On the eve of McKesson’s ideaShare, which begins July 20 in Orlando, Fla., Creating a Healthier Future caught up with Tony Willoughby, McKesson vice president and chief pharmacist of Health Mart. Health Mart, a McKesson pharmacy franchise, operates more than 3,200 independently owned community pharmacies across the country. IdeaShare is an annual educational and networking event sponsored by McKesson for community pharmacists and pharmacy owners. Sure to be discussed and debated by attendees at this year’s event are the macro economic trends in healthcare that are having a practical and dramatic impact on pharmacists and pharmacies on the front lines of patient care. Creating a Healthier Future asked Willoughby to explain how pharmacists and pharmacies can convert those trends into better health for patients and customers and better business health for their own operations.
CAHF: How does the high cost of prescription medication, especially specialty pharmaceuticals, affect your work with other providers and your service to patients?
WILLOUGHBY: As the part of the delivery chain that dispenses medications and assures they’re being taken properly, the high cost places an additional burden on pharmacists and pharmacies. Every other part of the delivery chain wants to make sure they’re getting value for what they’re buying, selling or prescribing. Payers want to make sure patients are getting the appropriate medication. Manufacturers want data to make sure their medications are being dispensed properly and to learn how they’re working. And physicians want patients to start their medications as soon as possible. That raises the stakes for us, who are responsible for adherence and must respond to the needs of the other stakeholders, not just the patients.
CAHF: What about the revenue side? Do high-priced pharmaceuticals and specialty medications present a business opportunity for pharmacists and pharmacies?
WILLOUGHBY: Definitely. Although it’s a small margin percent, it’s a small margin percent on a very large number, so that means more dollars.
CAHF: How does healthcare price and performance transparency affect pharmacists? And how can pharmacies take advantage to generate additional business or revenue?
WILLOUGHBY: Transparency will have a profound effect on how a patient chooses a pharmacy. Historically, patients choose a pharmacy based on cost and location. Is the price right, and is it convenient? But as pharmacists make their clinical performance measures known to customers directly or indirectly through health plans, patients will begin choosing their pharmacy based on value. We’re not talking about whether your prescription was filled on time or whether your bottle contained the right number of pills. We’re talking about whether this pharmacy’s patients are on the appropriate and most effective medications, whether this pharmacy’s patients are adherent to their medications and whether this pharmacy’s patients are off high-risk medications that aren’t appropriate for their disease state or health status.
CAHF: Speaking of performance, value-based reimbursement arrangements between payers and providers are growing. What role do you see pharmacists playing in those arrangements and what impact could they have on the business health of pharmacies?
WILLOUGHBY: This is the opportunity that pharmacists and pharmacies have been waiting for. It’s an opportunity for us to be recognized — and compensated for — the outcomes we drive beyond simply dispensing medications. We know that effective medication therapy management and increased medication adherence decrease medical costs. That puts us in a great position to support all the other stakeholders, whether they’re payers, hospitals, physicians, accountable-care organizations, patient-centered medical homes, whatever. They’re all being incentivized to control medical costs, and who better to help them do that than the people who come in most contact with their patients or enrollees. Community pharmacies are the connection between all the other stakeholders and their patients after their patients go home.
CAHF: What recommendation do you have for a pharmacy that wants to participate in a value-based reimbursement plan with other providers?
WILLOUGHBY: Pharmacists and pharmacies should learn who in their market is part of such an arrangement, whether it’s a payer or a provider, and offer their assistance. But just participating as a downstream or ancillary provider under contract may only be the first step. For this to work, pharmacists and pharmacies may need to be part of the incentive arrangement — which could, at some point in the future, involve assuming risk for engaging with patients regarding their medication regimes. That’s the real long-term business opportunity.
CAHF: How can pharmacists best play a role in the population health movement? How can population health improve the business health of pharmacies?
WILLOUGHBY: To me, the key to improving outcomes from a population health management standpoint is patient engagement and community engagement. And there’s no one more accessible than the community pharmacist. They should be at the hub of that patient and community engagement. They should be reaching out to the other stakeholders in their markets and participate as key members of their population health management strategies. You’re seeing the big pharmacy chains do it. Some are running their own ACOs or operating their own retail clinics or taking unhealthy products like tobacco products off their shelves. There’s no reason community pharmacies can’t do it in partnership with other providers in their markets.
CAHF: Some would consider population health an old idea whose time has come. Some think it’s a new disruptive innovation in healthcare. What have you seen in the practice of pharmacy that you would consider a transformative innovation?
WILLOUGHBY: At the top of my list would be medication synchronization. This is where the pharmacy syncs up a patient’s multiple prescriptions to be refilled at the same time each month. It’s a concept that’s been around for several years but now is really taking hold because of the positive effect it has on medication adherence. For example, we’re seeing chronic medications go from being filled six to seven times out of 12 times per year to eight to 10 times out of 12 times per year. More than 50% of our Health Marts who are in the Top 20% from a quality performance standpoint are using medication synchronization for specific patient populations.
CAHF: That’s great for patient’s health status. What about for the business health of pharmacies?
WILLOUGHBY: It has a huge impact on the number of prescriptions filled. One study found that medication synchronization can generate an additional 1,200 to 1,300 filled prescriptions per year per 100 patients. That’s an extra week of prescription revenue for many community pharmacies. There’s not many business moves that you can make that have that kind of impact and, at the same time, improve the adherence scores for those patients to drive better outcomes.
Editor’s notes: Learn more about McKesson’s ideaShare, which will be held July 20-24 at the Gaylord Palms Resort and Convention Center in Orlando.
To learn more about how one pharmacy chain’s medication synchronization is improving medication adherence rates, read "The Pharmacist Is In" on Creating a Healthier Future.