Issues Summit Panelists talk hurdles to patient-facing care

BY David Orgel

There’s often more than one plot line to a story.

That’s the case with the drive to improve patient-facing care in community-based pharmacy. In fact, multiple angles were spotlighted during an executive panel at the Drug Store News Industry Issues Summit in New York City in late November.

On the one hand, panelists said that patients now have more control over healthcare decisions, and they don’t always find that the existing structure meets their needs. They have a wider range of choices, even as they face continued hurdles ranging from care access to price transparency.

“The cost of health care has just escalated to a point where consumers are now in much more control,” said Dain Rusk, vice president of pharmacy at Publix Super Markets. “It’s no longer just about patients going to their doctor; it’s about bringing health care to the consumer.”
At the same time, some said that pharmacists are working harder to deliver outstanding results in collaboration with key partners. They face obstacles in freeing themselves up for more face-to-face time with patients and in overcoming the constraints of traditional reimbursement models.

“An important piece is transparency on how we get paid for the improved outcomes, and that we’re providing value to our patients,” said Rina Shah, vice president of pharmacy operations and specialty at Walgreens. “Currently, the targets continue to change and the measurements vary.”

Pharmacists, their partners and patients all face challenges as the industry strives for better patient-facing care.

Identifying patients’ unmet needs
Patients have a lot of unmet needs that need to be addressed, the panelists said. “I believe if we start by talking about the needs of the patient, the solutions will flow through,” said panel moderator Chris Dimos, president of retail solutions at McKesson.

Ryan Rumbarger, vice president of pharmacy operations at CVS Health, added that “cost and price transparency are what we hear most about from our patients. We’re all doing different things to try to make prescription drug prices more transparent, and to lower out-of-pocket costs.”

Patients also need ongoing education about their conditions, even if this isn’t always apparent to them, he said.

“Our patients don’t know what they don’t know, and it will be a problem if we’re not proactive with them, in telling them what they need to know, and making sure they understand it,” he said. “For example, ‘it’s important that you take this every day, it’s important that you not skip doses.’ We’re focused on this through a lot of different counseling programs to make sure that our patients have what they need to keep them adherent.”

A lingering patient problem is access to care, particularly in certain parts of the country, said Todd Treon, vice president of marketing management at Cardinal Health, which operates the Medicine Shoppe International franchise system.

“For small-town patients and rural patients, access is still somewhat of an issue,” he said. “In very rural areas, technology can help through telepharmacy. We, from a Medicine Shoppe perspective, have seen a number of success stories, where there may be a clinic in a county and the next closest pharmacy is more than an hour away. Being able to help fill those acute prescription needs right away improves their care and their access. So there’s progress that can be made.”

Leveraging tech to enhance outcomes
Some of the panelists emphasized that pharmacists are on the front lines of meeting patient needs, but they increasingly are balancing a growing range of job responsibilities.

“It’s very difficult for pharmacists to have engagement with the patient, because they’re multitasking through so many different aspects of what a pharmacist has to do today,” said Frank Maione, chief business officer at PerceptiMed. “We have all talked about it, about practicing to the highest level, and they’re not.”

Technology can help enable pharmacists to spend more time on higher-level patient services, according to Doyle Jensen, executive vice president of global business development at Innovation.

“We feel that we’re helping pharmacists to practice at the top of their license, to differentiate through services,” Jensen said. “The prescription is the same price wherever patients go. If it is delivered to the home, where is that interaction with the pharmacist? So we feel that technology investments we can help leverage with our partners enable them to put the pharmacist back up front.”

Meanwhile, Clay Courville, vice president and general manager at McKesson Pharmacy Technology and Services, pointed to a couple of areas for future industry technology investments.

“Efficiency is at a premium, and there’s more that we can do to help you become more efficient,” he said.

In addition, there’s a growing opportunity for technology to become even more intelligent by providing more insights and answers, and this mission will become more important. “Instead of requiring so much work on the part of our customer partners, what if we said, ‘Here’s the answer, and based on your goals, here are the assumptions we made. Press this button, and it will happen,’” Courville said.

Assessing generational impact
The panel noted that one of the important questions for pharmacists is how much emphasis to place on varied patient preferences by generation. Yet, there were different schools of thought on this question. Most agreed that generations need to be considered, but others pointed out that certain behaviors transcend patterns typical of various age groups.

“A millennial with a chronic disease is going to act differently than a millennial picking up an antibiotic or birth control,” said Jeff Key, president of PioneerRx. “So it’s really about understanding where a person is, being able to quickly capture that, store that, respond to it. I think that’s critical, and it has to be in your software, has to be in your workflow, and you have to empower people to figure it out and track it.”

