Laying the foundation for a more profitable pharmacy practice

Drug Store News, Nov 3, 1997 by James Frederick

Since then, he said, the Sacramento model has been applied to three other managed MediCal/Medicaid plans over the past year and a half, "and we continue to monitor interventions through the university.

"What that did was demonstrate the dollar value of these types of services," Bystrom continued. "As a result of that, we have met with a couple of health plans and are now finalizing our contracts to perform pharmaceutical interventions with their commercial HMO populations in California, which to us is very exciting because it demonstrates that managed care administrators realize the value that pharmacy provides, and they are willing to pay for it."

Beginning with the 23,000 patients that it was managing in Sacramento, Longs also initiated a pilot program to document the effectiveness of a more targeted disease management effort. Said Bystrom, "We've identified a number of high-risk, high-cost asthmatic patients within that population, and we've provided training and added expertise to a number of our pharmacists within that network."

According to Bystrom, pharmacist patient educators help identify patients who could benefit from the program. Once enrolled, patients are assigned to a pharmacist patient educator, who performs a thorough initial assessment and then provides education and training in the use of metered-dose inhalers and nebulizers. Patient educators also perform monthly or quarterly re-evaluations and consultations, either by appointment or by phone, along with regular compliance follow-ups.

The results of those consultations are submitted back to the health plan as well as the primary care physician. Importantly, Longs pharmacies are being paid based on the service performed and time required to perform it, Bystrom said.

"It's been running a little over a year, and our last enrolled patients just finished their first 12 months of the program," Bystrom told Drug Store News. "The savings from reduced hospital and emergency room visits appear to be substantial--75 percent and more, based on very preliminary outcomes data.

Inspired by the success of the effort, Longs is expanding its asthma program to another managed care Medicaid population in Southern California. The new contract will reach 300 to 400 acute asthmatics through a network of as many as 150 pharmacies, Bystrom said.

"For the service to be valuable to the payer, it really needs to address their high-cost members, and wherever they go is where we have to provide the service," he explained. "So, we'll first identify what pharmacies they're using and work with those pharmacies to provide pharmacist education, including non-Longs pharmacies."

Longs has also expanded its growing disease-management capabilities into the area of diabetic care in a pilot now under way in Santa Barbara, Calif. The test also includes other drug stores in the area.

"We were actually approached by a medical group's director of pharmacy, who's working in coordination with an endocrinologist and a medical director," Bystrom said. "On average, it cost their outfit about $125 for any type of intervention they have with their diabetes patients. Their belief was that the pharmacy may be able to do the same functions ... at a much lower cost, together with providing more access to members.