Move beyond filling prescriptions to filling gaps in care

SRRX – 327 -January 2020_Disease-State-Management_BANNER

Keeping patients with chronic disease healthier makes your pharmacy healthier

In brief

  • More than 50% of adults have a chronic disease, such as diabetes, hypertension or depression
  • By identifying care gaps and providing services, a pharmacy can improve patients’ lives
  • Multiple opportunities exist for pharmacies to be paid for disease state management

Independent pharmacies can flourish in today’s competitive market by focusing on those patients with chronic diseases.

High incidence of chronic disease

More than half of the adults who walk into your pharmacy have a chronic disease.1 In the United States:

  • 6 in 10 adults have a chronic disease
  • 4 in 10 have two or more chronic diseases

Among the most common chronic diseases in the United States are heart disease, diabetes, cancer, stroke, asthma, Alzheimer’s disease and kidney disease.

Source: The CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)2

How pharmacies can help chronic disease patients

Reviewing medications and ensuring medication adherence are vital services that a pharmacy can provide, but pharmacists can do even more for patients with chronic diseases to:

  • Improve health outcomes
  • Decrease costs of care
  • Raise quality of life

For example, research has shown that having pharmacists involved in medication therapy management can lead to patients’ lowering blood pressure and A1C levels.3

Payment models are evolving so pharmacists may be able to generate revenue for clinical services that benefit patients with chronic disease, including:

  • MTM payments
  • Collaborative practice agreements and incident-to billing
  • Reduced DIR fees and contract bonuses from payers for impacting performance measures
  • Grant programs to improve health in underserved populations
  • Payments directly from patients who want to improve their health

Filling gaps in care

Because patients with chronic disease often have multiple conditions, take multiple medications and require a great deal of care, many patients experience gaps in care — which your pharmacy can help fill.

Some gaps can be filled through services your pharmacy can provide alone. In other instances, it is important to work with other providers in your community to develop a team approach. Such a team shares medical information to ensure patients receive services that allow them to maintain optimum health.

Your pharmacy can:

  • Identify gaps in care. Through MTM sessions, automatic flags in pharmacy systems, checking records such as state vaccine registries and other conversations with patients, compare whether their care matches recommended guidelines for their conditions.
  • Screen patients. Many patients don’t realize they have high blood pressure, diabetes or depression.
  • Develop a care plan with patients and providers, setting goals and monitoring progress.
  • Train patients to manage their care. Ensure that patients understand why they must take certain medications and how to take them properly for optimum benefit. Check that they use inhalers, glucose monitors and blood pressure monitors properly.
  • Offer programs for weight loss and smoking cessation, as well as education on topics such as healthy eating.
  • Monitor home glucose results and lab levels and whether patients are complying with diet and exercise programs. Coach those who aren’t and offer alternatives.

Why focus on chronic diseases

Turning a patient with a chronic disease into a loyal customer gives your pharmacy the opportunity to work with that patient to improve their health.

It can also be beneficial for your pharmacy.

For example, a patient with diabetes could spend up to $10,000 in your pharmacy. This is based on the patient’s spending on prescriptions and supplies, over-the-counter purchases, immunizations, and other front-end products. And, one patient can influence an entire family’s pharmacy decision.

By focusing on patients with chronic diseases and on common diseases — like heart disease and diabetes — your pharmacy can develop greater expertise and capabilities, build credibility in your community, and increase loyalty and profits.

Interested in learning more?

Crystal Lennartz, VP of Pharmacy Performance at Health Mart Atlas™, shares insights on gaps in care, how you can spot them, and what you can do to close them.

Read article

1Chronic Diseases in America,” National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Oct. 23, 2019.
2Chronic Diseases in America,” National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, infographic.
3Pharmacists in Federally Qualified Health Centers: Models of Care to Improve Chronic Disease,” Jennifer L. Rodis, et al., Preventing Chronic Disease, Centers for Disease Control and Prevention, Nov. 21, 2019.