We often equate regulatory mandates to government overreaching that impose roadblocks, which prevent pharmacists from providing solid healthcare to patients. However, changes and goals stemming from the Affordable Care Act (ACA) could actually give community pharmacies a new competitive advantage.
In North Carolina, collaborating pharmacies looked at the pharmacists’ role in a new light. What they discovered has taken root in the Tar Heel State and is starting to branch out across the country and is most likely an effort already being discussed in your state.
Several years ago, Community Care of North Carolina (CCNC) began looking at changes stemming from the ACA. The group knew pharmacists had to be included in the healthcare loop to a greater degree. With the goal to improve patient outcomes, pharmacists needed a voice in the process beyond dispensing prescriptions. In 2014, CCNC launched the Community Pharmacy Enhanced Services Network (CPESN™) initiative. CPESN is designed to improve the quality of healthcare and patient outcomes through optimal medication management.
“The idea behind CPESN is to involve community pharmacies that have an interest in reducing the total cost of healthcare with complex patients by offering enhanced services,” said Ashley Branham, Pharm.D., BCACP, director of Network Development and Marketing for CPESN USA, LLC and director of Clinical Services for Moose Pharmacy in Concord, NC.
CPESN is part of a three-year grant funded by the Centers for Medicare and Medicaid Innovation to test new reimbursement models for community pharmacies. CPESN is based on the collaborative-care model where community pharmacists are integrated as participants in the medical home-care team. QS/1 is a proud partner in this effort, helping provide software resources to give pharmacies leverage to participate in CPESN.
“Pharmacists are already key players in healthcare,” said Ed Vess, R.Ph. and senior manager of Market Analysts at QS/1. “What CPESN can do is show providers how picking the right pharmacists can help them improve ratings when working with Medicare patients.”
Many patients, especially those in rural areas, are more likely to visit a pharmacy and seek the pharmacist’s advice rather than making an appointment to see a physician. CCNC saw an opportunity to capitalize on that statistic. The group believed pharmacists could use their expertise to work closely with patients to help make changes to not only how they were taking their medications but also changes in lifestyle that could improve outcomes.
“While patients may see many doctors, they typically only visit one pharmacy,” Vess added. “While one doctor may not be aware of what another is prescribing, the pharmacist sees the big picture by having the advantage of seeing all of the medications a patient is taking. From there, he can offer advice and make suggestions to help improve that person’s health.”
It’s more than the specific medications that patient is taking. It is equally about medication adherence. Not taking a prescription regularly can have costly effects.
“Pharmacists are also a key component to helping improve medication adherence,” Branham added. “The doctor isn’t always aware if the patient is taking a medication as prescribed. However, pharmacies can track whether the patient is refilling prescriptions on schedule. If the patient is not, pharmacy staff can intervene to help get that person back on track.”
The consequences of not taking drugs as prescribed by the provider can lead to more expensive measures down the road, such as hospital visits that would otherwise be unnecessary had the patient been adherent to the doctor’s instructions. Pharmacists, in essence, become gatekeepers who see what is happening, and what is not happening, between the provider and patient between visits.
“This is the new way pharmacists should view their role,” Vess stated. “The core dispensing services are essential and are in no way diminished in the CPESN model. What does change is the pharmacist becomes more involved in the patient’s overall health and plays a significant role in improving that patient’s outcomes.”
The Department of Health & Human Services is considering a plan to tie more than half of Medicare provider payments to how well providers care for patients rather than how much they provide. CPESN’s approach could mean physicians will want to refer patients to pharmacies that can help them improve quality of care.
“This is a voluntary network where pharmacies that are performing well benefit from referrals,” Branham said. “When pharmacies let providers know they are there to help reinforce patient care and educate them on the types of services they perform, community pharmacies will increase their customer base.”
For pharmacies that adopt this business model and show performance in quality of care, the benefit could be a rush of new patients coming from doctors in the area. When providers see the role pharmacists and their staff play makes a difference, they will want them to be a part of their network.
When asked about the future of healthcare, Branham says CPESN is not overly concerned with promises from the current administration to repeal the ACA.
“We know we are in the process of health reform,” Branham said. “We feel strongly that if we continue this course of action, it will still be beneficial to community pharmacies. Various payment models will start paying pharmacies differently for enhanced service to reduce the total cost of care.” When CPESN started in 2014, more than 60 North Carolina pharmacies came together to join the effort. A year later, it began to expand the effort nationwide by forming the Multi-State High Performing Community Pharmacy Collaborative (MSPC). MSPC oversees the expansion and helps connect pharmacies and other pharmacy stakeholders that have an interest in patient-centered care. CCNC is working with 35 states that want to develop their own CPESN program. CPESN is sharing what it has learned in North Carolina with pharmacies in other states. It is a voluntary program that allows pharmacies to sign up and participate. Once you are a part of the program, you can share in the wealth of knowledge that can help all pharmacies achieve better care for current patients and bring new patients through the door. For community pharmacies, this model is an ideal way to create care-team relationships by offering clinical activities and establishing relationships and reimbursement models with purchasers of value.
“We believe that not all community pharmacies are the same,” Branham explained. “Community pharmacies that want to be a part of the CPESN focus on building relationships with patients and the extended medical neighborhood. We believe these relationships and the enhanced services offered to support the needs of patients are what set CPESN pharmacies apart.”
CCNC is embarking on the next phase of the program called the Pharmacist eCare Plan. More than 40 QS/1 pharmacies will participate in the pilot program that will help healthcare providers and pharmacists work with patients to make lifestyle changes to improve their health. Action plans to implement those changes will be developed.
For more information on CPESN and how to participate, visit the group’s website at https://cpesn.com/.