Increase Medication Adherence through Patient Relationships, Part 1

Tony Makarich, PharmD and vice president of clinical services at Catalyst Health Rx, sat down with Drug Topics® to discuss the benefits for health care providers of a relationship and team-based pharmacy model.

This 3-part series dives into Catalyst Health Rx's current pharmacy model that values relationships with convenience for medication home delivery and assures that providers do not lose sight of the impact they have on their patients.

Drug Topics®: I am joined today by Tony Makarich, vice president of clinical services at Catalyst Health Rx. Thank you for joining me today, Tony.

Tony Makarich, PharmD: Thank you for having me.

Drug Topics®: Can we start with you telling me a little bit about your background?

Makarich: I have a PharmD degree, Doctor of Pharmacy from The Ohio State University, spent some time in the retail pharmacy space with target pharmacy, which is now CVS pharmacy. I worked in long-term care for my own company for about 5 or 6 years doing consulting within nursing homes. I spent some time with a company called Prime Therapeutics and ran a large scale mail-order for them for about 4 years. And then I've been here at Catalyst for almost 4 years now, overseeing the pharmacy operations and clinical services for the network.

Drug Topics®: That's wonderful. Can you tell me a little bit about the mission of Catalyst Health and what the organization does?

Makarich: Yeah. So, Catalyst Health is in a network of independent physicians. So, there are about 1000 independent physicians, all throughout the state of Texas. And our network is an accredited clinically integrated network. We have a care team of about 100 people that support those physicians to provide them clinical services for a wide range of disease states to coordinate their care, lower their cost of care, and just overall improve patient health.

Drug Topics®: Wow, that's incredible. How can Catalyst Health work to revolutionize medication adherence through the model that you have and sort of that physician-relationship you have?

Makarich: Yeah. And so that's a really good question. The medication adherence component is relationship driven. And the way that our model is set up, it's a longitudinal model.

So, a lot of care management has patients who come in and they're - let's use an uncontrolled diabetic, for example. And they work with a caregiver until their diabetes is under control, or they achieve a goal. And then they may unenroll from those services. And our medication management services are longitudinal.

And we are doing a check-in every month with those patients when we dispense their medications. And it's not a simple, "Do you have any questions?" Which is kind of common in the industry.

We know if they have diabetes, or high blood pressure, and we ask patients specific questions to see if there's any information we need to share with the physician as their coordinator of care. And because we have those check-ins, and the medications aren't just mailed out simply to the patient, we build those strong relationships with the patients and can continue to have an influence on their overall health care. It's not just medications show up on a patient's doorstep. It's a set of curated clinical questions that happen for every patient, every month, before those medications are mailed out.

So, it's tying the relationship piece with the convenience piece of home delivery, and making sure that you're not losing sight of the impact that the pharmacist and their physician have on that patient each month.

Drug Topics®: You mentioned checking in with patients. Can you explain a little bit about how your organization's model overall differs from other models?

Makarich: Yeah, the key thing is, we are a direct extension of the physicians care team. And so, we have electronic medical record (EMR) access. We have the ability to directly communicate almost in real-time and the native system that each physician uses to ask for medication refills, potential dose changes, inform the physician of all the information that we gather from the patient in those monthly check ins, and quickly get the information back to the physician in a real-time fashion.

So, if, for example, I have a patient who started on a new medication and they're having some side effects. A lot of times patients will just stop taking the medication and wait till they see the physician if it's 3 months or 6 months down the road and then say, "I stopped taking that 5 months ago because I was having some side effects." Our pharmacists will do a check in with them that following month and say, "Marissa, how are you doing on your medication? Have you had any side effects?" And if there aren't some side effects or some information that needs to go back to the physician, we can quickly expedite that directly to the PCP in the EMR, rather than calling the office, sending a fax. It's a 1-on-1 conversation.

So, why our model is different is, 1, we form those relationships with the patients, even in a virtual world. Also, we have those direct relationships with all of the thousands of physicians that we have to quickly overcome barriers that they need.

Drug Topics®: Oh, that's incredible. Going off of that, can you explain a little bit about how this system promotes with integrated pharmacy services? How it sort of promotes overall that relationship?

Makarich: Yeah, so and that really stems from - when I when I talked about us being a high touch longitudinal model, these are patients that may come to us, they generally need some help clinically. They're uncontrolled, they have multiple conditions. And so, our model is really built upon, and we frame up that we will have these check-ins, we will ask these questions. It's not meant to be a deterrent for any of these patients.

It's meant to really find out how they're doing, dig into their thoughts and their beliefs around their medications, to pull out all of the things that potentially could be a barrier for this patient. And then working with the physician to overcome that barrier by making sure the plan is accurate for that specific patient.

Because a plan for one patient may not be the exact same plan for another patient based off of the nuances and the uniqueness of each person. And so we take the time to take to listen, to frame up that conversation, to get the information we need to get that patient on the way to wellness.

Editor's note: This interview transcript has been lightly edited for style and clarity.