McKesson : Reaching the Triple Aim with Pharmacy Technology

Health system pharmacies can use advanced pharmacy technology to help their provider organizations meet the three goals of the Institute for Healthcare Improvement's Triple Aim¹:

• improving the patient experience
• improving the health of populations
• reducing the per capita cost of care.

Pharmacy technology can replace manual functions that have slowed providers' progress in reaching the three goals. Technology also can create new pharmacy capabilities that enable providers to sustain their success in those three areas.

Using pharmacy technology to improve the patient experience

The most significant impact pharmacy technology can have on the patient care experience, which the Triple Aim defines as both clinical quality and patient satisfaction, doesn't come from any direct use of technology with the patient. Instead, it comes from freeing up pharmacists' time to spend on clinical care and direct care with patients.

Technology frees up that time by automating and streamlining many time-consuming tasks that were previously done by pharmacists such as entering patient data, filling prescriptions and dispensing medications. The same tasks now can be done accurately and safely by pharmacy technicians because of advances in technology. Technology also frees up time by collecting and aggregating medication data like drug information, dosage alerts and medication histories in one place and making it easily accessible to pharmacists at the point of dispense or care.

Examples of this are prescription drug discharge programs, or what some call 'meds to beds' programs. When patients are discharged from the hospital, they typically want to go home instead of stopping off at the pharmacy to pick up their prescriptions. Studies show that on average about 20 percent of new medications go unfilled.² That leads to non-adherence and potential re-admits. Many hospitals and health systems are bringing those same medications to patients in their rooms prior to discharge. As a result:

• Pharmacies can intervene and correct any medication use or prescription drug problems before patients leave the hospital.
• Patient satisfaction improves because they can go home without stopping to fill a prescription.
• Bedside deliveries create additional opportunities to counsel patients on their medications and answer patients' questions.
• Patients leave with a better understanding of how to take their medication, why they are taking their medication and potential side effects.

It's all made possible by using technology for other routine tasks.

Enhancing the health of populations with pharmacy technology

Ideally, that same direct pharmacist-to-patient care will improve clinical outcomes for individual patients who are more likely to adhere to their prescription medications because of the face-to-face contact.

Clinical outcomes are the second component of the two-part patient experience objective, along with patient satisfaction. But what about clinical outcomes on a population health level-the second of the Triple Aim's objectives? This is where pharmacy technology can play a more direct role in at least three ways:

• Identifying patients who are nonadherent to their prescribed medications. Pharmacies can use adherence applications in pharmacy management systems to alert them when patients haven't filled their prescriptions on a timely basis. With that information, pharmacies can contact patients or their prescribers to discuss any compliance barriers and offer appropriate assistance to overcome those barriers. That approach can drive improved adherence rates across an entire patient population and a resulting improvement in population health.
• Creating clinical programs for patients in their market with chronic illnesses or targeted disease states. The clinical programs alert pharmacy staff when a patient with a targeted chronic illness or disease state is getting a prescription processed. Drug utilization screening adds a layer of patient safety checks for medications that may be contraindicated for a patient. This information allows pharmacies to contact patients or prescribers to recommend changes to improve medication use. A clinical program also can interface with other technologies along the continuum of care like specialty providers and consumer blood pressure devices and bring that data into the patient prescription record.
• Extending reach to satellite locations. This tech-driven approach across a patient population can improve the health status of the whole group. A pharmacy management system can reach outside of the four walls of the pharmacy and be connected to wherever patients are being seen by providers and prescribers. As a result, prescriptions can be filled at a central location and delivered to satellite locations, to patients' homes or to patients' local pharmacies.

Reducing the per capita cost of care through pharmacy technology

When the clinical outcomes of individual patients are improved and the overall health status of an entire population is improved, it follows that the cost of care should drop. Costs should drop because healthy people are staying healthy, and those with chronic illness are as healthy as possible. Both effects-aided by the use of technology by health system pharmacies-reduce the need for higher-cost medical interventions.

However, there is a more direct effect on health care costs from pharmacy technology. In fact, there are at least three ways pharmacy technology can reduce costs:

• Workflow efficiencies Technology generates efficiencies by customizing and prioritizing workflows to allow staff to focus on the immediate needs of patients. It automates and centralizes functions like claims resubmission and drug ordering. That frees up valuable pharmacy staff resources and maintains the appropriate workload balance for pharmacy staff.
• Inventory management. One of the other functions that can be integrated into the pharmacy workflow is formulary management. Technology can flag a lower-cost alternative medication, such as generic options that produce the same clinical benefits but at a savings for the patient and the pharmacy.
• Dispense and fill. Technology can automate the filling and dispensing of medications, reducing per prescription costs. Pharmacy management systems interfaced with an automated dispensing device reduce manual counting. Some health system pharmacies may consider a central fill system. Central fill allows pharmacies to centralize the tasks of dispensing, filling and even shipping medication. It allows one location to house expensive medications instead of at multiple pharmacies.

By using technology to reduce operating costs, health system pharmacies free up time for staff to spend on direct patient care, and the Triple Aim process cycle begins, touching each of the three primary objectives.

Pharmacy technology needs and capabilities

Improving the health of patients is a multifaceted endeavor, and it requires the engagement and commitment of partners across the community - from the hospital to the pharmacy to the patient to the caregiver.

At the center of this tech-driven approach to the Triple Aim for health system pharmacies must be a robust pharmacy management system (PMS). The PMS must be capable of:

• Interfacing with multiple technologies. For example, the PMS must be able to accept patient information like demographics and medication histories from EHR systems. The PMS also should interface with platforms outside of the health system. This allows for communication directly to the patient or outside physicians. The PMS should be able to receive new electronic prescriptions and send electronic refill requests to the patients' prescribers.
• Supporting a comprehensive drug inventory management system. That includes all pricing, ordering, tracking, delivery and payment reconciliation functions. It also includes just-in-time or perpetual inventory systems that mitigate drug shortages yet keep minimum inventory on site.
• Interfacing with the community. The PMS must be able to reach outside the health system's walls into the community where patients reside. It should enable two-way communication between the pharmacy and patients (or their care givers), the pharmacy and prescribers, and the pharmacy and other providers. That could be a PMS web portal that allows patients to view their prescription records and drug information, order refills and check the status of their prescriptions. It could be an interactive voice response system that calls patients with refill reminders.

The effects on the Triple Aim of all these pharmacy technical capabilities can be measured in several ways, including:

• Adherence rates
• Medication-related readmissions
• Patient satisfaction scores
• Drug inventory spend
• Drug inventory turnover

It's not just the health system that owns the responsibility for meeting the Triple Aim's objectives. Every department, and every person in those departments, owns the responsibility, including pharmacy, pharmacists and pharmacy staff. Pharmacies can do their part by skillfully using technology to improve the way they fill and dispense medications to patients.

Related: Learn more about McKesson's pharmacy automation technology and services for health system pharmacies