AI Tools Can Help Pharmacies Advance Value-Based Care Practices

Organizations across the health care ecosystem continue to navigate growing patient expectations, staffing pain points, health inequities related to the social determinants of health (SDOH), reimbursement challenges, and much more. Amid these headwinds, payers and providers are increasingly shifting to value-based care (VBC) models that prioritize quality care and positive patient outcomes over sheer volume.

Pharmacy organizations also have a key role to play in accelerating VBC, given their firsthand knowledge of the costs and complexities around medication access and the resulting barriers to therapy (especially for those who are uninsured or underinsured). By utilizing leading tools and technologies powered by artificial intelligence (AI), pharmacies can help bridge the gap between the financial and clinical elements of care to unlock better patient experience and improved outcomes.

Key Health Care Challenges From a Pharmacy Perspective

Several factors are prompting pharmacy organizations to consider AI-supported, patient-centric VBC strategies. Image Credit: © nakigitsune-sama - stock.adobe.com

Several factors are prompting pharmacy organizations to consider AI-supported, patient-centric VBC strategies that benefit all stakeholders:

1. ·Medication nonadherence. In the US, the failure to adhere to prescription drug guidelines is a common challenge for a variety of reasons, especially among chronic disease patients, resulting in hundreds of billions of dollars in avoidable health care costs and at least 100,000 preventable deaths annually.¹
2. Growing consumer preference for home health. According to a recent EY survey, 66% of patients are prepared to receive care in non-health care facilities such as at home or in a store.² Further, 52% prefer delivery of medications over in-store pickup.³
3. The rise of tech-driven care. The digital health market size in the US was over $81 billion in 2023, expected to increase by 19.5% annually between 2024 and 2030.⁴
4. Workforce shortages. By one estimate, the US is facing a shortage of up to 86,000 physicians by 2036,⁵ with applications to pharmacy schools plummeting by 64% between 2012 and 2022.⁶
5. Inventory management challenges. Without accurate demand forecasting capabilities and real-time visibility into inventory at their disposal, pharmacies will have difficulty competing with large retailers and new market entrants.

For patients, navigating medication access in this environment can be complicated, often due to barriers around affordability even among those who have health insurance. Further, among uninsured and underinsured populations, the obstacles around obtaining essential medications can be even more pronounced. From tracking medication adherence to navigating eligibility, identifying at-risk patients and much more, pharmacies have a big opportunity to help revolutionize care delivery in the VBC era—especially given the rise of new technologies that reduce costs and enhance efficiency.

Embracing AI to Build the Pharmacy of the Future

Leveraging AI and other digital capabilities, tech-enabled solutions can streamline pharmacy processes, improve patient data, and enhance collaboration with provider and payer organizations in the following ways:

• Billing and reimbursements. AI tools can automate data entry, coding, and claims management for billing and reimbursement processes. This activity streamlines financial operations while allowing pharmacy staff to focus on patient care.⁷
• Improvement in the medication-use process. AI-driven decision support systems help pharmacists choose the right drugs and dosages, as well as identify potential drug interactions and adverse events. These resources improve clinical judgment while reducing medication errors.⁸
• Prescription management. AI can assist in managing prescription records, driving accuracy and efficiency in pharmacies’ handling of medication orders.
• Adverse drug reaction monitoring. AI algorithms can monitor patient data to detect adverse drug reactions early, allowing timely intervention.
• Inventory management. Through the use of AI algorithms, tech solutions can optimize inventory levels, reducing waste and validating that medications are available when needed.
• Digital education and training. AI can provide personalized educational content for patients and pharmacy staff, enhancing knowledge and compliance.⁹

By implementing solutions that harness the power of AI, pharmacies can reduce burnout among pharmacists and other staff, navigate new home health care models, and keep pace with both competitors and evolving pharmacy consumer expectations. With the right AI-driven strategies in place, today’s pharmacies can help put patients at the center of the care journey and bridge the gap between the financial and clinical elements of health care for a better overall patient experience, also unlocking leaner and more agile pharmacy operations in the process.

Enhancing Patient Experience and Outcomes Through Technology

As VBC and consumer-focused digital health care continue to take shape and the imperative to improve medication adherence grows, pharmacies should consider leveraging technology to achieve a host of related benefits, including personalized patient insights and more timely communications. Initiatives such as virtual medication management, health education and preventive care services, and better provider coordination can also save considerable time for pharmacists by lowering burnout and enhancing patient outcomes.

