Strengthening Prescription Capture to Address Patient Leakage

How McKesson can help health systems achieve more by enhancing prescription capture.

By McKesson Health Systems Editorial Team

Date

January 19, 2023

Read time: 5 minutes

By: Ram Arumugam

A Shifting Sector with Critical Challenges

Health systems are facing financial challenges that are no longer simply anecdotal at the local level — they’re being felt across the industry. Declining volumes, negative operating margins and high costs have prompted economists and analysts to warn of hospital closures and downgrade their sector outlook for health systems. In this climate, patient leakage — the break in the continuum of care that occurs when patients seek services outside the health system network — can be especially devastating. And, while preventing patient leakage is a complex issue requiring strategic action on multiple fronts, enhancing prescription capture is a great place to start.

Understanding Patient Leakage

When patients visit out-of-network providers or have prescriptions filled at institutions not owned or contracted with the health system, the health system loses revenue — along with at least some degree of control over patient care and outcomes. To provide integrated care across the continuum, health systems need to ensure that patients have full access to all levels of care services without going out of network. That includes making it convenient and affordable for patients to have their prescriptions filled within the health system.

Keep the Prescription, Keep the Patient

Outpatient retail pharmacies may have once been considered a nice-to-have feature for health systems, providing patient convenience through on-site locations. Increasingly, however, owned and contracted pharmacies are also becoming essential revenue centers while delivering continuity of care for patients whose prescription business might otherwise be lost to an out-of-network drugstore. When patient leakage occurs, even at the pharmacy level, the health system loses revenue and visibility into the patient’s healthcare journey, which is essential for tracking patient progress and administering future treatment.

Following a patient’s hospitalization, outpatient retail pharmacy services provide a critical component in simplifying medication regimens and improving medication adherence post-discharge.¹ Prescription capture offers hospitals the potential to reduce readmissions and improve outcomes by conducting patient follow-ups, synchronized medication refills, and monthly medication reviews administered by a clinical pharmacist. It also drives patient satisfaction, making them less likely to seek services elsewhere.

Prescription Capture Strategies

For health systems that don’t have an outpatient retail pharmacy, or those unable to handle the patient volume or breadth of medications being prescribed, the sobering outlook for the industry may provide a timely incentive to add, expand, or optimize pharmacy services. To get started, McKesson’s Payer Solutions for Health Systems recommends a straightforward methodology to drive prescription capture, aligned with a Six Sigma process: Define, Measure, Analyze, Improve, and Control.

Define

Identify absences or opportunities in prescription services such as:

Meds to beds
Transition of care via clinical pharmacist to outpatient pharmacist
EHR integration
E-prescribing to health-system owned retail pharmacies
Home delivery
Specialty pharmacy and specialty contracting such as Atlas Specialty
Emerging channels for outpatient expansion such as Home Health and Home Infusions

Measure

Tap into analytics tools to take stock of current volumes and costs, including:

Drug purchasing data
Utilization by diagnosis
Reimbursement by drug and payer
Leverage all internal and external data such as reports generated by myMcK-myHMA by Health Mart Atlas for its member organizations (Financial Insights, MAC Success Manager, DIR Fees and Effective Rate Reporting).

Analyze

Weigh the projected cost, care, and prescription capture advantages of new initiatives in areas such as specialty pharmacy:

What does it take to compete with — or contract with — large pharmacy benefit managers (PBMs)?
How can clinically integrated programs help with oncology-based prescription capture?
What are the advantages and constraints of different specialty pharmacy types?

Improve

Work with advisory experts within the McKesson Payer Solutions team to capture more prescriptions by seizing opportunities such as:

Launching new prescription services
Optimizing existing prescription services and pharmacy operations
Implementing access strategies for limited-distribution drugs
Developing ways to allow specialty prescriptions to be filled within the healthcare system’s network by being part of Atlas Specialty, a specialty-focused pharmacy services administrative organization (PSAO)
Creating a complete patient prescription profile to support positive outcomes while driving revenues
For health systems still defining their outpatient pharmacy strategy, partnering with McKesson can help navigate the intricacy of this challenging landscape. The team assesses the financial feasibility of ambulatory pharmacy services, assists in building an ROI proposal, and offers a consultation to help health systems efficiently plan and successfully open an ambulatory pharmacy.

Control

Leverage the health system’s clinical credentials and resources to:

Manage the whole patient profile, not specialty and retail prescription in isolation
Deliver on the expectation of quality care at a hospital retail pharmacy vs. a chain pharmacy
Reinforce patients’ fondness for continuous care, especially with chronic disease management

Review

Health systems should continue to reassess their outpatient and ambulatory strategy using the same Six Sigma defined processes (DMAIC) to ensure their tactics align with their organization’s goals and vision.