Pharmacies turn to automation as workloads, data needs rise
Retail pharmacy is being squeezed.
Even as an aging population and expanded insurance coverage under Obamacare propel rising dispensing rates and add to pharmacists’ workloads, they’re being called on to practice “at the top of their license” by filling an ever-expanding role as front-line patient-care specialists and fully engaged members of collaborative care provider networks.
With “the healthcare landscape … undergoing its most rapid transformation in a century,” to quote the National Association of Chain Drug Stores Foundation, chain and independent pharmacies are facing an existential challenge. How do pharmacists — no matter how highly trained and motivated they are — juggle rising prescription counts with expanding clinical and such preventive-care services as medication therapy management, diagnostic screenings, immunizations, medication adherence programs, appointment-based patient counseling sessions, and chronic disease monitoring and management? And how do they link those efforts to a broader, more holistic model of patient care in collaboration with doctors and health systems?
Technology firms say their solutions will enable community pharmacy to keep pace with the explosive changes occurring in health care. In an era of collaborative and accountable care, outcomes-based reimbursement models, rising prescription volumes, a shrinking pool of primary care physicians and urgent cost-cutting imperatives, pharmacy retailers and their technology vendors are more closely linked than ever. And automation is more critical than ever — both as a labor-saving tool and as a means of capturing, sharing and applying prescription data on behalf of healthier patients and lower health costs.
Some pharmacists might argue that those labor-saving tools aren’t being applied fast enough to keep up with the added burdens of clinical care. But massive investments in robotic dispensing systems and other tools are clearly shifting some of the dispensing workload away from pharmacists and onto more highly trained technicians — and into high-volume, highly automated central-fill facilities.
At the same time, systems to mine, measure and analyze patient data are advancing rapidly, giving pharmacists more powerful decision-making tools to support patient interventions and connect more seamlessly with the broader health network.
“We’ve seen this amazing transition taking place in community pharmacy with it becoming more clinical in nature,” said Brian Glaves, director of sales for ScriptPro. “Today’s incoming pharmacists are chomping at the bit to be a healthcare provider to their customers —developing those personalized relationships and helping set up prescribed medication therapies.”
For its part, “ScriptPro is keeping abreast — developing new technologies that enable pharmacists and their teams to stay connected across their network and with their patients and prescribers,” Glaves said.
Glaves called robotic dispensing systems “a game changer” that “go a long way to streamlining workflow, saving time and improving accuracy.”
“Now you can seamlessly integrate all these new technologies that keep patients and their pharmacies connected,” he added, citing ScriptPro’s own RefillPro and PharmacyPro mobile point of sale systems. Within “our industry’s growing collaborative care mindset, the retail setting is facing a huge need for organized case management and treatment plans for patients undergoing chronic disease, pain management and specialty drug therapies,” Glaves told DSN.
It’s about applying technology and patients’ electronic health records “to integrate pharmacy care from the payer to the provider to the patient,” CVS Health president and CEO Larry Merlo noted earlier this year. The company’s “truly integrated assets,” he added, give CVS “a full view of each patient and a single patient record for prescriptions and care regardless of the CVS Health channel used.” And it allows the broad-based retail pharmacy and pharmacy benefit management giant “to offer innovative services and to deliver additional value to [other healthcare] stakeholders.”
Supporting health provider status
The American Pharmacists Association calls health IT “an effective vehicle for exchanging information between practitioners, patients and pharmacists.” To that end, “Pharmacists need access to pertinent clinical information about their patients, and in turn should contribute information to the health care team in order to improve patient outcomes,” APhA noted.
“Information technology plays a major role in monitoring any adherence program. That’s especially true when it comes to tracking outcomes,” said Sandy Canally, founder and CEO of the Compliance Team, the first certified, woman-owned healthcare accreditation organization to hold “deeming authority” from the Center for Medicare and Medicaid Services.
“In this day and age, nearly every pharmacy uses some type of software program that enables them to submit data to payers and referral sources,” Canally added. “The best use of IT is utilized in the patient monitoring follow-up. Careful documentation is key to providing proof of a positive patient outcome.”
For that and other reasons, she told DSN, “Obtaining a complete medication history is critical in assessing the appropriateness of the prescribed medication therapy, and to create a reconciled medication list and care plan for the patient. Equally important is the coordination of care by the pharmacy with a patient’s prescribers.”
Automation experts agreed. “Technology, integration and interfaces are the way of the future,” said Crystal Ratliff, market analyst for technology provider QS/1. “As pharmacy’s role in the patient care team expands, technology is becoming a greater factor in removing barriers between the pharmacy and a patient’s other healthcare providers. This expanded team provides a more collaborative, efficient process to improve patient outcomes.
“Pharmacists’ ability to substantiate their value in improving patient outcomes will be crucial to their recognition as healthcare providers,” Ratliff pointed out. “Pharmacists are already providing services beyond filling prescriptions, but this work must be documented and shared with the healthcare community for the pharmacist's value to be realized.”
