Albertsons takes personal approach to specialty
As more specialty medications are approved, and as they eat up more of healthcare spending, companies are faced with the dual need to offer these drugs — some of whose distribution is limited — and contain the costs. Albertsons Companies has taken that dual goal and added a few of its own — delivering on convenience through its network of roughly 1,800 pharmacies.
One of the areas Albertsons pioneered is its now ACHC- and URAC-accredited specialty approach that has been through its pharmacists being able to administer long-acting injectables to patients in 20 of the states it operates in. That required the company to build a model that facilitated seamless communication from the prescriber to its Boise, Idaho-based care coordination center, which in turn communicates with pharmacies and its two fulfillment centers — MedCart in Livonia, Mich., and another in Santa Fe Springs, Calif. — or any in-store pharmacy.
“Through the process of connecting specialty to the community pharmacies, we found that there are a lot of other opportunities where that model of care can be applied to a whole host of additional medications,” said Brian Hille, Albertsons vice president of patient, specialty and wellness. In particular, manufacturers that want to build more support into their delivery channel, including such reimbursement support as benefits verification, prior authorization and co-pay assistance all can be done in this model. Then a patient picks up the specialty medication at any of its roughly 1,800 community pharmacies.
“The community pharmacy fills a prescription that’s fully supported by the centralized specialty pharmacy team, just like the care provided by traditional specialty pharmacy today, but it doesn’t go to the fulfillment center and ship to the patient’s home,” Erin Shaal, director of specialty care said. “Actually, we’ve seen some significant advantage with patients picking up their specialty medication at our community pharmacies. Utilizing community pharmacy is just a lower cost, more personal approach, with the opportunity to provide patients face-to-face services.”
Building out specialty is key to a strong pharmacy offering, said Mark Panzer, Albertsons senior vice president of pharmacy, health and wellness.
“That’s where the growth is going to be as far as taking care of patients, as well as the companion script that comes along with it,” Panzer said. “Having the correct patient care protocols and having the relationship with that patient, their doctor and their healthcare group is important.”
Albertsons’ empowerment gives pharmacists an edge
Albertsons has long recognized its pharmacists’ clinical skills and continues to expand them
At the center of Albertsons Companies’ pharmacy strategy is patient care — and at the center of its patient care efforts are pharmacists who have been empowered to put their significant clinical education and skills to work.
Executives said the chain realized early on that making sure pharmacists are empowered to provide clinical services and build patient relationships — and thus loyalty — were two sides of the same coin.
“The priority is one and the same: to become very accessible to the patient, to remove friction and be able to improve their health care with whatever project we may be able to do,” said Dan Salemi, Albertsons group vice president of pharmacy services. “It drives the incremental sales, which is great, but it also builds that relationship with a patient that is ‘sticky’ and keeps them in our stores. To take care of that patient and be able to differentiate ourselves from our competition is going to pay off in the long run.”
Such services as medication therapy management, comprehensive medication reviews, diabetes management and immunizations are a cornerstone of Albertsons’ strategy — and they have been longer than there have been central metrics by which pharmacies are measured, from the perspective of both patients and payers.
“What was once ‘my hobby’ is now standard — MTM services is a very standardized service,” said Brian Hille, vice president of patient, specialty and wellness. “We put a huge amount of effort into making sure that our pharmacists can be successful with MTM services. It’s important to show our commitment to our partners that we’re going to do a good job taking care of our patients.”
Besides MTM, Albertsons was the first large national chain to offer immunizations in the late 1990s, and since then has made a point of ensuring it stays on the cutting edge of what services its pharmacies can offer. With regard to immunizations, in 2017, due to an Idaho law, Albertsons and Washington State University College of Pharmacy trained the first pharmacy technician in the nation to administer immunizations. In addition to adding an extra set of hands to the pharmacy, leaving pharmacists with more time for other clinical services, the offering has gotten technicians more invested in the job.
“When you go talk to them at the store directly and ask them how it’s going, they absolutely love it,” said Nikki Price, director of pharmacy operations at Albertsons’ Intermountain region. “They really take ownership from the initial conversation to after they give the immunization.”
Ahead of the tech immunization law being enacted, Albertsons participated in a pilot for the service, an approach it also used this past year when preparing for expanded prescribing authority — treatments for urinary tract infections, cold sores and gaps in care, particularly statins for patients with diabetes — in Idaho to take effect. In both instances, being an early adopter has been a way to set Albertsons’ pharmacists apart through their clinical capabilities.
