Taking into consideration the phrase, “medications do not work in patients who do not take them,” and the statistic that 50 percent of the patients that enter your pharmacy suffer from a chronic condition, it stands to reason that the healthcare community is becoming more focused on patient adherence.1
Multiple studies have referenced 80 percent medication adherence as the threshold at which patients can benefit from chronic medications to improve outcomes and reduce the risk of further complications while decreasing overall disease-related costs.2,3
Most pharmacists appreciate the need for better patient adherence and the opportunity for a medication synchronization program to be part of a patient’s adherence solution. However, the challenges of implementing a new process in the pharmacy can be intimidating, and the decision to disrupt the staff and current workflow with a new program that will require additional training and new processes can be overwhelming.
The motivation to implement a medication synchronization program generates from understanding the impact it could have on patients, workflow, finances and performance.
It is without question that medication synchronization addresses many of the challenges of patient adherence and develops appointment-based adherence in patients. Better adherence has demonstrated improved outcomes and decreased risk, yielding healthier patients.
Furthermore, medication synchronization can have a meaningful impact on customer service and patient convenience. In addition to reduced pharmacy visits, patients and staff may experience less unproductive, negative interactions and engage in more meaningful interactions.
Medication Synchronization Program
The process of coordinating all of a patient’s chronic medications to be filled at the same time each month, offering a convenient solution focused on customer service.
Pharmacy Workflow Definition
The process of proactively anticipating the chronic prescription reordering process, efficiently counting and checking all of a patient’s chronic medications per month and consolidating checkouts or deliveries to the patient.
Pharmacy Management Definition
The process of scheduling staff to proactively and efficiently process chronic-medication prescriptions, managing inventory with an on-demand mentality, interacting with patients for a more meaningful outcome and reducing duplications to save time and expense.
Imagine the experience patients would have in your pharmacy if conversations about lack of refills, out-of-stock medications, prior authorizations and insurance issues could be replaced by conversations about recommended therapies, disease-state questions or immunization recommendations? Synchronization offers the solution of advanced pharmacy processing to identify and resolve prescription and insurance issues prior to the patient’s need for the medication. It also provides the pharmacist an opportunity to review a patient’s chronic medications to identify meaningful opportunities for healthier outcomes.
Perhaps the most underestimated of synchronization impacts is workflow. A synchronization program expanded to a significant number of patients creates a substantial opportunity for a more efficient pharmacy.
A synchronization program identifies prescriptions that are due to be filled prior to the patient depleting their home supply, and pharmacies should envision a workflow with significantly less incoming calls for refill requests, fewer patients waiting for prescription refills, reduced monthly checkouts and consolidated patient deliveries. Answering incoming phone calls, checking patients out in the pharmacy and preparing and processing deliveries accounts for a significant amount of time, and in turn, dollars in the pharmacy’s budget.
Improved medication adherence correlates to more prescriptions per patient which improves outcomes and decreases overall costs to the system. For the pharmacy, increased prescription volume dilutes the per-prescription cost of dispensing, resulting in increased profitability.
In a pharmacy workflow designed for medication synchronization, the pharmacy can process more prescriptions more efficiently; accurately schedule staffing to meet the anticipated demands of workflow; and order and manage inventory more effectively – providing a more cost-effective and organized pharmacy operation.
Although the impact of improved performance may not be obvious to a pharmacy immediately, pharmacies across the country have demonstrated the impact of a synchronization program on adherence scores. The projected models indicate that insurance plans will, in fact, pay for performance. Even today, some insurance plans assess direct and indirect remuneration, known as DIR fees, on a sliding scale based on pharmacy adherence scores.
Additionally, the impact on workflow will allow pharmacies to focus on additional performance measures, programs, services or opportunities to improve or grow their businesses, including clinical services, such as immunizations and medication therapy management.
Challenges and Opportunities
While a medication synchronization program may improve adherence rates and remove many barriers to adherence, it still may not translate to patients taking their medications correctly at home. However, with a well-designed synchronization workflow, pharmacists can have more meaningful interactions with patients.
Pharmacists are tasked with the challenge, and the opportunity, of identifying patients who do not meet the threshold for adherence and providing counseling to identify and offer a patient-specific solution to improve medication administration in the home.
Adherence solutions may include medication pill boxes or compliance packaging, administration records, reminder communications or scheduled alarms. All of these patient-specific solutions will be more successful as part of a synchronization program that coordinates prescription refills. Pharmacists and technicians must be mindful that not every solution will be right for every patient. Some patients may require a combination of solutions and, ultimately, patients depend on the pharmacy team to help find the solution.
Options in Synchronization
Today, there are a variety of synchronization model programs with options, including 28- or 30-day dispensing, daily or consolidated workflow, pre- or post-call, vial- or compliance-package dispensing, appointment-based, and finally, whether the program is driven by paper and pencil, software or third-party platform. Additionally, pharmacies have adapted their programs to utilize varying levels of technology and automation. With these options in mind, pharmacies must design and implement processes that will be successful and sustainable for the members of the pharmacy team, the pharmacy operation and the patients who receive the services.
The QS/1 Impact
QS/1’s software offers multiple approaches for improving adherence, including cycle fill reports, Health-Minder®, adherence reporting, InstantFill® and Tickler files to simplify and schedule workflow. Used together, QS/1’s software features can create an efficient and sustainable workflow for a successful synchronization program.
Medication synchronization is being embraced by pharmacists across the county as a tool for improving adherence and a solution for pharmacy workflow. An expanded program and structured workflow will create a better customer experience, a more organized and efficient pharmacy team, a more cost-effective pharmacy operation and a positive step towards a model that’s shifting towards paying for performance.
1 Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. Karve, Sudeep, Mario A. Cleves, Mark Helm, Teresa J. Hudson, Donna S. West, and Bradley C. Martin. “Good and Poor Adherence: Optimal Cut-point for Adherence Measures Using Administrative Claims Data.” Current Medical Research and Opinion 25.9 (2009): 2303-310. Web.
2 Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality; 2014. Accessed October 30, 2015.
3 Sokol, Michael C., Kimberly A. Mcguigan, Robert R. Verbrugge, and Robert S. Epstein. “Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost.” Medical Care 43.6 (2005): 521-30. Web.