By Vicki Wood
There is always abundant energy flowing when large groups gather, and it was no different when 3,000 independent pharmacy owners converged for the annual conference of the National Community Pharmacy Association (NCPA) in Orlando in mid-October. At every professional conference, there’s a topic du jour—the one that keeps popping up in keynotes, theme documents and the most popular sessions—and this event was no exception. And if history is any indication, the next-phase initiative being talked about and tested by pharmacy owners south of the border is likely what’s coming to Canada in the near future.
Two decades ago, the talk at NCPA was all about the advent of managed care and pharmacy benefit managers (PBMs)—healthcare driven by the mandate of cost-conscious third-party payers. In the mid 00s, medication synchronization was being embraced by community pharmacies as a system of workflow and practice transformation that could enable both better use of pharmacy resources and improved patient care and adherence. Around 2010, the push at NCPA was towards the rise of the Clinical Community Pharmacist—a patient-focused model that combined the med sync workflow model with enhanced specialty skills to allow pharmacists to differentiate themselves as professionals providing specialty patient care. In recent years, the excitement has centred around an initiative being heralded as the next logical step in this methodical move away from product-dependent pharmacy practice: the rise of Community Pharmacy Extended Services Networks, or CPESNs.
CPESNs: Community pharmacy’s Next Big Thing
Judging by the standing- (and even floor-sitting-) room only crowds packing conference sessions about the new networks, and the steady lineup of pharmacists waiting to talk to someone at the CPESN information booth on the exhibit floor, this is community pharmacy’s Next Big Thing.
So, what’s a Community Pharmacy Enhanced Services Network? According to Coco Beach, Florida, pharmacy owner and outgoing NCPA president, DeAnn Mullins, “CPESNs are independent pharmacy’s only chance to survive,” as public and private payers continue to move towards an outcomes-/quality-based model of payment for services. The networks specifically target Medicaid and Medicare programs that offer bonus payments to pharmacies that can demonstrate their impact on adherence and patient outcomes.
An initiative launched about three years ago, CPESNs are the next logical extension of medication synchronization—the system that facilitates the co-ordination of patients’ medication refills at one pre-planned appointment, where the pharmacist can take the time to provide in-depth counselling and additional patient care services. When NCPA began promoting med sync to its members about a decade ago, it was with the goal of allowing them to differentiate themselves from the low-price-focused chains. The system frees up pharmacists’ and patients’ time to allow for the provision of expanded services that improve adherence and outcomes (and pharmacy revenues). Within a couple of years, national drugstore chains, including the country’s largest, Rite Aid, had jumped on the med sync bandwagon. More recently, Canadian pharmacies, including numerous independents and the Rexall banner, have also begun to roll out versions of med sync.
NCPA believes that CPESNs are the next logical step for community pharmacies. In a nutshell, pharmacists who provide enhanced professional services are forming networks with other pharmacists and healthcare providers in their communities to support each other and be able to offer an umbrella of patient care services within their own regions at a higher level of care that meets or exceeds Medicare benchmarks. There are now CPESNs in 13 U.S. states, with several others in the process of being set up. Pharmacies can either join the national network or their local regional network, if one exists.
Owned by participating members, each network supports members in becoming more deeply involved and integrated into the healthcare teams in their communities. Resources include help in creating patient care networks, optimizing care delivery, and creating value-based payment models for pharmacy professional services. Each network also helps members optimize their performance in ways that both enhance patient outcomes and match up with payers’ reimbursement requirements.
If all of this seems like an awful lot of work for pharmacies—well, it is. But it’s the new reality in a world in which payment for services is increasingly linked to quality of care and outcomes. And, according to network participants speaking at the NCPA conference, in the end, patients benefit from a much higher level of care, and participating pharmacists enjoy a satisfying practice in which they feel integral to the patient care team and can see both professional and financial rewards for practising to their highest possible standards.
Time to re-calibrate
While the rise of CPESNs dominated this year’s conference, another underlying theme was the dire need for a re-calibration of the current healthcare system, which has become so centred around numbers, forms and codes that, according to some speakers, the patient has almost been forgotten. Keynote speaker Dr. Zubin Damania, AKA ZDoggMD, has become one of the country’s most popular and influential champions of healthcare reform. A second-generation physician and award-winning clinical teacher, Damania is also a comedian who has garnered a huge following for his musical parody videos that highlight serious issues in healthcare.
“The current PBM-directed system almost completely bars us from providing actual patient care,” said Damania. “It rewards speed, clicks and correctly completed paperwork over actual time spent listening to, problem-solving with and taking the very best care of our patients.” Both Damania and NCPA’s Mullins stressed that it’s time for all healthcare professionals to break out of their silos and instead, work together to push—very hard and loudly—for complete reform.
“Healthcare 2.0 is about technology. We need Healthcare 3.0,” said Damania. This new model still relies on technology; not as a tool to restrict care to narrow algorithms, but to enable real relationships between care providers and patients, and between healthcare professionals as a care team.
NPCA CEO Douglas Hooey echoed their sentiments the following morning. The association has launched a call to investigate the current model, in which health care is dictated by the financial goals and care guidelines of payers, in particular a few pharmacy benefit managers with a monopoly over non-public health spending. “There is an urgent desire for a new model,” said Hooey, “PBMs get in the way of providing patient care while adding absolutely no value to the system.”
This article was originally published in the November issue of Pharmacy Practice+Business.