Power in Numbers

Jam-packed with COVID-19 cases, Jonesboro’s only two hospitals had no choice but to begin turning away symptomatic and positive-testing patients. Local infusion centers in this Arkansas town were just as inundated, lacking the staff and infrastructure to keep up with the demand for what was the first and only COVID-19 treatment – monoclonal antibodies. Pharmacies were up for the challenge, but could only administer the therapy under a time-consuming collaborative practice agreement.

Under the PREP Act,¹ HHS expanded the scope of authority for pharmacists to order and administer select COVID-19 therapeutics. Pharmacies across the nation seized the opportunity to “test and treat,” a longtime advocacy focus for the profession. Some pharmacies emerged as monoclonal antibody infusion centers.

The Medicine Shoppe Pharmacy (MSP) and its new Wellness Clinic have championed these efforts in Jonesboro, Arkansas, providing much-needed relief to its overwhelmed health care facilities.

Pharmacy owner Jett Jones, PharmD

“Pharmacists have been advocating for provider status for years, and we knew this was our big chance,” shares owner Jett Jones, PharmD. “If pharmacists proved that we could do this, we knew it would open doors for our profession.”

After more than 100 treatments administered, it is hard to imagine that MSP was once a traditional dispensing pharmacy: no appointment-based model, minimal clinical services, and certainly lacking its own Wellness Clinic down the street. Jett and his newly-hired clinic pharmacist Jill Wolf, PharmD attribute their pharmacy’s extraordinary transformation to their participation in Flip the Pharmacy.

As part of Flip the Pharmacy, pharmacy teams work to transform their community-based pharmacy practice beyond point-in-time, prescription-level transactional models toward longitudinal, patient-level care processes and value-based models. Using monthly change packages organized by domains described below, pharmacies implement workflow innovations within key practice transformation domains that emphasize delivery of quality patient care and documentation in an eCare Plan platform. MSP has leveraged all six domains in their monoclonal antibody service set.

Flip the Pharmacy's Monthly Change Packages

Domain 1: Leveraging the Appointment-Based Model

Before Flip the Pharmacy, MSP’s walk-in policy hindered them from taking control of their workflow and scaling their clinical services. Now, they have embedded an appointment scheduling portal into the pharmacy’s website that syncs directly to Jill’s phone. This enables the patient to complete digital forms in advance, while Jill prepares for the infusion at the wellness center. Once the patient arrives, Jill checks their vitals, explains the procedure, and sits by their side for the entire one-hour infusion.

Domain 2: Improving Patient Follow Up and Monitoring

Clinic Pharmacist Jill Wolf, PharmD

While many patients claim they begin feeling better instantly, Jill insists on calling each patient one week after receiving the monoclonal antibody therapy. The response has been inspiring.

“Patients are pleasantly surprised by how much better they feel, both physically and mentally,” shares Jill. “For many of them, we are the light at the end of the tunnel. Their appreciation is very rewarding to me.”

Domain 3: Developing New Roles for the Non-Pharmacist Support Staff

With MSP’s expansion of clinical service offerings, Jett acknowledged the need to invest in his staff; his previous staffing model with one pharmacist and two technicians was no longer going to cut it. They are committed to empowering pharmacy technicians and support personnel to take on more meaningful responsibilities in the pharmacy, such as fostering relationships with local providers, advising patients on insurance plan selection, and optimizing workflow through the appointment-based model.

“Working in an independent pharmacy can be more than a nine-to-five job. It can be a career that makes a difference in the community,” expresses Jett.

Domain 4: Optimizing the Utilization of Technology and eCare Plans

At the wellness center, Jill is responsible for submitting eCare Plans on behalf of patients receiving monoclonal antibody therapy. Although it was initially challenging to integrate eCare Planning into their workflow, the MSP team has found creative ways to document their care. For example, when calling patients about a medication synchronization pick-up or vaccine appointment, they ask if the patient would like a blood pressure reading.

“It really opens patients’ eyes to all the services we provide and gives them another avenue outside of their primary care physician,” shares Jett.

Domain 5: Establishing Working Relationships with other Care Team Members

MSP acknowledges that collaboration with the local health care professionals has been crucial to improving patient outcomes. The pharmacy serves as a first-line screening and triage center, determining eligible candidates for therapy or referring severe cases to the hospital. They have nurtured working relationships with local primary care physicians, who regularly refer patients to their pharmacy for treatment.

Domain 6: Developing the Business Model and Expressing Value

Implementing enhanced clinical services themselves is a feat in itself, but restructuring the business model to reflect the value of pharmacy care is another.

“The future of pharmacy will be based on getting paid for clinical services, not relying on prescription fills,” Jett points out. “Flip the Pharmacy has given us the tools to incorporate billing into our workflow.”

When asked if other independent community pharmacies should begin offering monoclonal antibody therapy, Jett answered with a resounding yes. He believes that the more pharmacies that jump in and work together, the more that government stakeholders and payors will take notice.

“There is power in numbers,” he adds, nodding to Flip the Pharmacy’s mission of scalable practice transformation. “That’s how we move pharmacy forward.”

The Flip the Pharmacy program has over 1,000 community pharmacies actively engaged in practice transformation, which are supported by over 450 pharmacy coaches from 63 local Flip the Pharmacy teams and ten Technology Solutions Partners. Learn more at www.flipthepharmacy.com and access the publicly available change packages, by clicking here.

Reference

1. Ninth amendment to the declaration under the PREP Act for medical countermeasures against COVID-19. Federal Register. US Department of Health and Human Services. Publihsed September 14, 2021. Accessed October 24, 2022. https://www.federalregister.gov/documents/2021/09/14/2021-19790/ninth-amendment-to-declaration-under-the-public-readiness-and-emergency-preparedness-act-for-medical