Of all the caregivers a patient encounters, community pharmacists are often the most accessible. There is increasing focus on how their availability and clinical know-how can be used to create better outcomes for patients, particularly the high-risk and chronically ill. While enhanced services should be within the scope of almost all pharmacies, often they’re not provided due to workload and time constraints. Community Pharmacy Enhanced Services Networks (CPESNs) offer a promising new way to help pharmacists differentiate themselves by providing these services.
CPESNs provide tools and support to help member pharmacies improve patient health through optimal medication use; members agree to provide enhanced services beyond dispensing and basic patient education. The goal is to help pharmacies that provide these additional services gain higher reimbursement rates compared to pharmacies that only focus on filling prescriptions. While these services could be provided to individual patients at their expense, CPESN pharmacies show their value by grouping multiple services to many patients and tracking the improved outcomes. Third-party payers are taking notice.
Pharmacies pay a membership fee that allows them to participate in a clinically integrated network. Most networks are state-based, but there’s no limit of one network per state. Each state has several luminaries who provide guidance and direction for the network. QS/1’s Ed Vess, R.Ph., serves as a luminary for South Carolina. Ed said the networks’ ability to show pharmacists’ value offers hope for those dealing with declining profit margins.1
All member pharmacies must provide a list of core services. This minimum service set is required for participation, although networks may add to the service set as they see fit (think transitions of care, chronic care management, pharmacogenomics, point-of-care testing, and more). The services are described below, including what they entail and how to use your existing QS/1 community pharmacy software to make them happen.
eCare Plan (Will be required by CPESN effective December 31, 2018)
What: An electronic document with details like a patient’s current medication regimen, drug therapy problems, medication support needs, the pharmacy’s interventions, and the patient’s health outcomes over time. eCare Plans are easily shared with other healthcare providers because they’re based on the common technical language for electronic health records: HL7 C-COA (or HL7 FHIR) and SNOMED CT (Systemized Nomenclature of Medicine – Clinical Terms). For example, “low sodium diet” is expressed as the code 11816003 for any provider using these records.
How: QS/1 participated in the eCare Plan pilot sponsored by Community Care of North Carolina (CCNC), and we built an eCare Plan feature into NRx and PrimeCare GUI at no charge. The software can submit eCare Plans to CPESN-USA, and work is underway to expand this. We also offer interfaces to STRAND and PrescribeWellness, vendors focused on patient care coordination and adherence. See Quick Clicks & Tips (p.4) and Updates (p.31) about eCare Plans, for more information on exactly how to create and submit eCare Plans using our software.
Comprehensive Medication Management
Personal Medication Record (PMR)
What: Creating a comprehensive list of current patient medications manually or from dispensing software; the PMR should include prescription and nonprescription medications, herbal products, and other dietary supplements.
How: Reports from QS/1’s Patient Chart help provide legible PMRs for the healthcare team. The many selectable data fields include medication name, directions, physician, and last fill date.
What: Comparing a patient’s new medication orders to everything the patient has been taking to avoid duplication and errors, especially during vulnerable periods like care transitions.
How: QS/1’s Patient Records, including the Patient Chart, have numerous sortable data fields that help optimize efficiency when doing cross references. For example, the last fill date can be especially valuable to assess the potential for patients to wrongly resume a medication stored at home if they’re not warned about it.
Comprehensive Medication Reviews
What: Providing a systematic assessment of medications to identify drug therapy problems, prioritize those problems, and create a patient-specific, documented plan to resolve them by working and sharing information with the extended healthcare team.
How: In QS/1 software, the Patient Chart is where you can document non-prescription medications, store lab values, and create SOAP notes (an acronym for subjective, objective, assessment, and plan) for customer visits. The software also includes both manual medication therapy management (MTM) features and optional integration with Mirixa® and OutcomesMTM®.
Medication Adherence Programs (Medication Synchronization)
What: Aligning a patient’s routine refills for the same time each month, in conjunction with the pharmacist’s clinical disease-state management and monitoring, to progress toward desired therapeutic goals. Increasingly common in the industry, the benefits are many: customers get increased convenience and better medication adherence while pharmacies build store loyalty and better plan the timing of patients’ store visits, which helps with inventory management, staffing, and delivery.
How: NRx and PrimeCare offer Cycle Rx, a tool to create and maintain a synchronized fill date, including short-fill calculations. Then the software’s Health-Minder tool handles the refill reminder task, creating a report of upcoming refills for patients participating in the Cycle Rx program. This report can be scheduled in advance and can send these prescriptions to the Tickler file or to InstantFill for a more efficient filling process. QS/1 also has interfaces to outside vendors that focus on medication adherence, such as PrescribeWellness and FDS. See Quick Clicks & Tips (p. 5) about Cycle Rx for more detailed information.
What: Screening patients for Advisory Committee on Immunization Practices (ACIP)-recommended immunizations, educating them about what’s needed based on age or disease state, and either referring them or providing the shots (maybe through monthly clinics or partnering with businesses).
How: All QS/1 systems let you create and bill for immunizations directly from your software and print or fax notifications to physicians so they can update records. We also have an interface with Script Management Partners to submit immunization information to state registries. To enroll in any of the services mentioned in this article, contact Pharmacy Services at firstname.lastname@example.org.
Community Software > Enhanced Services > Healthier Outcomes
Community pharmacy is about more than dispensing, and a purposeful, daily focus on patient outcomes is what differentiates CPESN pharmacies. QS/1 stands beside you with tools to be part of CPESN and improve outcomes for patients, from fewer hospitalizations to lower costs. This will mean healthier profits for your community pharmacy, using the software you already have.
1Vess, Ed. “Hope for Community Pharmacy.” Drug Store News. August 2018. p. 50. Web. 10 September 2018.
CPESN-USA. Web. 10 September 2018.