Grant Helps Quantify the Value Pharmacists Can Have in Patient Care

Randy McDonough knew when he left his post as a full Clinical Professor at a major university that he wanted to do community pharmacy differently and he set out to make some changes.

More than a decade later, he’s been able to quantify just how significant those changes have been, thanks to a grant from the Community Pharmacy Foundation.

Randy McDonoughMcDonough, PharmD, MS, RPh, is Co-owner and Director of Clinical Services of Towncrest Pharmacy in Iowa City. He’s spent the last decade systematically implementing changes at the community pharmacy with one goal in mind: to free up pharmacists to play a bigger role in patient care.

During that time, McDonough, and Co-owner, Michael Deninger PhD, RPh, have made significant changes to the pharmacy’s workflow in an effort to implement what they refer to as continuous medication monitoring or a pharmacist drug review every time the pharmacist has an encounter with a patient.

“We want them to do what they can to collect information and-- if they have enough information-- identify and resolve drug therapy problems and document their activities,” he says.

 A recent grant from the Community Pharmacy Foundation, allowed McDonough and his team to study the impact continuous medication monitoring has had on the pharmacy.

During the 12-month study period of the grant, McDonough says the pharmacy conducted approximately 17,000 clinical interventions. About half of the time an intervention was made, a drug problem was identified.

These problems weren’t just identified at the initial time of the prescription. In fact, the data showed that about 60% of the drug problems were identified outside the initial drug fill. McDonough believes this shows the importance of doing thorough pharmacist-led reviews at every patient encounter.

The grant period also coincided with the pharmacy’s participation in a pilot project with one of the biggest payers in the state, giving the pharmacy access to payer’s claims data. Towncrest Pharmacy took care of about 600 to 700 of the payer’s beneficiaries and was able to determine that through the clinical interventions, the pharmacy was able to save the payer about $300 per member per month.

As a result of the pilot program, this summer the payer rolled out a high-performance network where participating pharmacies are going to be paid based on performance.

Making the changes a reality

McDonough and his team have been pleased with the success they’ve seen, but say it hasn’t happened overnight. To make continuous medication monitoring a reality, McDonough says the pharmacy had to implement significant changes to its workflow over the last ten years.

For instance, the pharmacy relies on a technician-driven dispensing system.

“The technicians pretty much run the show and then the pharmacist in our system is placed at the end of that whole dispensing function. They are doing continuous medication monitoring and reviewing every single patient, every single time,” he says.

They also participate in a “Tech-check-tech” pilot program with the Iowa Board of Pharmacy. The program is designed to place a greater reliance on experienced technicians to improve efficiencies and improve patient care at community pharmacies across the state.

Aside from using technicians more efficiently at the pharmacy, Towncrest also uses an automation system to help fill, label, and cap about 70% to 75% of its prescriptions each day.

Finally, a medication synchronization program allows the pharmacy to more proactively control when patients will be visiting the pharmacy. The program currently serves about 600 of the pharmacy’s patients, but that continues to grow.

To make these changes, McDonough says the pharmacy knew it would have to make significant changes to its staffing as well.

The pharmacy has been able to make the staffing and dispensing changes because the pharmacy has also increased its sales by providing clinical services.

For example, the pharmacy also serves about 500 to 600 people in nursing homes or group home settings and receives payment for medication therapy management (MTM) services from the residential facilities. 

The pharmacy also gets paid for MTM services through Medicare Part D, is paid a professional fee by one of the larger payers in the state, and charges for medication reconciliation and compliance packaging.

“For everything we do, we have some kind of fee structure associated with it,” McDonough says.

Not every pharmacy will be able to implement all the changes Towncrest has, but McDonough says community pharmacies can adopt similar strategies to patient care. It begins, he says, by examining what changes can be made to the work flow of a pharmacy.

“You’ve got to break the model, you’ve got to diversify, you’ve got to make sure that when you do bring people on you have a purpose in mind in what you are trying to grow,” he says.