The number of stops patients are making along the continuum of their care is increasing, and the amount of time they are spending at each of those stops is decreasing.
These changes in a typical episode of patient care are creating new challenges for pharmacies that serve alternate care sites like skilled nursing facilities, post acute rehabilitation centers, home care services and specialty medical practices. For forward-thinking alternate site pharmacies, the changes create new opportunities to grow their businesses by becoming more valuable strategic clinical and business partners to those sites.
Three Forces Are Reshaping the Continuum of Patient Care
To recognize and take advantage of those opportunities, alternate site pharmacies first must realize the big economic health care forces redefining the continuum of patient care. The three major forces are quality, cost and choice.
Discharging patients from the hospital as soon as clinically possible reduces unnecessary and costly inpatient utilization. Advances in the quality of care make discharges safer for patients as they now can receive higher-intensity medical care in other settings. And patients often prefer those other settings to an inpatient hospital room.
At the same time, the federal government has added an element of financial risk to go along with those three forces. Hospitals face financial penalties if their all-cause 30-day readmission rates are higher than expected. Medicare has a five-star rating program for nursing homes that awards stars based on various performance and quality measures. Medicare also has a star-rating program for home-health agencies.
As higher-acuity patients pass through the continuum of care more quickly and through more settings along that continuum, the clinical and financial risk to providers and patients increases. For example, a new study by researchers from the University of Texas Southwestern Medical Center said 20 percent of patients discharged from hospitals have at least one unstable vital sign. The study, which was published in the Journal of General Internal Medicine, found that patients discharged with one or more unstable vital sign had higher readmission and mortality rates than fully stabilized patients.
Clinical Challenges and Opportunities for Alternate Site Pharmacies
With higher-acuity patients being treated in long-term care, home care, outpatient and other settings, the medication needs of those patients become more acute. For instance, the number of different medications each patient is on may be higher. The complexity of the medications for each patient may increase. The sophistication of the drug-delivery system required to administer a patient's medication may rise. And the need to monitor the clinical effects of a patient's medication may be higher.
For alternate site pharmacies not prepared for those possibilities, the challenges may be too difficult to overcome, and their value to long-term care and home-care providers may diminish. But for alternate site pharmacies prepared for those possibilities, the challenges become opportunities to provide clinical services and programs in those settings to drive down costs, increase quality care, and reduce preventable readmissions.
Among those clinical services and programs are:
- Medication adherence programs and services
- Medication therapy management and comprehensive medication reviews
- Wellness and prevention services for high-risk patients
- On-site drug-administration services for complex injectable medications
- On-site infusion therapy
- Medication monitoring services
- Care coordination services
- Clinical trial opportunities and enrollment
- Specialty medications for patients with chronic medical conditions
Further, alternate site pharmacies should consider expanding into retail to fill the prescriptions of patients after they're discharged from each of the settings along the continuum of care. Such retail services may be particularly attractive to patients that have grown accustomed to an alternate site pharmacy's unique medication packaging, which in turn, may increase medication compliance.
Seeing the Bigger Picture as a Strategic Clinical Partner
The clinical services and programs available to patients in long-term care, home care, outpatient and other settings through alternate site pharmacies have the potential to improve the health status of those patients. And they also have a direct financial benefit to the pharmacies themselves by virtue of being able to bill health insurers for many of those services and programs.
Alternate site pharmacies should see the bigger picture as the continuum of care evolves. The ability to offer those clinical services and programs positions alternate site pharmacies to be highly valued strategic clinical and business partners to hospitals, skilled-nursing facilities, home care agencies, specialty medical practices and rehabilitation facilities as well as to new care delivery models like ACOs, patient-centered medical homes and bundled-payment arrangements.
Alternate site pharmacies can help each site along the continuum of care and every new care delivery model drive down costs and improve care in settings preferred by patients.
Related: Learn about McKesson's Alternate Site Pharmacy Solutions.