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Q&A: Resources for overcoming the adherence challenge

BY DSN STAFF

Winning the patient adherence battle is about aligning all stakeholders, from the patient to the pharmacist, to payers, employers, physicians and pharma, in a collaborative, patient-centered model that not only educates patients, but also actively engages them in managing their health and treatment regimens. To find out more about how McKesson is helping community pharmacists deliver better patient care through one-on-one interventions and coaching  — and get paid for it — DSN spoke Tuesday to Peggy Yelinek, VP and general manager of McKesson Patient Relationship Solutions.

DSN: What is the biggest challenge when it comes to getting patients to adhere to their medications?

Yelinek: The biggest challenge is identifying the unique adherence barriers each patient will face. Barriers may be anything from drug costs, to thinking it’s not important, to a lack of visible clues that reinforce the drug is working. What’s more, these barriers can change over time. For example, a patient with diabetes who is newly prescribed insulin may face denial, feel overwhelmed and feel like a failure because he or she didn’t succeed on oral medications — all of which can lead to nonadherence. An experienced insulin user may have other barriers, such as not testing blood-glucose levels or challenges with lifestyle management. This is a great example of why messaging for each patient needs to be tailored to their distinct needs in order to develop a comprehensive solution to help them overcome the barriers to taking their medications as prescribed.

DSN: Why is it so important that people take their medications as instructed?

Yelinek: While there are significant financial implications to medication nonadherence, perhaps the greatest concern is the impact on a patient’s quality of life. Medications simply do not work as effectively if not taken regularly, and skipping doses can have serious health consequences. With chronic conditions like diabetes, COPD or hypertension, taking your medications as prescribed could mean the difference between having a good versus a poor overall quality of life.  

DSN: What is the role of the pharmacist in addressing nonadherence?

Yelinek: We strongly feel that community pharmacists and their relationship with their patients are an integral part of the solution. Since pharmacists are knowledgeable, accessible and trusted by their patients, they are in a unique position to play a significant role in helping to control healthcare costs by offering patients convenient, cost-effective healthcare.  

McKesson’s Pharmacy Intervention Program, which expands patient access to one-on-one behavioral coaching from their retail pharmacists, is helping to achieve better patient care, enhance the role of the pharmacists and transition the pharmacy to a service-based business model. The Pharmacy Intervention Program found patients who received face-to-face behavioral coaching from their pharmacists showed significant adherence benefits. For example, COPD patients who received coaching showed an average of 1.6 incremental fills over 12 months, and patients coached in multiple diabetes programs showed an average of four incremental refills over 12 months when compared to patients who did not receive behavioral coaching.

DSN: How does McKesson facilitate delivering adherence programs to patients?

Yelinek: Supporting patients and driving their loyalty to their community pharmacy is the cornerstone of McKesson’s Sponsored Clinical Services Network. We are committed to providing our pharmacy customers with new forms of clinical services and technologies that not only result in healthier and more connected patients, but also provide compensation to pharmacists for their clinical expertise.

McKesson’s Sponsored Clinical Services Network is the industry’s largest active patient support network with significant experience implementing adherence support programs. Building on our partnerships with many of the largest pharmaceutical manufacturers in the industry, pharmacies active in our network have implemented innovative clinical services programs, such as delivering unique face-to-face adherence coaching, refill reminder letters and text messages, as well as opportunities to support patients in finding and participating in valuable clinical research. In 2011, participating pharmacies earned $1 million in service fees for providing patient support services and supported an estimated one-quarter million patients.

DSN: What else is McKesson doing to address this national issue?

Yelinek: McKesson recognizes that effective support of medication adherence requires an integrated effort from all healthcare stakeholders: physicians, pharmacists, employers, payers and pharmaceutical manufacturers. We believe we can help facilitate this collaboration through a patient-centered approach designed to educate patients and motivate them to actively manage their health and stay on therapy.

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McKesson’s Sponsored Clinical Services Network draws much attention from pharmacists, owners looking to balance business needs with patient care

BY Rob Eder

LAS VEGAS — In many ways, the future of community pharmacy relies on evolving the role of the pharmacist to drive better patient adherence, improve health outcomes and perhaps most importantly, from a business perspective, to get paid for it. To help independent pharmacy owners and community pharmacists step closer to that future today, McKesson, the largest healthcare services company in the country, showcased Tuesday its Sponsored Clinical Services Network to hundreds of attendees here at McKesson ideaShare 2012.

Community pharmacies that are focused on elevating their role in healthcare delivery, enhancing patient loyalty and outcomes and seeking new reimbursement streams are adopting sophisticated behavioral adherence programs into their practice. McKesson’s Sponsored Clinical Services Network, the largest active patient support network in the industry, has significant experience implementing adherence support programs, executives noted.

