Computers, smartphones, and the continued transformation from an analog to a digital environment that provides “real-time access” to information are profoundly changing the foundation of how we live and work. These influencers are permeating and impacting our lives every day in many ways, including significantly influencing how we are providing healthcare services.
Author: David J. Fong, PharmD
Telehealth is a well-documented solution for increasing access to care and health information for underserved and rural communities, and its capabilities have significantly expanded with the advancement of technology solutions.
Despite health costs accounting for more than 20% of U.S. GDP spend, the reality is that health outcomes goals have not been achieved in our primarily transactional and fragmented market. Challenging market dynamics include:
- Consolidation of providers
- Rising deductibles/copays
- Lack of access to adequate healthcare, especially in rural areas
- A projected 45,000 primary care physician shortage over the next several years
- Coordinated care management and collaboration between healthcare providers to care for chronic and acute conditions to avoid costly complications and hospital readmissions
CMS, employers, and payers are pressuring providers and calling for more public policy regarding value-based outcomes. And that is having a direct impact on traditional provider business models, forcing the provider community to explore “outside the box” solutions.
The most compelling drivers for this growth the some 62 million people that lack access to adequate healthcare, especially in rural markets, as well as the cost-effectiveness of healthcare services and the need to meet patient demand resulting from a potential shortage of primary care physicians.
While reimbursement continues to be an issue towards adoption, it is improving. In recent years, a number of states have continued to adopt relevant legislation, and in January 2017, CMS changed its reimbursement calculation structure to include remote monitoring services.
As I shared in my blog of a year ago, telemedicine’s best business opportunity was collaborating with retail clinics. While telemedicine is still struggling to gain traction in the U.S., telehealth is gaining rapid acceptance and adoption. As a technology delivery platform, it enables a broader portfolio of technologies and operational processes that not only remotely diagnose and monitor patients, but also include delivery of virtual medical, health, and education services to providers and patients in addition to clinical services. More importantly, telehealth service delivery is relegated not only to physicians, but may involve nurses, pharmacists, and other healthcare professionals as well.
Pharmacy’s current market trends and challenges
Community pharmacy continues to demonstrate its value within the changing healthcare landscape, leveraging its attributes of access, affordability, and trust as it continues to expand its portfolio of transaction-based prescription fulfillment, expanded clinical services, and care management responsibilities.
Transitional challenges include:
- Aging demographics, increased prescription volume, consolidation and competitive pressures, consumers motivated by convenience and real-time access to healthcare information/ services
- Margin squeeze driven by lower reimbursement, rising expenses, and increased expectations of all channels of retail pharmacy business toward value-based reimbursement by payers
- Projected shortage of 45,000 primary care physicians over the next 3 years, creating access issues for consumers and opening opportunity for pharmacy to expand its retail portfolio to provide services traditionally handled in physician offices
- Regulatory oversight and expectations on patient safety, privacy, and confidentiality continue to grow with greater dependency on enabling technology solutions
Telehealth opportunities for community pharmacy: Connecting to the patient
Telehealth technology platform works to expand pharmacy’s business and care outside of the walls of the retail store and integrating with current workflow while managing operating expenses. As pharmacy continues to expand its personalized role of holistically managing the health and wellness of its patients, it continues to work on implementing the right balance between prescription fulfillment business and clinical expectations/deliverables.
Telehealth enables the pharmacist to engage in team-based care, participating as a specialist for real-time consults in a virtual network with peers, in-home monitoring of patients to follow up on chronic conditions, continuing education, and training of staff for important engagements.