“You want to be on the ground floor because if you’re waiting to see what’s going to happen, you get left behind,” said Mark Panzer, senior vice president of pharmacy, health and wellness. “If you’re the first to be able to test it, you can take advantage of that as a differentiating point with the consumer and the patient.”
Another differentiator in which Albertsons was getting in on the ground floor on was administering long-acting injectables, a service that began in Texas roughly seven years ago and has expanded to be a large part of how Albertsons sets its specialty offerings apart. In states where pharmacists can — 20 of the states the company operates in — they administer the drugs in a private consultation room when patients arrive to pick them up.
“The direction of travel for therapies in the future is towards long-acting. If you can get one dose once a month or once every three months, that’s fantastic, we just have to solve for the convenience and availability for the patient to receive the administration,” Hille said. So the company built a model in which a prescription goes to Albertsons’ care coordination center in Boise that handles the authorization and affordability, then pushes the prescription to the community pharmacy for administration. With these drugs, which include osteoporosis, opioid recovery and mental health treatments, being able to go to the local store is more than simply an increased convenience, it improves adherence and persistence as compared with traditional administration in a clinic.
“It really improves the convenience and takes the stigma away. Typically you go to a mental health clinic or recovery clinic and there’s a lot of stigma associated with those places. Unfortunately, American society has done that,” Hille said. “Coming into a Safeway, an Albertsons, a Vons, wherever to have this administered, nobody knows the difference.”
Albertsons found that when it comes to patients’ acceptance of pharmacist-administered injectables, it sits around 96%, and a meta-analysis found that its patients see a roughly 86% adherence rate, compared with adherence rates between 33% and 54% in other studies. The company has expanded into ventrogluteal injections and is eyeing subcutaneous administration of immunoglobulin to assist patients with the transition to self-administration at home.
Key to enabling all of these services, Hille said, has been making sure that a pharmacist’s time is not taken up entirely by administrative duties.
“I have this philosophy that I want to keep our pharmacists in the store patient-facing, and not working on administrative work,” he said, and as a result, many of the company’s clinical offerings are outlined for pharmacists through resources they can access before performing the service. “We give them a service outline that tells them how to perform the service and lets them use their education, training and relationships with their patients to change behaviors. In my opinion, that’s how pharmacists improve care,” Hille said.
The Albertsons’ approach boils down to leadership realizing that its pharmacists are the key to improving patient care and to setting the chain apart from competitors. “We look at scope of practice, and we look at anything that’s innovative and ask, ‘How do we be the first to market?’ You jump on those opportunities not because you’re going to be first and it’ll generate sales, but because it’s good patient care” Panzer said. “Pharmacists went to school for clinical outcomes and they have great clinical skills, so why not utilize them?”
CMS: Health care spending growth slowed in 2017
The Centers for Medicare and Medicaid Services’ Office of the Actuary’s latest analysis estimates that health care spending growth slowed in 2017 to a rate more akin to that seen between 2008 and 2013. Spending hit $3.5 trillion in 2017, growing at a rate of 3.9%, which CMS’ report noted followed two straight years that saw a slowdown in health care spending growth — 2016’s 4.8% followed 2015’s 5.8%.
Retail prescription drugs, in particular, saw the lowest growth rate since 2012 — 0.4%. Expenditures for the category reached $333.4 billion in 2017, making up roughly 10% of overall spending. CMS’ report attributed the slowdown to slower growth in prescription dispensing, as well as a shift to generics and slower growth in volume among high-cost drug categories, particularly hepatitis C.
While private health insurance and Medicaid saw spending growth slow, Medicare spending growth was relatively flat. CMS’ study, which will be published in the January 2019 issue of Health Affairs, also noted that because U.S. gross domestic product growth increased by 4.2%, health care spending held steady at 17.9% of GDP — marking the first year since 2013 that its share of spending did not increase.
“Prior to the coverage expansions and temporary high growth in prescription drug spending during that same period, health spending was growing at historically low rates,” said Anne Martin, an economist in the Office of the Actuary at CMS and first author of the Health Affairs article. “In 2017, health care spending growth returned to these lower rates and the health spending share of GDP stabilized for the first time since 2013.”
The report also highlights 5% spending growth for clinical services in 2017, which outstripped spending growth for physician services, which came in at 3.9%. Spending for outpatient care centers were contributors to stronger clinical services spending growth. Overall, the report points to a decline in the use and intensity of goods and services as a key driver in the slowdown of health care spending growth.