As for QS/1, she said, its role “is to provide pharmacies with the tools necessary to adapt to this rapidly changing market and to give them a substantial competitive advantage. We provide the technology to speed workflow and track compliance and reimbursement, thereby increasing the time available for important counseling opportunities.”
Another critical benefit community pharmacies can bring to the new health paradigm is their proven ability to improve patients’ adherence to medication therapies — a key core competency that can lead to reduced hospital readmissions and healthier patients long-term. The installation of unit-dose or multi-dose packaging systems within the pharmacy can be a powerful tool for improving adherence rates, said Mark Rinker, senior director of sales for Synergy Medical.
“We continue to strongly … advocate the use of packaging to improve patient outcomes,” Rinker told DSN. “The FAME (Federal Study of Adherence to Medications in the Elderly) study and others clearly indicate a patient is better off with their medication organized by the pharmacy by day and time of administration in a blister card, opposed to patients self-medicating with multiple vials.”
“Adherent patients drive plan Star ratings, and in turn this improves their reimbursement and plan inclusions,” Rinker noted. “Blister packaging as part of a broader medication adherence strategy is a means for community pharmacy to survive and thrive.”
‘Balancing expense and investment’
Meanwhile, the quest by pharmacy leaders for the right tools to free their pharmacists from most of the basic mechanics of dispensing and tracking scripts goes on. They’ve made — and continue to make — huge investments in both behind-the-counter robotics and other automation, and in offsite central fill facilities that can churn out and track hundreds of scripts an hour with multiple robots and other fast-track technology to ease in-store dispensing pressures.
“Pharmacy providers are constantly balancing expense versus investment,” said Doyle Jensen, executive VP of global business development for Innovation. “In these times of shrinking margins, money invested in pharmacy operations must provide the best possible return. That’s why more and more providers are turning to central fill; it’s the best way to leverage their technology spend.”
“Dispensing technology deployed at retail is severely underutilized, while centrally deployed technology supports hundreds of stores — and the volume of the stores can best leverage each dollar spent,” Jensen told DSN. “With up to 60% or more of the prescription production handled at central fill, retail pharmacists have much more time to deliver patient-facing care and other patient-related services.”
Other technology solutions providers also are focused hard on that quest for higher levels of productivity behind the counter and more time for pharmacists to practice at a higher level of care. Bobbie Riley, pharmacy director for LexisNexis – Health Care, said, “Our focus is on getting pharmacists the technology they need to be compliant and to be able to work as efficiently as possible.”
“As provider status progresses and prescriptive authority expands, these types of validations and insights become even more important,” Riley said. “And as reimbursement continues to shift from fee-for-service to value-based payment, treating the patient more holistically is key.”
“In addition, we are seeing more and more how social, economic and environmental factors are impacting the health of patients. Providing insights to help better understand behaviors [that] could influence medication adherence is becoming critical. The LexisNexis Socioeconomic Health Attributes and Scores is a solution that can help offer greater visibility into these key factors,” Riley told DSN.
Technology firms have developed a range of increasingly specialized tools to solve different aspects of pharmacy automation and pharmaceutical processing. PerceptiMed, for instance, was founded in 2013 to reduce pharmacy-based medication errors through its VeriFill automation processes.
PerceptiMed’s IdentRx proprietary technology “enables pharmacies to place the pharmacist at the top of their license by utilizing a remote-verification platform that rebalances verification workload across its footprint,” said Frank Maione, chief business officer. “Other benefits include labor savings from the time devoted to the Schedule 2 double-count and tracking process through a one-pour, triple-count, image-capture and record-retention [process], all in under 15 seconds.”
For its part, Morris Plains, N.J.-based Temptime has focused since 1987 on developing solutions to the safe storage, handling and transportation of medical products and pharmaceuticals. According to Chris Caulfield, VP of global customer development, “Temptime offers an entire range of temperature-monitoring solutions from low-cost, chemically based products to sophisticated, data-driven devices equipped with low-energy Bluetooth capabilities and cloud-based data storage.”
“Temptime understands that pharmacists are taking on an ever-growing responsibility of assuring that highly valued, temperature-sensitive medications are received by the patient per the temperature requirements of the manufacturer and … the state board of pharmacy,” Caulfield added.
Online search fuels healthcare decisions
Ryan Olohan, Google industry director for health care
Internet search activity, particularly on mobile devices, has become an important element of consumer healthcare decision-making.
Consumers are taking more ownership in their health than ever before, said Ryan Olohan, national industry director for health care at Google, during a presentation at the Health Innovation Summit, co-hosted by CVS Health in partnership with Drug Store News and Mack Elevation.
“They’ve got more information and data at their fingertips, and they are using the information to become more discerning, more educated and more demanding,” he said during his presentation in June. One-in-20 Google searches is related to healthcare information, and a large majority (86%) of consumers go online when experiencing new symptoms, Olohan said.