Patients from different generations often portray unique interaction styles, said Publix’s Rusk. Publix tends to “over-index” on baby boomers, given its heavy Florida presence. He said members of that generation often are focused on such questions as, “Do we take their Part D Plan? Can we help them pick out a Part D plan? Can we help them be more adherent to their medications?”

On the other hand, Rusk said millennials and Gen X-ers often are focused on convenience. “They want to transact how they want, when they want and where they want.”

While it is no surprise that younger consumers are more likely to be engaged with digital platforms, Treon of Cardinal Health warned against broad stereotypes.

“We’re finding that some of the older folks, they do need a little digital coaching, but once they receive it, they will interact, and they will enjoy that technology connection to include Facebook videos and mobile prescription refills,” he said. “So I would argue it’s important to personalize things to who the patient is and how they want to interact with you.”

All of these considerations need to be figured into technology and service solutions as well, said Rumbarger of CVS Health. “We think of it as more situational than generational,” e said. “But there are people of all generations that are using all different kinds of solutions. So it’s really a matter of making sure that you have a suite of products and solutions that can serve whatever the situation is, whether you’re a chronic patient with a complex disease state, or someone looking for convenience who doesn’t want to leave their couch and just wants their prescription delivered.”

Viewing the big picture of health care
In addition to targeting specific solutions, Rumbarger said retailers need to assess how their stores fit into the bigger picture of health care.

“It’s important to make health care local. This can be accomplished by having a suite of services in the store, having the store be a one-stop shop destination,” Rumbarger said. Having a holistic picture of the entire patient, and not just a segment of the patient, so that no matter which area of the store they’re going to, we can point them in the right direction to what that next best action is to really improve their health.”

Ultimately, some panelists said it will be crucial to better connect the pharmacist’s activities to the larger health ecosystem to significantly boost patient-facing care.

“How we’re communicating with the patient has to change,” said Walgreens’ Shah. “This isn’t just a pharmacy issue, this includes the physician, pharmacist, nurse practitioner and others. Every healthcare professional feels that it’s OK to lecture to a patient, and that by educating and taking a one-size-fits-all approach, the patient will actually listen. They won’t. What we’ve started to do is leverage our various communication vehicles to engage with our patients in a personalized way based on their preferences, so that we can effectively help them understand why their medication is important and what they need to do to be adherent to therapy.”


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6 trends driving pharmacy’s future


Where is the pharmacy industry heading as it focuses on creating enhanced patient experiences?

At the DSN Industry Issues Summit Chris Dimos, president of retail solutions at McKesson, outlined six key trends, including:

  1. Product Mix Shift: “Brands dominated, then a generic wave came in, and now the wave of specialty and biosimilars are taking off. This evolution changes the patient’s experiences with those products.”
  2. Government Repositioning: “We’re seeing changes in how we’re going to think about government involvement, and as more people age into Medicaid and Medicare, how that will influence our patients’ experiences and our practices.”
  3. Pricing Pressures: “These have been around forever. I don’t think anybody comes in and says, ‘I’d like to pay you more for prescription reimbursement.’ For those retailers in the room, if you do, I’d love to know who that is, because I haven’t seen it in my 30-plus years in the industry. But, there is a willingness to reimburse services that lead to an enhanced patient experience.”
  4. Industry Consolidation: “We’re seeing consolidation both vertically and horizontally. These consolidations create both threats and opportunities, but most of the time there’s an opportunity to have new and creative solutions come about.”
  5. New Entrants: “Nontraditional health care new entrants are changing and shaping the way that health care will be provided in the future.”
  6. Digital Impact: “One of the most impactful trends is consumerism. Patients are saying, ‘I want to take more control of my own journey, and I want to have the tools associated to be able to create that journey.’”

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Which area of the industry do you think Amazon's entry would shake up the most?
older woman flu shot

Webinar to focus on flu prevention in older adults

BY David Salazar

Sanofi Pasteur will be offering a live educational webcast for pharmacists aimed at helping pharmacists understand the impact the flu can have on older patients and those with chronic conditions.

The webinar, “The Role of the of the Pharmacist in Helping to Prevent Influenza in Older Adults,” will be presented by Michael Hogue, dean of the Loma Linda University School of Pharmacy and speaker of the American Pharmacists Association House of Delegates. Recently, it was announced that Hogue was elected president-elect of the APhA, an office he will assume in 2019-2020 prior to taking over as APhA’s 165th president in March 2020.

The presentation will focus on the medical burden and economic impact of the flu on patients older than 50 years old, as well as how the flu can exacerbate chronic conditions. It will feature a review of data on two flu vaccines that were compared to standard-dose flu vaccines for efficacy and safety in older adults. It also will feature strategies to improve immunization rates to prevent the flu in older patients.

The webinar will take place Jan. 24 at 12:15 p.m., 1:30 p.m. and 3:15 p.m. EST. To register, click here.


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Which area of the industry do you think Amazon's entry would shake up the most?