NCPA 2024: Enabling Clinical Program Growth Requires a Change in Mindset

Although pharmacists largely recognize the need for increasing clinical programs, implementing those programs still presents significant challenges. In a session at the National Community Pharmacists Association 2024 Annual Convention and Expo, presenters Crystal Bryan, PharmD, and Tara Pfund, PharmD, discussed why a change in mindset is crucial.

Changing the way pharmacists and pharmacy staff think about themselves is key, although providers, payers, and patients must also change how they view the value of pharmacy services.

Pharmacist talking with a patient | Image credit: javiindy | stock.adobe.com

“We’re the pharmacists,” Bryan, chief clinical officer at Cascadia Pharmacy Group, said. “We have to change how we think about ourselves, and we have to know that the services we’re providing are quality, billable services.”

Pharmacy staff are often reluctant to take on new tasks and responsibilities, particularly given the already-high workloads. Intrinsic and extrinsic forms of motivation, as well as proactive communication strategies, can help smooth the process. Pfund, chief strategy officer at Cascadia, said team members want to matter and are motivated by purpose, mastery, and autonomy. Therefore, highlighting how new programs can open new opportunities for them could be helpful.

Pharmacy leaders should also continue to reiterate the vision, progress, and successes as they undertake new programs. Enabling bidirectional communication allows team members to give feedback and feel that their opinions matter and can also help find solutions to challenges along the way.

“If you think about a good communication plan that layers in the vision and where you’re headed, that can make a huge difference,” Pfund said.

Pfund and Bryan discussed a novel workflow for clinical programs providing vaccines, although they added that clinical programming can take many forms. Rather than focusing solely on the administration of the vaccine, Pfund and Bryan urged attendees to consider how they can best utilize the entire clinical experience, from the time the patient schedules their appointment until they leave.

Currently, Bryan said pharmacy workflows are largely designed to shorten wait times. Although this is a patient priority, the future state of pharmacy will be designed around quality patient care, thereby shifting patients’ mindsets and how they view their community pharmacy.

“What we want to work toward is instead of our patients coming to us for a short wait time, they come to us for care, as the point of access, and they trust us for advice,” Bryan explained.

Including technicians, clerks, other ancillary staff, and students and residents is crucial from day 1. Not only does this give them ownership and autonomy, but it also relieves some of the burden from pharmacists. In particular, Pfund said students and residents can be involved in preparing for the clinical encounters, with patient recruitment during the provision of a clinical service, medical decision-making, and charting and billing. Considering each role and who will fulfill it in advance is crucial.

“I say a lot of times, having spent 10 to 15 years in the medical billing world, it’s like quitting smoking,” Pfund said. “You have to sit and make a plan. You’ve got to think about how you’re going to do it and how you’re going to make it work.”

In one case study, Pfund reviewed Vashon Pharmacy in Vashon, Washington. Owner Tyler Young, PharmD, has built out a comprehensive website, robust clinical programs, a roster of credentialed providers, and clinic rooms. Pfund emphasized that this is a high-throughput pharmacy with 500 or more prescriptions per day, highlighting how even the busiest pharmacies can successfully implement clinical programs.

In the Vashon Pharmacy vaccine program, for instance, patients schedule their appointment online, via a form that includes basic information in addition to eligibility questions and insurance information, much like a physician’s office. A remote intern performs the data entry and reviews patient eligibility beforehand, as well as reviewing opportunities for other vaccines or services the patient may need. When the patient arrives for their appointment, the charting and billing are almost all complete, allowing the pharmacist to focus on the interaction.

In most pharmacy models, an encounter for a flu vaccine takes around 7 minutes and has maybe a $20 profit, Bryan said. Under Vashon’s model, the patient may get a flu shot and 1 or 2 other recommended vaccines, increasing the profit to $60 to $100 and taking only marginally longer for the encounter. Depending on the state, Bryan said pharmacies may also be able to bill for the vaccine assessment.

In addition to vaccine programs, pharmacists can evaluate, screen, manage, and treat select conditions; perform medication management; and improve health outcomes and value-based care payment models. Opportunities for point-of-care and test-to-treat programs include influenza, COVID-19, strep, and hepatitis C. Similarly, pharmacies can screen for blood pressure, hemoglobin A1c, and lipids. Pharmacists may also be able to treat minor ailments such as yeast infections, burns, shingles, or bites.

Bryan encouraged pharmacists to voice their opinions with providers, demonstrating their value to both physicians and patients.

“We are pharmacists,” she said. “We monitor the medications, and we know what we’d want to adjust. You can have that quality encounter with the patient and work with the provider to make adjustments…and that’s a billable encounter.”

With all of these opportunities in mind, Bryan and Pfund reviewed the traditional pharmacy workflow and compared it with a novel, optimized workflow. The basic workflow involves prescription drop-off, data entry, dispensing, verification, and checkout. Instead of reinventing the wheel, a clinical workflow can be reimagined to that it’s integrated within this preexisting workflow.

Rather than simply receiving the prescription, pharmacies can view that like a check-in at a physician’s office. Ensure that their medical card is on file and verify personal information. Further, rather than simple data entry, use this time for a chart review and medication synchronization, allowing staff to identify opportunities for upcoming refills or a needed vaccine.

At the verification stage, pharmacists can perform a clinical review, not only for the correct medication, but also adding the suggested vaccine or making a clinical intervention. This optimized workflow only adds 1 new stage for pharmacists: intervention. When the patient comes into the pharmacy, the pharmacist is already prepared to take them aside and make an intervention, driving quality patient outcomes.

“People have to know where to come,” Pfund said. “They have to think of you differently, not just as a place to get a prescription really quickly.”

REFERENCE

Bryan C, Pfund T. Workflow and Mindset Shifts: Enabling Clinical Program Growth in Community Pharmacy. Presented at: National Community Pharmacists Association. October 26, 2024.