Here are a few examples of leading AI-driven tools and practices that can help pharmacies achieve these milestones while also enhancing the patient experience and promoting early detection of health issues:

• Personalized pharmacy assistants provide patients with information on side effects, drug interactions and other risks to enhance adherence and customer retention while minimizing burnout.
• Prescription fill prioritization completes orders based on urgency and past patient behavior.
• Voice of the customer assesses customer feedback and other metrics around effectiveness to drive process improvements that increase brand loyalty.
• Product demand forecasting predicts demand for products and leverages greater accuracy on product availability to improve patient satisfaction.
• Prescription status chatbot sends automated reminders and updates to patients and providers to enhance medication adherence.

Starting the Journey to AI Integration With Pharmacy

For pharmacy organizations that are looking to leverage AI to improve care delivery and streamline company operations, taking a strategic approach will be critical. In our experience, 7 critical activities are necessary to establish the appropriate foundation to embed cost-saving technology across pharmacy operations. This approach will improve the overall patient experience and patient outcomes today and in the future:

1. Utilize robust data infrastructure. Real-time data on medication usage patterns and inventory levels can optimize inventory management, reducing waste and unlocking medication availability.
2. Develop a value-based strategy. This strategy should focus on creating value for patients via improved outcomes while also containing costs.
3. Provide training and resources for pharmacy staff. AI tools enable pharmacists to reduce their administrative burden, improve their efficiency, and reduce their error rates.
4. Acquire technology that bolsters VBC initiatives. Key solutions include medication adherence tracking tools and analytics software.
5. Analyze historical data. Prescription volumes, seasonal variations in demand and demographic trends can all inform more accurate demand forecasts, enabling pharmacies to adjust inventory levels and staffing accordingly, thereby improving efficiency and patient satisfaction.
6. Implement VBC-related services. Care coordination, preventative care services, and chronic disease management programs can enhance outcomes proactively.
7. Benchmark progress. KPIs, data collection efforts, and ongoing reporting can help pharmacies identify and address areas for improvement.

For pharmacies, AI and other leading technologies are the key to thriving in the era of VBC. Adopting this approach can help pharmacies remain competitive and responsive as the demands of health care delivery evolve. It will also be instrumental in shaping the efficient, equitable and people-centric future that every patient deserves.

The views reflected in this article are the views of the authors and do not necessarily reflect the views of Ernst & Young LLP or other members of the global EY organization.

REFERENCES

1. The Unmet Challenge of Medication Nonadherence. National Institutes of Health.2018. Accessed August 27, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045499/

2. How to give health consumers the access and experience they value most. EY.June 6, 2023.Accessed August 27, 2024. https://www.ey.com/en_us/insights/health/ey-consumer-health-survey-2023

3. Prescription Delivery and Digital Pharmacies Consumer Adoption. Rx Savings Solutions. February 27, 2023. Accessed August 27, 2024. https://rxss.com/blog/digital-pharmacies-and-prescription-delivery-drive-savings/#:~:text=Over%20half%20(56%25)%20had,in%2Dstore%20pick%2Dup.

4. US Digital Health Market Size & Trends. Grand View Research. Accessed August 27, 2024. https://www.grandviewresearch.com/industry-analysis/us-digital-health-market-report.

5. New AAMC Report Shows Continuing Projected Physician Shortage. Association of American Medical Colleges. March 21, 2024. Accessed August 27, 2024. https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage

6. Pharmacies are struggling to refill their own ranks. Axios. February 6, 2024. Accessed August 27, 2024. https://www.axios.com/2024/02/06/pharmacy-staffing-shortage-burnout

7. The Future of AI: Pharmacy Applications & Workflows. DocStation. July 24, 2023. Accessed August 27, 2024. https://docstation.co/ai-pharmacy/

8. End burnout with mobile magic. NextGen Healthcare. Accessed August 27, 2024. https://www.nextgen.com/nge/all/demo/general/provider-efficiency-mobile?utm_source=paid_search&utm_medium=bing&utm_campaign=701Do000000p9ZXIAY&utm_content=1357899377774937&utm_keyword=ai%20for%20medical&device=c&placement=&gclid=b2f5d466fb3e19562412b231c946de62&msclkid=b2f5d466fb3e19562412b231c946de62&utm_term=ai%20for%20medical.