Future-Proofing Pharmacies Amid a Changing Health Care Landscape

It may feel as though pharmacies are sometimes treated as the underdog misfits of the health care community, given industrywide challenges such as direct and indirect remuneration (DIR) clawbacks and the fight for fair compensation when negotiating value-based contracts.

However, after the COVID-19 pandemic showed how critical pharmacists are to keeping people healthy, we’re starting to see a noticeable shift in 3 areas:

1. The role of the pharmacy as a gatekeeper to health.
2. How pharmacists are perceived by their care partners, notably payers and physicians.
3. How pharmacists are seen by their patients.

Research suggests that more pharmacists are now operating at the top of their license more than ever before, and it’s clear pharmacies are empowered to shape health outcomes in new ways, influence compensation, and drive new revenues.

But these additional opportunities bring additional responsibilities, such as the need to navigate new financial and collaborative practices with care partners or the need to play a more direct role in disease management and overall care experience.

They also raise a big question: What is the best way for pharmacies to move forward, given their increasing importance in value-based care?

Vying for the Biggest Slice of Pie

To stay successful in any industry, organizations must always consider how broader changes, such as incentive programs or new regulations, will affect day-to-day operations. This is especially true for pharmacies feeling the impact of multiple industrywide shifts in 2022. One of the biggest of these? The shift toward value-based care models, which aligns financial incentives with patient experience as well as outcomes.

Consider that CAHPS metrics pertaining to member experience now account for nearly 40% of a health plan’s CMS Star rating. As pharmacies are a lifeline for health plan success, the extent to which patients have a positive experience with their respective pharmacies affects all stakeholders in the health care ecosystem.

Although pharmacies aren’t the only touchpoint for patients, they are responsible for ensuring patients are clear about their health conditions, medications, and expectations, and often have the most touchpoints with patients throughout the year.

Medication adherence is also particularly important to pharmacies and understandably so: As many as 50% of all Americans don’t take their medication correctly, which contributes to an estimated 275,000 deaths per yeardue to non-optimized drug therapy. It’s a central part of the Pharmacy Quality Alliance (PQA)’s goals around its pharmacy performance measures.

Of course, simply dispensing medications or verifying prescriptions with providers is no longer sufficient. Pharmacies must do more and collaborate more closely with their health plan and provider partners to ensure patients are adherent.

Sadly, collaboration is not a task that comes naturally, or easily, to care partners vying for the biggest slice of pie—or the largest portion of compensation. As a clinical manager of pharmacy programs at Blue Cross Blue Shield of North Carolina noted in a recent interview, “oftentimes there’s an adversarial relationship when you first start out…because we're used to kind of butting heads.”

Tapping into Technology

Given the broader industry changes afoot, now is the time for pharmacies to adopt the tools that reshape their communications with payers and other care partners, and future-proof their organizations.

Here are 3 areas pharmacies should focus on when evaluating potential technology investments:

1. Collaboration

We hear a lot about the sophistication of tools to support pharmacy workflows and streamline the process of filling prescriptions. However, a pharmacy management platform should go one step further by offering an integrated solution that enables complete visibility into everything from clinical opportunities to payer-funded clinical interventions.

2. Patient engagement support

The average patient sees their pharmacist 12 times more often than their primary care provider. Community pharmacies are in a unique position to take on an increased role in primary and preventive care with the right engagement support tools. These can include, for example, applications that dispatch messaging, education campaigns, and reminders at pre-determined times based on particular individual’s medication fill history.

3. Growth enablement and support

As technology evolves, and new regulations materialize, pharmacies will be expected to stay flexible, so they’ll need technology that can support them as they grow. For example, if pharmacies want to offer ancillary revenue services, such as urinalysis, bone density scans, or even chronic care management via telehealth, they’ll need tools to help them with coding, documenting services, and sharing information with care partners across the continuum.

As the role of pharmacies in patient care evolves, now is the time to revisit processes, people, and technology—but especially the latter. Adopting the right solutions to foster better collaboration is a key aspect of moving forward and setting up care pharmacies for continued success.

About the Author

Anna Hall is chief compliance officer for Transaction Data Systems, the leader in pharmacy software solutions. Its portfolio of products and services included Rx30, Computer-Rx, KloudScript, PrescibeWellness, and Enhanced Medication Services.