Experts: Vaccine Gap Program Can Address Variety of Health Care Gaps in Any Community

In a discussion regarding the successful vaccine gap closure program in Missouri, Jake Galdo, managing network facilitator at Community Pharmacy Enhanced Services Network Health Equity, and Annie Eisenbeis, director of practice development at the Missouri Pharmacy Association, attested to the program's ability to close health care gaps for any disease state. Galdo and Eisenbeis spoke to the ability for the program to be implemented in any community, emphasizing the "fill in the blank" nature of the program, and how the program can help advance the field of community pharmacy overall.

Pharmacy Times®: How can this program help advance the field of community pharmacy?

Jake Galdo, Managing Network Facilitator, CPESN Health Equity: It goes back to diversifying your revenue stream. You know, if you look at the 10k reporting for publicly traded companies, they'll say that, you know, 85-90% of their book of business comes from prescription sales, and the other 10, 15% are from over-the-counter sales. And that's how we've always viewed pharmacy: product-base. OTC, prescription. Nowadays, we start to recognize that there's a third line of revenue that we should categorize, which is clinical service sales, diabetes education, point-of care-testing, things that are not intrinsically tied to the product. And when we're working on these programs, and what can we take outside of this, is it's the recognition that there's a fourth line of revenue that’s the health equity sales. It's delivery services. And from an independent perspective, that is our delivery driver at the patient's house. From some of those chains’ perspective, it might actually be a drone, but regardless, delivery is a delivery is delivery. But we sit here, and we say, that's a delivery service I do for free. Yet, we have major insurance companies that will hire car services to pick up patients, to take them somewhere, and they call that access to care, and they pay for that. So I give away delivery services, but they pay someone else for access to care, which is literally the same thing. And so why are we not categorizing that as a health equity revenue opportunity and selling that as a package service of what we're doing to address those social determinants of health or non-medical drivers of health?

Pharmacy Times: Are there important considerations to keep in mind for those looking to replicate this program in their own communities?

Annie Eisenbeis, Director of Practice Development, Missouri Pharmacy Association: I think the biggest thing is, don't let others put you in a box. So basically, we push against the model to say we know what pharmacy can do, so stop putting us in this box. We know that we can have an impact on primary care. We can be primary care community pharmacists. When you go see your PCP, then you come to the pharmacy, why are we not extending that primary and preventive service there? And then 2, why are we not extending that further when we have our CHWs go with our delivery drivers and provide vaccine education or access? And then again, in any context, it's not just vaccines. So, I think that's the key there is, let's have everybody involved.

Galdo: And I think, you know, to Annie's point, what that really boils down to is this fill in the blank. And that fill in the blank, and the things we've seen, is colorectal screenings, we've seen naloxone availability and access, glucagon access, we've seen chronic kidney disease screenings. So there's so many things that we're already working on that we're already seeing, that we're already kind of engaging in, that really resonate in this area. I think, from my perspective, what it really boils down to is our ability to express our value, and expressing our values, expressing our quality. And expressing our quality is not a top-down payer measure, looking at me about adherence, because I do more than just adherence, or my adherence might not be the data that they're looking at. And so being able to express our value, to say “I am a different type of pharmacy. Let's work together to help our community.”

Pharmacy Times: How can this program be utilized for other serious health care challenges involving disease prevention and reaching patients?

Eisenbeis: Yeah, so we've already started some of this work. I mean, even if you look at just vaccines alone and say, vaccine education and addressing vaccine hesitancy, and preparing for the next emergency or pandemic, we're actually already ready to do that, whether the management of that is a vaccine or not. Because our CHW and pharmacy teams now can coordinate care for anyone, anywhere, even if it's not at my pharmacy. So, we can help coordinate management or care for anyone, whether they have access issues or not, as well. I think the other is just in a simpler model to say with chronic disease gap closures. Are there specific gap closures that we can address using education or coordination of care with diabetes, hypertension? The list goes on for all of the top chronic conditions, right? And then backing up a little bit, screening for those. So screening, like Jake mentioned for colorectal cancer screening, or is it diabetic retinopathy screening, even just prediabetes or pre-hypertension screening? I think we know, and have known as a society, really, for a really long time, that education can raise everybody up. And that's not just, you know, K-through-12 education, it's also health literacy and health education and being able to self-manage your disease at home, because let's face it, even those of us in health care don't see the doctor like more than twice a year, right? So, we have to be the advocate at home and self-manage, and that requires coordination, education and support. From the other leaders, experts, and community workers in our community.

Galdo: And I think when you hear that, it sounds overwhelming. You say, “you have to do everything for everyone at all times?” and that's a lot. But that's why it's so focused with the current program that we're doing, which is vaccine gap education, and sometimes the intervention is just on influenza, sometimes it's on influenza, pneumococcal, RSV, doesn't matter, it's just education, and then it grows from there. I think, you know, it's all about the piecemeal. We don't turn on the faucet and say, “do everything for everyone.” Do specific things, right? You know, there's a lot to be said about maternal health. There's something to be said about mental health and depression screenings. There's so many opportunities out there that this can get layered on. Part of it is, you know, making every encounter count, and evaluating us as clinicians, being interventionists, and saying, “I just dispensed lisinopril, let me monitor blood pressure.”

Eisenbeis: That's actually why this program was built the way it was, because we've had prior pilots and programs that flopped because we tried to do too much, too fast, and just even making sure that we look back at our profession as a whole and say we understand that there's staffing shortages everywhere, not just pharmacy, but in other spaces in health care too, right? And so, we have our primary care shortages, we have our pharmacy technician shortages, we have – staffing needs time. Everybody's a little bit maxed out. So how can we make sure that we don't burden the entire team or one pharmacist who's trying to do it all in all of these additional services. So that was where tying in the entire team of the pharmacy too, to provide this from the beginning, and that it's just a quick like 5-to-10-minute conversation. This is not something that you do at once, and you have to check all of these boxes. We say that success in the program is not moving somebody from a “no, I don't want a vaccine,” to “yes.” It's moving from “no, I don't want a vaccine, but if I have questions, I know who to ask, and it's going to be you.”

Pharmacy Times: Is there anything else you would like to add?

Galdo: I think ultimately, the success is driven by the collaboration with so many various stakeholders and, you know, we're sitting here and saying, “the pharmacy does this, the pharmacy does that,” and really, it's the community health worker in the pharmacy that did this, and that.

Eisenbeis: I think too, to echo what Jake just mentioned, it's like ending with a lot of thank yous. Thank you to the pharmacy that brought the idea of training a pharmacy technician as a CHW, thank you to the State Department of Health for saying, “Yeah, we can pilot this, and then let's expand this to anyone who wants it. We'll give them a scholarship.” Thank you to CE Impact for taking this and running with it in every state. Thank you to Jake and CPESN and everybody who's been involved in this project who hasn't said “no” to our crazy ideas for next steps.