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Quick, easy and (mostly) painless: Simplified immunizations at the pharmacy

BY Mike Carmody

You’ve seen the sign, probably early fall, posted right there on the marquee of the local pharmacy: “Most insurance accepted.” It means that when a patient stops by the pharmacy for a flu shot, the pharmacy can probably bill the health plan for the covered medical benefit. Quick, easy and (mostly) painless. This trend in retail medical claiming, or covering and billing for medical benefits at the pharmacy, is quickly spreading to other products and services, and is largely expanding the scope of convenient, clinical care options for both the patient and the pharmacy.

The numbers are staggering. Influenza alone is a serious virus that results in more than 200,000 hospitalizations annually. Yet, the Centers for Disease Control and Prevention report that only 28% of healthy, non-high risk adults ages 18 to 49 years received the vaccination in 2010. Among the myriad of reasons why patients purport they do not receive the vaccination are fear of needles, safety concerns or not wanting to contract the virus. The pharmacy industry is in a unique position to not only serve as a handy destination for receiving vaccinations, but to also maximize the opportunity to provide patient education on the health benefits of vaccinations. Clearly, that role has been amplified in recent years and will likely continue to grow. According to the American Pharmacists Association, the number of pharmacists nationwide trained to deliver vaccines has quadrupled since 2007.

Until now, one challenge to expanding retail medical claiming has been the amount of items included on the health plan formulary (i.e., list of approved drugs or items). Health plans typically temper their formularies with the most commonly prescribed drugs, dosage amounts and durable medical equipment needed to manage certain conditions. Since formularies can change often, they are considered to be living, breathing documents. The good news for the pharmacy is that as the health plans modify their formularies, the changes can typically be processed and enacted via the pharmacy technology software very quickly across the entire software system. As an example, if the CDC reports a shingles outbreak in the United States, and the commercial health plans alter their formulary to include the vaccination Zostavax, usually those edits can be rolled out within an hour, and pharmacies can immediately begin billing the health plan for administering Zostavax to their customers. The ability to be nimble in the face of the ever-changing healthcare landscape is vital to the pharmacy in the environment of retail clinical care.

Nevertheless, retail medical claiming extends beyond billing for vaccine administration and is designed to operate entirely within the standard pharmacy workflow, which reduces the traditional labor intensive paper-billing processes or manual entry of web-based services. By determining eligibility and patient co-pay and deductible information in real-time at the point-of-sale, pharmacies can improve payment rates for medically eligible services. And at the end of the day, having a revenue source for a pharmacy performed service identified before the patient leaves the pharmacy exponentially increases the likelihood of that encounter resulting in a paid claim.

All-in-all, we can probably expect to see an increase across the board. Increase in pharmacies performing vaccinations and other non-urgent clinical services, health plans expanding their formularies, more paid claims for medical benefits and, hopefully, a greater percentage of patients receiving a flu shot! 
 


Mike Carmody is the director of DME/MedRx pharmacy services at Emdeon. He is responsible for pharmacy solution product development and workflow efficiencies. Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions, connecting payers, providers and patients in the U.S. healthcare system.

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July retail sales see boost

BY Allison Cerra

WASHINGTON — U.S. retail sales experienced a small gain during the hottest month of the year, the Census Bureau reported.

The Census Bureau announced that advance estimates of U.S. retail and food services sales for July, adjusted for seasonal variation and holiday and trading-day differences, but not for price changes, were $403.9 billion, an increase of 0.8% from the previous month and 4.1% above July 2011. Retail trade sales were up 0.8% from June and 3.7% above last year.

July marked the first gain the industry had in four months. The bigger-than-expected increase followed a 0.7% decline in June that was weaker than first reported.

Looking across retail categories, adjusted sales at grocery stores during the month rose about 0.4% to $47.3 billion. Health and personal care stores increase more than 1% to nearly $22.8 billion. Retail sales for drug stores and pharmacies were not recorded; however, sales experienced a decline from May to June (to $18.7 billion). General merchandise stores’ sales rose 0.7% seasonally-adjusted month-to-month yet decreased 1.4% unadjusted year-over-year.

Commenting on the results, the National Retail Federation said the sales increase "demonstrates a confident yet cautious consumer."

"Halfway through the back-to-school season retailers are seeing positive signs that consumers are spending," NRF president and CEO Matthew Shay said. "However, sustained retail growth hinges on Congress’ and the administration’s ability to make smart decisions about the economy and Americans’ confidence in our long-term recovery."

NRF chief economist Jack Kleinhenz added, "Despite high unemployment, and political and fiscal uncertainty, consumers are spending again, albeit cautiously. Retail sales continue to remain resilient in the face of bleak international news, with retailers on track with sustained sales growth year-over-year and year to date. Retail sales will continue to see modest growth in the fall and winter."

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ManmohanManu says:
Aug-15-2012 07:58 am

Informative article. I work for McGladrey and there's a white paper on Retail on the website ( http://bit.ly/JDHmUU ) that describes current trends in US retail sector with insights from industry experts.

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NuSirt Sciences debuts NuShape, NuControl

BY Michael Johnsen

KNOXVILLE, Tenn. — NuSirt Sciences last week released a weight management product called NuShape and a product for healthy blood sugar called NuControl.

NuShape is an all-natural weight management product taken in pill form. When taken twice a day, it burns up to 300 calories a day by increasing fat oxidation, the company said. Clinical randomized studies show that when combined with modest caloric restriction (exercise or diet), participants nearly doubled both fat loss and weight loss over a three-month period. For a six-month period, they maintained 60% to 70% of weight loss or fat loss. The product also was shown to help participants retain lean muscle mass, which is typically lost during dieting. Results of the study can be found in the publication Nutrients.

"Let’s be clear; this is not magic," NuSirt Sciences founder Michael Zemel said. "Instead, this is a product that will work with you. We ask that you add about 15 minutes a day of moderate physical exercise over and above what you already do. That should burn about 100 calories. With NuShape, you will burn an extra 400 calories a day."

Zemel also stressed that customers who take more than two pills a day will only be wasting money — not burning more calories.

NuShape consists of the amino acid leucine, found in such foods as fish, soybeans, beef and lentils, and vitamin B6, found in such foods as bread, meat, poultry, eggs and bananas. The vitamin inhibits fat storage. When combined with leucine, it stimulates fat oxidation in the muscle. The specific ratio of the two allows for fat to be transferred to the muscle to be burned.

The second supplement, NuControl, helps promote healthy blood-sugar levels. It works by converging on the same metabolic pathway as the anti-aging nutrient resveratrol. "Insulin is, of course, a very important hormone, but you would like to operate at low levels of insulin," said Zemel. "As you gain weight, you become less insulin sensitive, and it takes more insulin to produce normal blood sugar control. NuControl helps address this issue by promoting the body’s natural ability to metabolize sugar more effectively. In fact, initial in vivo research showed the NuControl blend of leucine and resveratrol improved insulin sensitivity levels in mice by 40% to 50%."

A video about the products can be viewed by visiting here.


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