The pharmacy component of healthcare is evolving rapidly as reform gains momentum and provider consolidation and integration continue to accelerate. Better Thinking for Better Health interviewed two McKesson pharmacy experts about the trends they expect to impact pharmacy in 2013.
Al Linggi, vice president, corporate business development, has been with McKesson for 17 years. He has undergraduate degrees in zoology and pharmacy and also an MBA. Prior to joining McKesson, Linggi worked for a major health system for more than 25 years, managing hospital pharmacies, home infusion centers and a range of ambulatory care services.
Doug Donaldson, director, product management, MPSA, has been with McKesson for 10 years. He earned an undergraduate degree in pharmacy and has extensive experience in the retail and mail order pharmacy sectors.
What is the most significant trend you’re seeing in pharmacy today?
Donaldson: I think most of our customers have recognized for some time that the dispensing medication function ultimately would be complemented by a more active role in medication therapy management (MTM) and other clinical-type services. Our customers provide counseling services today and are getting reimbursed for those services, but the clear trend we’re seeing is a shift from pharmacy being a dispensing-centric function to a services-centric function.
Linggi: Probably the simplest way to think of it is that the pharmacy practitioner is in the process of becoming a provider. With a decrease in the number of primary care physicians and the increase in the number of patients that will need to be treated, the pharmacist represents an underutilized resource that can be leveraged to play a greater role in providing cognitive, clinical services to patients.
What kinds of services are we talking about?
Donaldson: Basically, it’s a wide range of health and wellness functions, including working to reduce medication non-adherence, monitoring the health of chronic disease patients; basically services that can ensure appropriate therapeutic outcomes.
Linggi: Pharmacists historically have done these kinds of things in connection with specialty products like injectable, high-cost medications. The payers want to ensure compliance, because of the cost of the medications, so they’ll reimburse for the services that the pharmacist can provide to increase the likelihood of compliance. What we’re seeing now is that this is expanding beyond specialty drugs into therapies for a range of disease states like diabetes, cardiovascular, respiratory, depression and pain management.
In what other ways is pharmacy evolving?
Linggi: In conjunction with the expanding clinical role of the pharmacist, there is an enormous emphasis on connectivity and trying to ensure that the pharmacy can share information across all aspects of the care continuum, including the provider, payer and patient. The objective is to be able to collect and exchange key information regarding adherence, outcomes, clinical condition and patient education.
Donaldson: The emergence of accountable care organizations and the meaningful use program are accelerating this push to link disparate systems to more effectively share information. It’s occurring right now in a variety of ways, for example pharmacy chains or individual pharmacies connecting directly with a local hospital system. We’re also seeing the emergence of a wide range of automation tools and digital applications, including auto-refill programs, that are designed to keep the patient engaged with their therapies. But the challenge is connecting the entire continuum. Many constituents in the industry are coming together now to define broader scale connectivity, Health Information Exchanges. We’re working closely across McKesson to define and provide these solutions.
What business imperatives are driving these changes?
Donaldson: For the pharmacy, it’s all about finding new business opportunities as margins continue to shrink. They understand that the pharmacist represents a highly educated clinical resource, so they’re looking at what kinds of additional services they can provide to add value to the system. And that includes not only the provision of clinical services, but also the collection of data that can be of use throughout the continuum.
Linggi: On the provider side, hospitals are seeking ways to reduce re-admissions. They recognize that pharmacists can play an important role by ensuring better compliance. This keeps patients healthy and helps reduce or eliminate the enormous costs frequently associated with re-admissions.
What advice can you give pharmacies about meeting the challenges of this fast-changing environment?
Linggi: It’s important that pharmacies continue to automate and streamline centralized, operational tasks that don’t require clinical resources. This helps free up the pharmacists and thus accelerates the transition to a service center approach. The second thing is creating the ability to convert data to information, so that pharmacies will be in a position to share useful knowledge with the providers and patients. And then, finally, continuing to seek out effective ways to connect across the continuum.
Donaldson: Pharmacies also need to stay engaged with their vendors and their industry associations. There is so much going on that these outside sources can be very helpful in identifying emerging trends and opportunities. Finally, it’s important to keep your eye on patients and not lose sight of good pharmacy practices. You need to treat your patients well and provide the services they need, so they will stick with you as you bring these new services to market.