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2015 Annual Convention
Date: Tuesday, October 13, 2015 Time: 2:45 pm – 4:15 pm Location: Gaylord National Harbor Resort and Convention Center, National Harbor 2 Title: All Hands on Deck: Using Your Pharmacy Team to Build Your Patient Services Sponsored by Merck
ACPE # 207-000-15-135-L04-P 0.15 CEUs ACPE # 207-000-15-135-L04-T Activity Type: Application-based Speaker: Matt Osterhaus, RPh, Osterhaus Pharmacy Chris Harlow, PharmD, St. Matthews Community Pharmacy Jake Olson, PharmD, President and CEO, Skywalk Pharmacy Pharmacist and Pharmacy Technician Learning Objectives: Upon completion of this activity, participants will be able to: 1. Discuss strategies for engaging in new pharmacy services without adding additional staff. 2. Describe revenue-producing programs ideally suited for non-pharmacist staff members. 3. Outline ways to incorporate students and residents into the existing pharmacy workflow in order to
improve the pharmacy’s bottom line and better serve patients. Disclosures: Matt Osterhaus declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Chris Harlow declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Jake Olson declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. NCPA’s education staff declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
NCPA is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is accredited by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit.
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All Hands on Deck: Using Your Pharmacy Team to Build Your Patient ServicesSponsored by Merck
Driving the Pharmacy Forward with Technicians
Jake Olson, PharmD
President and CEO
Skywalk Pharmacy
Disclosures
Jake Olson declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
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Learning Objectives
• Discuss strategies for engaging in new pharmacy services without adding additional staff.
• Describe revenue-producing programs ideally suited for non-pharmacist staff members.
• Outline ways to incorporate students and residents into the existing pharmacy workflow in order to improve the pharmacy’s bottom line and better serve patients.
Skywalk Pharmacy
• Children’s Hospital of Wisconsin
Outpatient Pharmacy
• Specialized patient populations
• Cystic Fibrosis
• Oncology
• Solid Organ and Bone Marrow Transplants
• Specialty and Compounded Medications
Skywalk Pharmacy
• Unique patient population
• Technology focused
• Convenience minded
• Very busy lifestyle
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Old Business Model
• Fill discharge prescriptions
• Transfer prescriptions to home pharmacy
• Focus on frequent fliers and profitable patient populations
• Reactive pharmacy
• Frustrated patients and pharmacy staff
• Inventory problems
The times they are a changing
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Appointment Based Model
Pharmacies• Increased revenue
• Operational efficiencies
• Inventory management
• Prior authorization management
• Stronger relationships
• Part D preferred pharmacy networks?
Appointment Based Model Med Sync
Patients• Convenience
• Personalization
• Satisfaction
• Overall Health - Adherence
Appointment Based Model Med Sync
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• APhA Foundation white paper
• NASPA ABM Implementation Guide
• Simplify My Meds®
• Ateb – Time My Meds®
• Pharmacy operating system programs
What type of bus should I drive?
August 11th, 2015
Get on the Bus
My Bus Drivers
• LaQuana
• Stephanie
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How do I pick my bus driver?
• Pick your technician
– Not necessarily your workhorse
– Personality
– Social skills
– Organization
– Experience
– Get them to buy‐in
Don’t hit the highway!!!
• Start slow!!
• Pick a few test patients
– High dollar medications
– Prior authorization medications
– “Last Minute Larry”
– “Daily Debbie”
– “Once A Season Sally”
– “Multiple Med Mary”
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Develop your bus route
• Come up with your workflow
Workflow Example
• New patient identified
• Introductory SMM Packet
• Review medications by pharmacist for MTM/WPQC interventions
• Transfer prescriptions from competitors
• Add to SMM database
• Synchronize Medications
Utilizing Technicians
• Train technicians to identify new patients
• Become a pro-active pharmacy instead of a reactive pharmacy
• Standardize scripting
• Focused targeting of new patient populations
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Examples
• Intro to SMM
• Medication history form
• Patient Agreement (general agreement)
• Caregiver agreement for foster care patients (agreement for specific patient populations example)
• SMM call script
• Intake-refill reorder form
Where did my bus take me?
• Focused targeting of new business opportunities
• Specialty Pharmacy
• Care4Kids
• Transitions of Care
• Prior Authorizations
• Pharmacy’s Appointment‐Based Model: A Prescription Synchronization Program that Improves Adherence, APhA Foundation White Paper, August 30, 2013.
