They say there’s no substitute for speed in sport. Mike Mills says there’s no substitute for adherence in the independent pharmacy business. Mills, a pharmacist, is the regional franchise operations director for Health Mart, McKesson’s independent pharmacy franchise.

In this edition of Pharmacist to Pharmacist, Mills explains why your patients’ medication adherence is critical to the success of your independent pharmacy. He also reveals how a combination of time, technology and people can create a culture of adherence that powers your entire operation.

What are you responsible for in your role at McKesson?

Mills: My job is to support our Health Mart pharmacies by making sure they’re getting the most they can get out of all our tools and services. Our focus is on performance, especially in the area of medication adherence. I’m on the road most of the week. I visit our pharmacies, and I visit with other pharmacies that are interested in learning more about what we can do for them.

When you talk to independent pharmacies, what are their medication adherence challenges?

Mills: Overall, it’s understanding that you have to manage your patients differently. They’re not going to be adherent just because you filled their prescription. It’s more complex than that. You need to know where your adherence gaps are and then do the right things to close those gaps.

How can independent pharmacies identify their adherence gaps?

Mills: One of the first things you can do is leverage online resources like EQuIPP (Electronic Quality Improvement Platform for Plans & Pharmacies). With EQuIPP, you can track and report your adherence rates against benchmarks. You’ll know things like the adherence of patients who take drugs for different chronic illnesses. It flags areas that you need to improve and highlights the gaps in your services that you need to fill to improve in those areas.

What operational issues cause the gaps that can lead to adherence problems?

Mills: The biggest reason is time. You’re running your pharmacy in a way that’s not giving you enough time to spend with patients to help them manage their drugs. Pharmacy is one of the only professions I know of where you don’t have to make an appointment to see someone. You make an appointment to see your doctor, your dentist or your lawyer. If you’re a pharmacist, anyone can walk in your door at any time and ask to see you. I mean, that’s the beauty of our profession, and that on-demand relationship is what builds your connection to your patients and to your community. But to be able to do that, you have to change operationally to spend more time with your patients when they need it.

What can independent pharmacies do to free up more time to spend on direct patient care?

Mills: One thing you can do is start a medication synchronization program. Rather than your patients coming in and out of your pharmacy multiple times a month to pick up their different prescriptions, with medication synchronization, they pick up all their drugs once a month at a scheduled time. You can build time into that monthly pickup to talk to them about their health. Then your schedule is more predictable, you have more time to spend with each patient and your patients are more adherent to their drugs.

You mentioned workflow. How can independent pharmacies improve workflow to drive adherence?

Mills: Workflow is really important to adherence. You have to know how each and every prescription is coming into your pharmacy and how to fill it efficiently. It could be someone walking in with a written prescription from their doctor. It could be an e-script from a physician’s office. It could be one of your patients calling in a refill. You need processes in place to manage all of those things. These processes can also help you spot opportunities where you could have a conversation with the patient about their health and any other services they may need from your pharmacy. That’s another reason why a program like medication synchronization can help manage your workflow.

How does technology improve the workflow at independent pharmacies?

Mills: You do need great technology to make it work. Technology manages the workflow based on the volume of prescriptions you’re getting, where they’re coming in from and when they’re coming in. You can use the scheduling tools in your pharmacy management system to make sure you’re using your staff efficiently. That means having more people during peak work times and fewer people on staff when things aren’t as busy. That also means being able to build time into your workflows to talk to patients about their adherence.

How does staffing at an independent pharmacy affect adherence?

Mills: First, you have to fully staff. You won’t have time to talk to patients and do all those other things that fill medication adherence gaps if you’re stocking shelves or running the front register. Next is having trained employees who understand what their roles are and who carry out their responsibilities. That starts with hiring the right people. You need to find people who have the skill sets you can’t teach, like work ethic, integrity and customer service. And you need people who are able and eager to learn the teachable skill sets you need to execute on your adherence strategy.

How do things like workflow and staffing improve the quality and safety of care?

Mills: Both come down to making sure your pharmacists and technicians are doing what they’re supposed to be doing. When I see errors happen, it’s usually because understaffing caused someone to rush and miss a step in their workflows. Or overstaffing made someone complacent and miss a step in their workflows. That’s why technology is so important. It can help you match staffing to your workload, and it can provide a safety check by verifying that you filled the right prescription for the right patient in the right dose for the right medical condition.

How will independent pharmacists be practicing differently five years from now?

Mills: As they continue their evolution from pharmacist to provider, they will become a more integral part of the patient care team. They will have collaborative practice agreements with physician practices and hospitals as they assume risk under value-based care models. Medication adherence will be critical to physicians and hospitals that want to meet their clinical outcome targets under those models.

What other trends should independent pharmacies stay on top of?

Mills: There’s a lot going on right now legislatively, and through regulation, that affects the business of pharmacy. So I think it’s important for you to connect with your local, state and federal officials about what’s happening with your independent pharmacy business. They need to understand what’s working, what’s not working and how they can help a small business that’s important to their community. You can talk to them about solutions that would let you expand your license to become a more integral part of the care team.

How does being a pharmacist help you work with your independent pharmacy customers?

Mills: I do tell them that I’m a pharmacist and that I have worked the bench at chain and independent pharmacies. I understand their pain points. I know what it’s like to work 14-hour shifts, trying to fill a lot of prescriptions accurately while dealing with all the interruptions and distractions. It gives me a lot of credibility when I talk to them about strategies and tactics to overcome those challenges and improve medication adherence. I know how good it feels to shut your gate at the end of your shift and know that you filled 400 prescriptions accurately and made people healthier. I want our customers to feel the same way.

Editor’s note: If you have a question for one of our pharmacists, please leave a comment and let us know. We’ll be sure to cover it in a future edition of Pharmacist to Pharmacist.

Related: Learn more about McKesson’s patient medication adherence programs for independent pharmacies

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