“McKesson is committed to helping community pharmacists achieve their goals with pharmacy-based adherence programs centered on the patient,” said Brian Tyler, president of McKesson U.S. Pharmaceutical. “With McKesson’s partnership with many of the largest pharmaceutical manufacturers in the industry, pharmacies active in the McKesson Sponsored Clinical Services Network have been assuming an even greater role in providing patient care and services, in addition to growing their revenues. In fact, in 2011, pharmacies in our Sponsored Clinical Services Network earned $1 million in service fees for providing patient support services and supported an estimated quarter of a million patients.”

McKesson’s Pharmacy Intervention Program, which expands patient access to one-on-one behavioral coaching from their retail pharmacists, is helping to achieve better patient care, enhance the role of the pharmacist and transition the pharmacy to a service-based business model. McKesson’s Pharmacy Intervention Program found patients who received face-to-face behavioral coaching from their pharmacists showed significant adherence benefits. For example, COPD patients who received coaching showed an average of 1.6 incremental fills over 12 months, and patients coached in multiple diabetes programs showed an average of four incremental refills over 12 months versus patients who did not receive behavioral coaching.

The results indicate that the Pharmacy Intervention Program’s pharmacist training, coaching session design and ongoing resources are driving patient compliance to their medication regimens, which in turn drive increased visits and revenues to the pharmacy. In addition to reimbursement fees from sponsors associated with coaching sessions, pharmacies can benefit from increased prescription volumes, incremental front-end purchases and further enhanced customer loyalty.

Key to reimbursement is making sure that, as manufacturers shift dollars to pharmacy services, that they are allocating at least part of those dollars for independent pharmacies, which is another critical role that McKesson plays for its customers, explained Stacey Irving, VP strategic channel solutions and sponsored clinical services network at McKesson Patient Relationship Solutions. “We want to make sure that [independent pharmacies] are not only considered for these types of programs, but that they are successful in delivering those programs,” Irving said — especially since this type of one-to-one service and counseling is something that independent pharmacies are known for, she added.

"Fostering patient loyalty and healthier outcomes is not only key to growing my business, but part of my role as a trusted healthcare provider in my community," said Christine Jacobson, owner of Wasatch Pharmacy Care in Ogden, Utah. "By participating in McKesson’s Pharmacy Intervention Program, I benefit from being part of the largest active patient support pharmacy network. This program is one example of how my wholesaler is helping me to increase prescription volumes and customer loyalty — ultimately driving better outcomes for my patients and my business."

For more information on McKesson’s Sponsored Clinical Services Network, its Pharmacy Intervention Program and all of the new product and service announcements from McKesson ideaShare 2012, visit the McKesson online newsroom at www.mckesson.com/newsroom.

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Partnering with patients to manage diabetes and other chronic diseases

BY Jonathan G. Marquess

The life of a patient with diabetes is a juggling act to maintain good glycemic control — from daily blood-glucose testing to eating healthy and staying active. This is a complex and sometimes inconvenient task requiring significant commitment. Today, the American Diabetes Association estimates 60 percent of diabetes patients do not adhere to their treatment regimen.

Because patients with diabetes spend only an average of six hours a year with their doctors, they need more help than ever to navigate therapy choices and maintain a healthy lifestyle. As community pharmacists, we’re often the front line of patient care, having frequent conversations to help patients stay adherent to their medications and successfully manage diabetes and other chronic diseases, including COPD, high cholesterol and hypertension.

As a Certified Diabetes Educator and a member of McKesson’s network of pharmacists trained in behavioral coaching, I work closely with patients every day. Here are a few recent examples of how I’ve coached patients on the proper use of medications and lifestyle requirements to manage their diabetes:

• As I was filling a patient’s prescription recently, I noticed he was a week late in picking up his refill. When I asked why, he told me that he needed to make it last longer to keep his monthly costs down.   Working together, we were able to identify a co-pay offset program and get him enrolled right away so he can take each dose as directed.
• One of my longtime patients was having difficulty with her insulin injections with the traditional vial and syringe, so I introduced her to a new insulin pen as an alternative. Not only does it allow her to set the right dose, she has found the injection process much easier and nearly painless.
• A newly diagnosed patient came in feeling overwhelmed and unsure of how to start controlling her diabetes. Through a series of coaching sessions, we’ve developed a long-term plan to manage her condition and know what to expect when taking her medications. Additionally, I introduced her to the Diabetes Life Center we maintain at Woodstock Health Mart Pharmacy, featuring a variety of over-the-counter health and lifestyle products she’ll need to be successful. 

Like many community pharmacists, I believe supporting our patients, starts — not ends — with the prescription. I encourage you to position yourself to patients living with a chronic disease as a partner dedicated to help them successfully manage their condition AND maintain a healthy lifestyle. 


Jonathan G. Marquess, PharmD, CDE, is a pharmacist and owner of Woodstock Health Mart Pharmacy in Georgia.  Follow Jonathan on Twitter @SugarDetective1. To find other Health Mart pharmacies that offer this type of support, visit www.healthmart.com

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