By Lindsay Dymowski, President — Centennial Pharmacy Services
According to a 2019 white paper by S. Michael Ross, MD, MHA, suboptimal medication management is costing the healthcare industry more than $528 billion annually. Far more important, 275,000 lives end prematurely every year because of poor adherence.
Yet, thanks in part to the pandemic, we now have a unique opportunity for healthcare providers to teach patients how to properly manage their medications. Doing so will improve the quality of their health, save them and their providers huge amounts of money, and even get them off of the medications they “need” when others are improperly administered — or not administered at all.
The first step is for those who know the most about medication management to become far more involved. Simply put, we pharmacists and our technicians must be allowed to treat our patients like patients, rather than customers.
Lives matter, and so, of course, do the numbers we use to manage them. Proportion of Days Covered (PDC) has long been the preferred metric by which to measure medication adherence. If we can increase PDC, readmissions will decrease automatically, as will a big chunk of that unnecessary spending.
In order to increase both PDC and adherence, however, we must develop more patient-centric medication management models with input from the dispensers. As a pharmacy owner for over 10 years, I know how much my colleagues and I care about our patients’ needs. We also know more than anyone about the barriers they face vis-a-vis adherence.
Cost is a huge factor for patients these days. The industry needs to look beyond PDC measures and consider how many medications patients are not picking up their medications because of the high price tag. Community pharmacies have established workflows to find alternatives if a patient can’t afford a particular medication — with their doctor’s input, of course — but time-pressed corporate pharmacists and techs will often set those scripts aside.
Community pharmacists want to make it easier for patients to manage their medications and their medical conditions on their own, though we are well aware of the challenges, not the least of which is human behavior. Most patients do not want to change their routines, particularly when it comes to taking medication. Onboarding them into an adherence packaging system is unlikely as it requires some external guidance. The good news is that once their adherence package is operational, a new habit is established and (usually) embraced.
When administered by pharmacists, these adherence programs have proven remarkably effective. According to a study published in The American Journal of Managed Care, community pharmacy-based post-discharge transition-of-care (TOC) programs can significantly reduce readmission rates. We see progress every day, though this is not always visible from outside the pharmacy. Unless a community pharmacy is specifically part of a big study, the industry does not consider its results. It’s the old conundrum of the tree falling in the forest; community pharmacists are clearing a path to better outcomes, but no one can hear it, so it must not be happening.
Payment and delivery models such as ACOs and PCMHs.
Speaking of metrics, cost is another important issue on both sides of the pharmacy counter. There have been a number of efforts to make pharmacies value-based, most notably accountable care organizations (ACOs) — which were first authorized by Congress in 2009 — and patient-centered medical homes (PCMHs). ACOs are groups of healthcare providers, including hospitals, that partner in order to provide high-quality care to a defined population, which then shares in the cost savings. PCMHs provide primary health care, including medication, under one roof.
These are promising new models for saving costs that should ultimately benefit the patient, but pharmacies should share in the rewards, too. For example, in addition to the price of the script, ACOs and PCMHs could pay a per-patient/per-month fee to the pharmacy for creating value. This value could be measured directly, such as hitting a PDC target, or indirectly, such as the estimated cost savings of lower readmissions. Otherwise, pharmacists will be relegated to the role of glorified retailer. In the context of a national pharmacy chain, this means that patients will too often find themselves treated like any other customer who walks into the store.
There are many opportunities for involvement beyond financial incentives. Post-Covid, patients are using the pharmacy in new ways, including for vaccinations and point-of-care tests which are now routinely done within pharmacies, and local governments have taken notice. We are participating in test-and-treat programs, while state legislatures consider both giving us provider status and increasing the scope of practice for technicians.
These are positive steps forward, but there is so much more we can do. Community pharmacies have evolved from dispensaries to high-impact points of accessible care. We are already gathering essential information about our patients every day, while delivering better clinical outcomes, higher cost savings, and healthier patients.
— Lindsay Dymowski is President of Centennial Pharmacy Services, a leading medication-at-home pharmacy, and co-founder and principal of The Centennial Group, a pharmacy management company supporting community pharmacies and health systems.