How this adherence solution is improving patients’ outcomes and pharmacies’ fiscal health
Recent studies show evidence that medication synchronization and the appointment-based model (ABM) are gaining traction among community pharmacies, and have the potential to change the game in delivering tangible benefits to patients and your store.
The Concepts of Med Sync and ABM
Lack of adherence to prescribed medications is a well-known and costly problem. Nearly two-thirds of Americans don’t take their medications properly1 and lack of proper adherence costs the U.S. healthcare system almost $300 billion each year.2 Payers, PBMs, pharmaceutical manufacturers, physicians and pharmacists have all been trying to tackle the issue of non-compliance.
In 1995, a community pharmacist in Long Beach, California conceived and implemented the appointment-based model, with prescription synchronization as “the engine that drives the ABM.”3
These two concepts work together:
- Medication synchronization. All of a patient’s prescriptions are synchronized to be refilled on the exact same day of the month, eliminating the need for separate call-ins and pick-ups.
- Appointment-based model (ABM). An appointment is scheduled for the patient to come into the pharmacy to pick up all of their medications at one time. Prior to this appointment, patients are contacted to confirm the prescriptions that are to be filled and to identify any changes in therapy. During the appointment, the pharmacist can review a patient’s health and medications, provide counseling or medication therapy management, and/or conduct a medication review.
In combination, medication synchronization and ABM turn a reactive process where pharmacies have traditionally waited to hear from patients about refilling their prescriptions, resulting in high rates of non-adherence, into a proactive process of contacting patients, reviewing their medications, refilling prescriptions and educating patients.
Multiple studies have shown that medication synchronization and ABM decrease gaps in getting prescriptions refilled (non-persistence) and dramatically improve patient adherence. One study showed a 52% to 73% improvement in non-persistence, based on drug class, and a three- to six-times improvement in adherence versus the control group.4
Other studies have found similar results.
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Med Sync at Thrifty White
Thrifty White is a regional pharmacy chain based in Plymouth, Minnesota, with dozens of pharmacies in the rural Midwest in North and South Dakota, Iowa, Wisconsin, Minnesota and Montana.
Med Sync was initiated company-wide in 2011 and is prominently marketed on the company’s website as being easy, convenient, free, and simplifying patients’ lives. Thrifty White’s marketing includes a short video on its website explaining its Med Sync and Ready Refill programs.
Follow-up research (which has been widely published) has shown that Thrifty White’s Med Sync program has improved medication adherence, has increased the number of refills filled per patient, is preferred by patients, and is seen as more convenient. Patients say the program and their discussions with Thrifty White’s staff make them more likely to take their medications, and 89% say they would recommend Thrifty White’s Med Sync program to friends and family members who take multiple prescriptions.6, 7
Key Implementation Considerations
Implementing a med sync and ABM program requires planning, decisions, and addressing several important considerations, such as:
- Purpose and goals. Before undertaking med sync and ABM, a pharmacy should have clarity on exactly what it is trying to accomplish. Is the main goal operational efficiency? Increased revenue? Improving adherence? Improved inventory management? Freeing up pharmacist time for other clinical services? And, how will success in achieving these goals be measured?8
- Business model. Along with the basic goals, it is important to think through the financial rationale for med sync/ABM. The model may be that increased operational efficiency on its own justifies med sync, or it may be that some payers will reimburse for medication synchronization and reviews. Have a clear financial plan before you start.
- Patients to target. Med sync and ABM is not for everyone. The best candidates are individuals with chronic conditions who take multiple prescriptions. It is these individuals who often have adherence issues and for whom medication synchronization and ABM can have the greatest value. Understand how many of these patients make up your pharmacy’s customer base, and what opportunities you have to attract new patients for whom a med sync service would be appealing.
- Technology. The APhA Foundation white paper on ABM says, “Technology can facilitate the implementation and scalability of the ABM.”9 Focused medication synchronization tools and technologies need to be integrated with a pharmacy’s existing pharmacy-management system. The pharmacy-management system might provide an automated data feed to a synchronization tool, which determines the best synchronization option for the patient. The tool used by Thrifty White is Time My Meds by Ateb, Inc. (For more information on how pharmacies can leverage technology to enable med sync, see this article of a roundtable discussion among tech experts.)
- Staff training. Staff must be trained on the processes and technologies to implement med sync and ABM. Also, a good idea is to designate a technician or staff pharmacist to oversee the program.10
- Start small. Those who have implemented med sync and ABM programs suggest starting small, with just a few patients, and first conducting a pilot to work out processes and identify issues to be addressed.
Challenges can include identifying and enrolling appropriate patients, implementing a new workflow, distinguishing between sync and non-sync patients, implementing the appropriate software, and managing plan coverage issues related to early and partial refills in order to achieve synchronization.11
Med Sync at Towncrest Pharmacy
Towncrest Pharmacy, a Health Mart in Iowa City, Iowa, began a medication adherence program a few years ago, which has evolved into a new medication synchronization offering. Randy McDonough, co-owner and director of clinical services, saw many patients who didn’t necessarily need a full-blown adherence program, but who could see great convenience in having their medications synchronized and picking them all up just once per month.
So, last September Towncrest began a medication synchronization program with about 50 patients. McDonough described this program as an immediate success and shared the following comments:
- Be prepared. McDonough said that customer interest was very high and as soon as customers learned about this program, many wanted to enroll immediately. For pharmacies, this means being prepared before you begin. Have all of your processes laid out, know how you will manage all documentation, have determined who on the team will handle the various responsibilities, and be ready to go. “You need to figure it out before you start because it can be very successful, very quickly,” said McDonough.
- Start with a pilot. Whenever you do something new, you don’t know what issues you will run into, and a medication synchronization program is no exception. Towncrest learned about training customers about the calls they will receive, and spreading out pickups over different days of the week to avoid being bombarded. After enrolling the first 50 customers, Towncrest actually stopped actively marketing the program so they could improve their processes based on what they learned.
- Incorporate technology. Towncrest began its medication synchronization program with a three-ring binder, but quickly realized that to manage the program with a larger number of patients, technology is essential. Towncrest is now in the process of developing their own technology to improve their ability to manage this program.
- Market the advantages. From McDonough’s perspective, synchronizing a patient’s medications provides operational advantages for Towncrest, but it also provides unique benefits versus other pharmacies in the community. As Towncrest improves upon and expands its med sync program, this will provide distinction.
A wealth of tools and resources exist to help community pharmacies learn about and implement med sync and ABM. These include:
- Stick To The Script. This website from the National Community Pharmacists Association is focused specifically on improving medication adherence.
- Simplify My Meds. This program from the NCPA provides tools and training to implement a refill synchronization program. This program includes a revenue calculator to calculate an increase in gross revenue from implementing med sync.
- ABM White Paper. The American Pharmacists Association Foundation has compiled a comprehensive paper about the appointment-based model and prescription synchronization. This white paper provides the history of ABM and med sync, summarizes the results of several studies, explains how ABM works, discusses aspects of ABM business models, provides guidance for implementation, and offers insights on how to market ABM and med sync.
- NASPA ABM resources. The National Alliance of State Pharmacy Associations has created a website with implementation tools for the appointment-based model, along with ABM studies and other ABM resources.
With drug adherence as one of the greatest challenges facing the healthcare industry, medication synchronization and the appointment-based model provide a great opportunity for community pharmacies to be part of the solution — with significant benefits for patients and pharmacies. Take advantage of the many resources available to decide how you can get started with med sync and ABM in your pharmacy.