Some of the telehealth services currently being offered by the community pharmacy include:
- Mail order services that deliver the medications directly to a patient’s home supported by care management services
- Operational efficiencies incorporating remote supervising, processing, and filling of prescriptions
- Customers needing more information on their medications and care management questions can initiate online video calls, making it convenient for the customer to access information in a timely manner without disrupting their care program
- Pharmacist outreach connection — pharmacist may wish to connect with their customers to follow-up on specific medications or track patients with compliance challenges
- Pharmacist to pharmacist — connecting at-store pharmacist with clinical-specialty pharmacy or experts in key areas to discuss a specific patient or drug therapy
- Connecting and collaborating with other healthcare professionals on care management programs relating to specific chronic conditions or medications and communication to coordinate care; opportunity to manage patients to avoid hospital readmissions
Roadmap to a successful telehealth offering by community pharmacy
The operational realities of healthcare do matter before telehealth can become a key practice enabler for a pharmacy. Pharmacy has always been a leader in technology innovation; we’ve built systems before and understand the roadmap of change before a solution can become a component in our standard of practice.
Here are some roadmap considerations as a community pharmacy explores a commitment into telehealth:
Regulations typically don’t adapt quickly to changes in pharmacy practice. Key areas of necessary regulatory changes include:
- Updating the Model Pharmacy Practice Act to include the provision of telehealth pharmacy services and to apply a standard across all 50 states
- Modernizing requirements relating to operations of pharmacies to include provision for telehealth services including facilitating remote dispensing, online patient counseling and care management, institutional clinical pharmacy services, etc.
- Develop framework for security requirements relating to the delivery of telehealth and mobile device services
- Address interstate practice of pharmacy requirements, allowing pharmacists reciprocity to provide telehealth services to patients across other states
As with any changes to retail pharmacy workflow, it is critical that the introduction of telehealth into the practice addresses the impact of integration into workflow, including how best to complement core services, roles, responsibilities, policies and procedures, customer satisfaction, cost/benefit, consistency of execution, change management (training/development) and performance metrics to ensure achievement of goals and objectives.
While telehealth services continue to expand and for its value to be fully recognized, reimbursement by publicly funded and commercially funded programs must be in place. There is good news for reimbursement:
- 48 states now provide for Medicaid reimbursement for telehealth services
- 32 states allow commercial payer reimbursement
- CMS, as of January 1, 2017, changed its reimbursement calculation structure to recognize remote monitoring devices
Thus, with an increase in reimbursement for many providers, pharmacy must collaborate on establishing criteria for reimbursement, payment models, process for billing, and qualifications for acceptance of a pharmacy to bill for these services.
A well-thought-out strategy needs to be established. Creating a solid set of business requirements, specifications, and options on equipment must be established, leveraging the expertise of resources and companies that are in the field of telehealth and telemedicine as advisors. Additionally, consider engaging data services for handling, storing, printing, documentation, and transmittal of medical information, training, and development of connected providers and staff, and marketing outreach to promote the services.
Strategic business and operational plan
Investment and cost-benefit analysis to achieve an acceptable ROI will vary depending on the types of services and targeted patient population to be served. There is potential increase in revenue from seeing higher numbers of patients and expanded services that are reimbursed. CMS Star Ratings and network participation should be included in the modeling and opportunity for cost/value. Using the same platform for MTM and other services can enhance offerings and reimbursements. Altogether, telehealth can help pharmacy build greater loyalty, improve compliance and adherence, grow scripts/revenue/profit, and incrementally grow “front-end” business.
Healthcare in the U.S. is changing, and pharmacy plays a key role leveraging its attributes and further personalizing the relationship with its patients beyond “over the counter” service. Transformational improvement utilizing telehealth provides greater access, availability, better spend, and improved outcomes.
Continuing to provide community pharmacy with the tools and resources to connect with the patient is good business and good care.
David J. Fong, PharmD, is president of Dave Fong Rx Consulting, Inc. A former senior retail pharmacy executive for Fortune 100 and Fortune 500 companies, he is recognized as one of the U.S. and Canada’s business and professional healthcare leaders, leveraging his knowledge and experience working with pharmaceutical manufacturers, distributors, retailers, payers, and healthcare technology companies to bring value to the industry and the consumer.