EHRs boost adherence, monitoring in diabetics
Use of electronic health records improves medical outcomes among patients with diabetes, according to a recent study conducted by Kaiser Permanente.
The study, published in the Annals of Internal Medicine, found that use of EHRs was associated with improved increases in medication, monitoring and risk-factor control among patients with the disease. Researchers also found greater improvements among patients with poorer control of diabetes and cholesterol. The study included 169,711 patients with diabetes at 17 medical centers in Kaiser Permanente’s Northern California integrated care delivery system between 2004 and 2009.
“What we saw in this study is that the EHR really helped our alignment with quality measures and clinical guidelines for treatment,” Kaiser Permanente Northern California Cardiovascular Risk Reduction Program director Marc Jaffe said. “Increases in information availability, decision support and order-entry functionality help clinicians to identify the most appropriate patients for drug-treatment intensification and retesting, which leads to better care of patients with diabetes.”
The study found statistically significant improvements in medication increases, also known as drug-treatment intensification, in patients with HbA1C levels of 7% or greater. Ultimately, the researchers found that use of an electronic health record resulted in better HbA1C levels and levels of low-density lipoprotein or “bad” cholesterol. The study involved more than 1.37 million HbA1C tests and more than 1.27 million LDL cholesterol tests.
A previous study, published in 2010 in the journal Health Affairs, involved 35,423 Kaiser Permanente diabetes and hypertension patients in southern California and found that secure patient-physician messaging in any two-month period resulted in improvements in healthcare effectiveness measures, including improvements of between 2% and 6.5% in blood sugar, cholesterol and blood pressure screening and control.
“Our next step is to see how EHR use improves downstream clinical events in patients with diabetes,” lead author of the most recent study, Mary Reed, said. “Since we have found that glycemic control and lipid levels were better, now we need to better understand if EHR use impacts measurable events like emergency room visits. This would be an important step in evaluation of the impact and potential value of electronic health records.”
EHRs have seen significant growth in recent years, spurred by financial incentives for healthcare providers who adopt them as part of the American Recovery and Reinvestment Act of 2009. Last year, 55% of physicians had adopted an electronic health record system, according to a study released in July by the Centers for Disease Control and Prevention. Electronic prescribing has likewise seen tremendous growth. According to Surescripts, 58% of office-based physicians were using e-prescribing by the end of last year, as well as 91% of retail pharmacies. In July 2012, Minnesota was ranked first in the country for use of e-prescribing in Surescripts’ seventh annual Safe-Rx Awards, with 61% of prescriptions routed electronically in the state.
Pharmacy is star of the show in new programs, store concept
Ultimately, there’s no “retail pharmacy” without the “pharmacy,” and that’s true of any store that dispenses prescription drugs — whether it’s a small independent drug store, a nationwide chain, a supermarket or a mass merchandiser. But in many respects, Rite Aid is trying to make the “pharmacy” component of that phrase just a little bit bigger.
Maybe one reason for that is because — at least for Rite Aid — pharmacy is bigger. That part of the store accounts for nearly 70% of the chain’s sales, and it’s from the pharmacy that the company has seen some of its most impressive growth. The company has grown Adjusted EBITDA and same store prescription count for seven consecutive quarters, although higher utilization rates of increasingly lower-priced generic drugs shaved some 750 basis points from same-store pharmacy sales, the company noted in its most recent quarterly earnings call.
At the heart of that growth has been a series of major initiatives — from the wellness+ loyalty card program to the Wellness store remodels and the Wellness Ambassadors in those stores — that are all ultimately tied to the pharmacy and all geared toward making customers bigger users of its pharmacy. And while there is no denying that the company got some help from the impasse between Walgreens and Express Scripts, which brought many former Walgreens customers to Rite Aid’s pharmacy, Rite Aid executives will tell you that was really just the gravy — the company had been cooking this up for a while, they say.
“The real story is, we had already begun making the turn,” Rite Aid’s EVP of Pharmacy Robert Thompson told Drug Store News. “Our initiatives, our focus, our strategy, our tactics were already taking effect, and so the Walgreens-Express Scripts dispute was just an additional opportunity on top of what we were already doing. I think it would be inappropriate if our key stakeholders didn’t realize that this had already started taking root.”
It really began back in April 2010, with the debut of wellness+ — the original goal of which was to get the front end and pharmacy to play off each other, driving sales on both ends of the store, but particularly in pharmacy, as the program is designed so that rewards accumulate faster for pharmacy purchases, with each prescription worth 25 points, where allowed by law. By the end of that fiscal year (Rite Aid’s fiscal year ends in late February or early March), the seeds of a turnaround had begun to take hold, with fourth-quarter same-store sales increasing for the first time all year, including an almost 1% increase in pharmacy comps.
“Wellness+ lays right on top of that,” Thompson said. “With the introduction of wellness+, we’ve seen continued growth, and that’s very important because wellness+ … is a pharmacy-centric loyalty program. There are greater rewards for being a pharmacy customer. The idea is to reward those pharmacy customers where we can with a program that really focuses on health and wellness.”
If wellness+ “lays on top,” then beneath that is a plethora of pharmacy services that Rite Aid has worked to expand in recent years. Rite Aid has emerged as a key leader in the push to advance the profession of pharmacy to take on an expanded role in the future of health care in America. One area in which it has demonstrated its leadership has been in its work with the Pharmacy Quality Alliance; Rite Aid has 200 pharmacies in its home state of Pennsylvania participating in the PQA research, as pharmacy, like other areas of health care, prepares for a time when reimbursement levels are influenced by star ratings, and providers are paid by their ability to improve outcomes and manage costs.