Consumers increasingly are unwilling to sit back and passively allow their doctors to make treatment decisions, he said. Nearly half (48%) of consumers said they wanted to partner with their doctors on treatment decisions in 2015, up from 44% in 2012 and 40% in 2008. “The trend is that consumers more and more want to have a two-way relationship with their doctor,” he said, noting that 84% of consumers conduct an online search following a doctor’s appointment.
As an example of the volume of research being conducted online, Olohan cited the activity around rheumatoid arthritis, which was the subject of 16 million Google searches in 2016, a more than 10% increase over the preceding year. An additional 230,000 searches took place on YouTube, where there are 135,000 videos related to rheumatoid arthritis and more than 1,500 related channels.
Healthcare-related search also is increasingly localized, especially for consumers who have immediate health needs. The number of searches containing the phrase “hospital near me,” “pharmacy near me,” “doctor near me,” “clinic near me” or “dentist near me” have been steadily increasing since they first began showing up on Google just a few years ago. “This is a new consumer behavior that up until 2013 never existed before,” Olohan said.
Localized searches also drive retail purchases, according to Google research. Three-in-4 people who conduct a local mobile search visit the store within 24 hours, and more than 25% of those searches result in a store purchase.
Time of day also is a factor in consumers’ online search behavior, Olohan said. For example, Google searches for the term “infant formula” peaked at around 3 a.m. to 4 a.m. every night in one recent week, according to Google Trends. Parents are looking for information about why their babies are waking up crying in the middle of the night, and that presents an opportunity for marketers to target solutions to these potential customers, he said.
Meanwhile, Google and its sister companies under the Alphabet umbrella are making significant advances in other areas of health care, as well. These include such disruptive technologies as contact lenses that contain a microchip that measures the glucose level in a diabetic patient’s tears, and a clinical-grade, wearable health sensor.
Health consumers migrating to retail
Futurist/economist Jane Sarason-Kahn
Healthcare goods and services will account for nearly 1-in-4 dollars spent in the United States within the next three years. That massive growth in spending will pose huge challenges for patients and health plan payers, said health economist Jane Sarasohn-Kahn. But it will thrust retail pharmacy even further into the front lines of care as the nation’s stressed health system desperately seeks ways to curb unsustainable costs, expand patient access and improve health outcomes.
Addressing the Health Innovation Summit, co-hosted in June by CVS Health in partnership with DSN and Mack Elevation, Sarasohn-Kahn highlighted the economic stresses Americans face as they grapple with rising out-of-pocket costs. “Increasingly, the patient is the payer,” she said. “The mass of Americans … haven’t had a wage increase in years, but [their] health costs are jumping. This is really part of our culture now.”
Americans’ alarm over the costs of health care is well documented. A recent Gallup poll found that “the cost of health care is Americans’ top financial concern,” and “leads the list of what Americans consider the most important financial problem facing their family,” Gallup reported.
Behind those concerns is the very real expansion of health costs in the United States. Between 1980 and 2015, healthcare costs as a share of the gross domestic product doubled, from 9% of the GDP to 18%, according to Gallup.
For that and other reasons, Sarasohn-Kahn said, “We must understand what our patients want. Say we prescribe something for patients that [costs] $90,000 a year. If that patient doesn’t have enough food to eat, the drug really isn’t going to work very well.”
But unsustainable out-of-pocket costs are only one of the stresses Americans are facing as they grapple with an opaque and disjointed health ecosystem, said Sarasohn-Kahn, who authors the Health Populi blog. Costs and quality of care can be wildly dissimilar and out of sync from one region to the next, and even from one community to the next, she said, depending on which health provider or hospital system serves that community, and which insurance plans are available.
“What really matters to your health is where you’re born,” she said. “You can have very different health outcomes two miles away from your own community, and state by state, your well-being is different.”
Both health plans and many local and regional health systems have failed to provide a clear picture of care and cost options, or to rein in rising out-of-pocket costs, Sarasohn-Kahn said. “People feel … pretty confused and dazed when they get sick and have to deal with the labyrinth of health care in this country,” she said.
As a result, she said, “Health plans are really … the lowest-rated industry segment in America. When it comes to the legacy healthcare system, … consumers don’t feel they get any respect.”
Instead, she said Americans increasingly have turned to such retail settings as pharmacies and in-store and stand-alone clinics as places that provide “trust to help [them] manage [their] health. Consumers are looking for transparency — ‘how much is it going to cost me, what’s the quality and is there a report card for this doctor?’ So whom do consumers love in terms of experience? Supermarket chains … and retail pharmacy.”
Given those trends, Sarasohn-Kahn said, “This is a great time in health care to be in this business … because we now have the technologies to help people turbocharge their engagement in their health.”
Supermarket and mass pharmacy operators that provide a broad array of groceries have an additional advantage as health care becomes more self-directed and patient controlled, she added. “Food has become really, really important” to the pursuit for healthier lives, she said. “Food is a gateway drug. People with chronic conditions are really serious about it, and need a lot of help.” That means that combo and superstore retailers that “figure out how to help people build a healthy grocery cart” will have a powerful market advantage. “Food and fitness are colliding. Hy-Vee now has a fitness center in a few stores,” she said.