• Starting a Refill Synchronization Program, Computer Talk for the Pharmacist, July/August 2013
References
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Incorporating Student Pharmacists into Your Practice
Christopher P. Harlow, PharmD, CGP
Director of Pharmacy Services
Commons & St. Matthews Community Pharmacy
Disclosure
Chris Harlow declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
Objectives
• Describe how to incorporate student pharmacists into your pharmacy practice while maximizing their learning experience and decreasing your payroll expense
• Explain the benefits of incorporating student pharmacists in your practice
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About My Practice
• Independent Community Pharmacies
– Commons Community Pharmacy
– St. Matthews Community Pharmacy
• Clinical Services Offered
– Pharmacist‐At‐Home®
– Medication Therapy Management (MTM)
– Immunizations and Injection Programs
– Opioid Recovery Program
– Bio‐Identical Hormone Replacement
– Medications for the blind and visually impaired
– Custom Compounding
– Integrative Pharmacy
Benefits to the Students
• Application of real-world practice experience to didactic education and skills
• Exposure to successful models that provide enhanced patient care with both clinical and economic outcomes
• Build confidence and competency in a supportive learning environment
Benefits to the Students
Patients (+Site) Preceptor
• Provide valuable patient care services
• Improve patient satisfaction and outcomes
• Potential development of new value added servicesnewrevenue streams
• Aid in professional development through in‐service education and staff newsletters
• Influence the professionalization process of new practitioners
• Enhance one’s own knowledge and skills of contemporary pharmacy issues
• Increase job satisfaction and professional pride
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Value of the Student
• 580 PharmD students over 4 years completing ten 4-week APPEs documented all clinical interventions made
• Total # of interventions: 59,613 • Projected cost avoidance: $8,583,684 (average of
$148/intervention)• Top 3 Categories of Interventions Made
– Identifying dosing issues– Conducting chart reviews– Recommending appropriate therapy
• Top 3 Categories of Inventions with highest cost savings– Identifying potential allergic reactions– Identifying drug interactions– Resolving contraindications
Shepler BM. Cost Savings Associated with Pharmacy Student Interventions. Am J Pharm Educ. 2014; 78(4) Article 71.
Value of the Student
Impact of Student Pharmacist Interventions in an Urban Family Medicine Clinic
• 18 students over an 8 month period during a 4 week APPE
• 718 interventions were performed with a 77% accepted rate by physicians
• Including 58% of 200 interventions that required immediate action
• Projected cost avoidance of $61,855
• Essential Interventions
– Filling out medication health card with the patient
– Patient counseling
– Medication reconciliation
Ginzburg R. Impact of Pharmacy Student Interventions in an Urban Family Medicine Clinic. Am J Pharm Educ. 2014: 78(5) Article 90.
Layered Learning Practice Model
• Modified traditional clinical model
• Pharmacy team acts as pharmacist extenders
• Incorporate all pharmacy members (clinical and staff pharmacists, residents (PGY1 and PGY2), student pharmacists, and pharmacy technicians)
Introductory Learner
Advanced Learner
Preceptor
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Layered Learning Practice Model
• Provide exceptional Patient Care
– Most important
– All pharmacy personnel have an active role in patients’ access to care
– Each pharmacy member has specific responsibilities in which to focus
• Preceptor Capability vs Availability
– Capability• Facility provides adequate space for students/residents
– Availability• Pharmacist does not have adequate time
• Pharmacist “extenders”
• Preceptors are able to have more time to precept
Introductory vs Advanced Pharmacy
Practice StudentsIPPE
• Introductory Pharmacy Practice Experience
• Generally during or after the first professional year of pharmacy school
• Topics covered during this time generally include:
– General pharmacy practice issues/laws
– OTC
– Antibiotics
– Biochemistry, physiology, pharmaceutics
– Nutrition
Introductory vs Advanced Pharmacy
Practice StudentsAPPE
• Advanced Pharmacy Practice Experience
– Begins at the end of the final didactic coursework (either end of 2nd year for 3 year program or end of 3rd year of 4 year program)
• APPE hones the practice skills, professional judgment, behaviors, attitudes and values, confidence, and sense of personal and professional responsibility required for each student to practice independently and collaboratively in an interprofessional, team based care environment
– The APPE curriculum includes:
• direct patient care
• interprofessional interaction and practice
• medication dispensing and distribution
• administration
• systems management
• Professional development
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Providing Value to Your PharmacyTotal CTF
Fixed Expenses $ 12,500.00 $ 12,500.00 $ 12,500.00 $ 12,500.00 $12,500.00 $ 12,500.00 $ 12,500.00 $ 87,500.00
RX Volume 4950 4801.5 4851 4950 5445 5692.5 5940 36630 $ 2.39
Employee Graph June July August September October November December
Mary 120 120 120 120 120 120 120
Trina 160 160 160 160 160 160 160
Jim 160 160 160 160 160 160 160
James 140 140 140 140 140 140 140
Lee 160 160 160 160 160 160 160
Students 120 120 120 120 120 120 120
Sum of hours 860 860 860 860 860 860 860