In that regard, it also is demonstrating a fair amount of creativity and innovation, with the introduction this year of its new Rite Care Prescription Advisor. Launched in March, the opt-in program actually maps out what a Rite Aid patient’s prescription-drug adherence looks like. Each Rite Care Prescription Advisor report includes a compliance score for each prescribed medication, depicted in an easy-to-read line graph. Scores also are calculated and graphed across multiple medications used to treat the same or related health conditions, and combined for an overall score based on all medications taken regularly. The Rite Care Prescription Advisor is a tool for the pharmacist to use to guide face-to-face consultations with the patient and to help break through some of the barriers to compliance like helping patients deal with side effects. Rite Care Prescription Advisor reports also can be accessed through a patient’s MyPharmacy account at RiteAid.com.
“We’re witnessing a new era of patient care that is more effectively utilizing community pharmacists to ensure that medications are taken as prescribed, which can lead to better patient outcomes and lower overall healthcare costs,” Thompson noted at the time of the program’s launch. “We believe face-to-face counseling is critical to improving therapeutic outcomes. The Rite Care Prescription Advisor is a new tool designed to do just that by facilitating meaningful face-to-face counseling and enhancing the pharmacist-patient relationship.”
Since its inception, Rite Aid pharmacists have conducted more than 1 million interventions with Rite Aid patients through this program, Thompson told DSN. Rite Aid has promoted the program heavily in its circular ads and on prescription information inserts.
Another area in which Rite Aid has demonstrated its leadership is in the expansion of vaccination services in community pharmacy. All of the chain’s pharmacists are certified to administer all immunizations allowed by the state to be delivered by a pharmacist.
Last flu season, the company administered some 1.5 million flu shots, and during its quarterly earnings call in September 2012, company executives said they hoped to take that number to 2 million flu shots this season. However, vaccinations, which won the chain the 2012 American Pharmacists Association’s Immunization Champion Award, aren’t just an important new service offering for Rite Aid; they’re also a key component of the company’s focus on the concept of prevention and wellness.
“Our idea around immunization is not just about flu shots,” Thompson said. “Our immunization program is designed to be a year-round, constant focus to ensure patients have access to immunizations when needed — that is a core part of wellness.” Indeed, Rite Aid promotes its immunization program as an everyday service, with reminders throughout the store, including an information board listing the pharmacy services at the checkstand and signage behind the pharmacy counter that instructs customers, “Our certified immunizing pharmacists are available at any time.” And of course, Rite Aid’s Wellness Ambassadors —Rite Aid reported in its most recent earnings call that it had 815 of its associates trained in this role — also play a key role in promoting the chain’s immunization services.
In the future, Thompson sees a role for pharmacists in more advanced injection services, and in the short-term, a role with first-dose injection training for more complex specialty drugs. As for specialty, the chain currently operates a central specialty pharmacy operation, mailing the drugs either to the patient’s physician or to the patient’s local Rite Aid pharmacy, creating a relatively seamless experience for a patient who may not understand that the medication for his or her rheumatoid arthritis or psoriasis is actually a specialty drug, or what that means from a distribution standpoint.
While Rite Aid hasn’t been a major investor in the retail clinic space the way its two biggest competitors have, it has forged several partnerships with clinic providers like Lindora. In addition to the acute care services it currently offers, Lindora began as a weight-loss clinic, and its Lean For Life program remains a differentiator for it and the six Rite Aid stores in which it co-locates in Southern California. Rite Aid also hosts three other clinics operated by Sutter Express Care in stores in the Sacramento area.
For Rite Aid, Thompson explained, the key focus is using its pharmacists to expand its clinical services, primarily through its immunization services and in broader patient consultations like it is doing with Prescription Advisor, as well as through more medication therapy management, particularly as payers beyond the Centers for Medicare and Medicaid Services begin to see value in paying for these services.
But there is another retail clinic model that Thompson and Rite Aid executives believe could have broader application for the chain in markets across the country. In September 2011, the company partnered with OptumHealth to launch NowClinic, becoming the first retail pharmacy chain to provide “virtual clinics.” With NowClinic, which currently operates at nine stores in Michigan and five in Pennsylvania, patients can video chat through an Internet connection with physicians, who can offer guidance, diagnoses and prescriptions. They also can converse with nurses, who can provide basic healthcare education, information on common medical problems and identification of appropriate provider options for care, with records of each interaction available for sharing with a primary care provider. These types of services, Thompson said, are the way of the future.
“Given the rapidly changing U.S. healthcare landscape, we are convinced that consumer-driven health care is going to play an even more important role in people’s lives moving forward,” Thompson said. “In a consumer-driven healthcare environment, people are going to need more choices, so figuring out a way to use technology to enhance the delivery of your services makes sense because it provides convenient and efficient access at a lower cost. That is why it seems sensible try to make it work.”
Study forecasts steady generics growth through 2023
LONDON — The global market for generic drugs will reach more than $125 billion next year, according to a new report by a British market-research firm.
Visiongane released its report, Generic Drugs: World Market 2013-2023, showing that the size of the market would increase to $127.8 billion from 2011’s $110.8 billion. Sales of generics in the United States represent more than 40% of worldwide sales and account for about 70% of prescriptions dispensed within the country, while sales here have more than tripled since 2000, according to the report. The report included the United States, United Kingdom, Japan, Germany, France, Spain, Italy, Turkey, Brazil, Mexico, South Korea, Russia, India and China.
"A number of factors have contributed to the growth of the world generics market," Visiongain senior pharmaceutical industry analyst Syed Ahmed said. "Prominent blockbuster drugs will lose patent protection in the next few years, with many having done so already."
Ahmed said branded drug manufacturers were set to lose more than $50 billion in sales next year to patent expiries, and the report predicts steady growth in the overall generics market through 2023.