,contractingwithphysiciangroups,insurancecompanies,etc.
Goodrichsaiditall.Providerstatusisnotrequiredtobillforourservices(SUPERVALU)RecognizedbyCareFirstasapreferredprimaryproviderfordiabeteseducationontheEasternShoreandtheyareactivelyreferringintoourprogram.(AppleDiscountDrugs)
7. Effectivepatientrecruitment Differenttypesofoutreach,differentphrasingwhenspeakingtopatients
Utilizepharmacystafftoleveragerelationships.UtilizereferralsfromPBMsandotherhealthcareentities.(SUPERVALU)Usingourmarketingdirectortoremindprovidersaboutourclinicalservicesthatcan
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Table3.ChallengestoaddressthroughPDSAprocess.Opportunitiestofurtherdevelopandadvancethedeliverysystemmodel
Majoropportunitiesthatwillimprovethemodeldeliverysystem Possiblesolutionstotest. Sitescurrentlypursuingtheopportunityina
systematicwaywithmethodanddisciplineaugmentthePCPservices.(AppleDiscountDrugs).
8. Exploredifferentwaytogeneraterevenuefromaclinicalpharmacyservice.
9. Testpaymentstrategieswithpayersthatemphasizepatientcare/outcomes
1. Payforperformance2. Prospectivepaymentsforcareand
retrospectivesharedcostsavings3. Developmentofhigh-performingpharmacy
networks
Metwithacommercialpayertonegotiateprospectivepaymentforservice/improvingpatientoutcomesinapayforperformancemodel(perpatient/permonth)nextyearaspartofahigh-performingpharmacynetwork.(MeyerPharmacy)Reviewcontractscloselytofindopportunitiestobereimbursedforpatientcare.(SUPERVALU)
10. CreatenewpartnershipswithhealthsystemsandACOs
1. Sharingpatientinformation2. Communitypharmacistsintegratedinto
patientcaredeliverysystems.3. Pharmacistsprovidingclinicalinterventions4. Measuringpatientoutcomes
Recentlyworkedwiththehospitalpharmacistdirectlyandhomehealthtocompleteamedreconaveryhighriskpatientthatwehavebeentryingtohelpforseveralmonths.Activelycounseledandplantofollowupregularlynow.Goingtopursueworkingdirectlywiththehospitalpharmacywhenpatientsaredischargedforfuturecomplexcasestohelpdecreasetherisksofreadmission.(havenotmetwithhealthcentertodiscussfuturecollaborationyet).(MeyerPharmacy)Reachouttootherhealthcareentitiesandfindcommongroundtodeveloprelationshipsandnewinitiatives.(SUPERVALU)