Hours minus student 740 740 740 740 740 740 740
Monthly Payout $ 11,100.00 $ 11,100.00 $ 11,100.00 $ 11,100.00 $11,100.00 $ 11,100.00 $ 11,100.00 $ 77,700.00 $ 2.12
delta $ 1,800.00 $ 1,800.00 $ 1,800.00 $ 1,800.00 $ 1,800.00 $ 1,800.00 $ 1,800.00 $ 12,600.00 $ 0.34
RPh Hours June July August September October November December
Stan 160 160 160 160 160 160 160
Joe 160 160 160 160 160 160 160
Darla 40 40 40 40 40 40 40
Sum of hours 360 360 360 360 360 360 360 CTF
Weekly Payout $ 21,600.00 $ 21,600.00 $ 21,600.00 $ 21,600.00 $21,600.00 $ 21,600.00 $ 21,600.00 $ 151,200.00 $ 4.13
Total RPH and tech $ 32,700.00 $ 32,700.00 $ 32,700.00 $ 32,700.00 $32,700.00 $ 32,700.00 $ 32,700.00 $ 228,900.00 $ 6.25
$ 316,400.00
Cost to fill $ 8.64
Student included $ 8.29
Student reduction 4.15%
Annualized $ 31,200.00
Providing Value to Your Pharmacy
In terms of profit
Rev $ 3,650,400.00 $60/rx
GM $ 803,088.00 22%
Pay roll $ 542,400.00 4.625 Tech FTE equivalents/ 2.25 Rph
Expenses $ 150,000.00
Net $ 110,688.00
APPE/net 28.19%*28% opportunity to average bottom line incorporating efficient students into workflow operations
Practical Approach
APPE Student Example for my Pharmacist-at-Home Model
• New patient visit– During the visit, the student will take notes and record all medicines in the home and assist with the
medication reconciliation • Back at the pharmacy
– Once back at the pharmacy, the student will create the comprehensive medication list and organize the medicines in the weekly medication planner
• Weekly home visit– While there is a Certified Pharmacy Tech who usually exchanges out the medication planners, the
student may provide the visit to free up time for the tech while providing a valuable patient care opportunity for the student
• Medication changes– Med changes are frequent and can take up a lot of time for the pharmacist, so use students to update
medication lists and take the meds out to the patient• Calls to physician offices
– Many physician calls require speaking with medical assistants; this is a great opportunity and experience for the students
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Building Patient Services with Pharmacy Residents
Matt Osterhaus, FAPhA, FASCP
Osterhaus Pharmacy
Disclosure
Matt Osterhaus declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria.
Can a resident be the catalyst for change in your practice?
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Community Pharmacy Residents
Impact:• The profession
• Quality of care you provide
• Your bottom line
PGY1 Community Pharmacy Residency
programs provide value for practice sitesDemonstrating a practice site’s commitment to providing outstanding patient care in a progressive environment that includes a range of patient care services
PGY1 Community Pharmacy Residency
programs provide value for practice sitesIncreasing the number of well‐trained pharmacists prepared to work in expanding patient care roles and providing additional opportunities to recruit pharmacists
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PGY1 Community Pharmacy Residency
programs provide value for practice sitesExposing greater numbers of patients to the clinical expertise of pharmacists by elevating the level of patient care provided and increasing outreach and engagement with the community
PGY1 Community Pharmacy Residency
programs provide value for practice sitesChanging the public’s perception of pharmacists and ultimately resulting in greater demand for patient care services
The patient care services delivered by the resident, in conjunction with other practitioners, aligns with the profession’s vision of pharmacists as advanced patient care providers
PGY1 Community Pharmacy Residency
programs provide value for practice sitesSupporting the professional development and job satisfaction of staff pharmacists serving as preceptors, enhancing retention
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But…even though it’s not about the money, it’s all about the money…
--B. Canaday
• Creating opportunities to develop relationships with other members of the health care team to expand collaborative care opportunities for the practice site
PGY1 Community Pharmacy Residency Programs Provide Value for Practice Sites
What value can a resident bring to my practice?
Keeping the practice site progressive through the introduction of new ideas, unique methods, and novel patient care activities by the resident and preceptor that generate new lines of revenue
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PGY1 Community Pharmacy Residency
programs provide value for practice sitesCreating and/or enhancing advanced patient care services that may attract new patients to the practice site and promote customer loyalty
Inspiring the entire pharmacy staff with the resident’s enthusiasm and energy, resulting in more effective, efficient, and high‐quality care.
PGY1 Community Pharmacy Residency Programs Provide Value for Practice Sites
What can the residency bring to your practice?
• Build capacity for expanded clinical services
• Add talented, energetic pharmacist to staff with a focus on patient care
• Escalate relationship building with other practitioners
• Educate the next generation of change agents for the profession
• Enhance the clerkship educational experience for students
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Residency Projects
• Significant part of the ROI
• Examples of real world success stories
Bottom Line
• Residents are good for the bottom line
• Provides focus on care based services
• Team effort is a must!
