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On-site pharmacies optimize patient care

January 10, 2014
by Shannon Brys, Associate Editor
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Pharmacy services may seem like a far away land that you don’t know much about, but that’s all changing as more and more behavioral health organizations choose to integrate an on-site pharmacy into their facilities. Companies such as QoL Meds, North Rock Community Pharmacy and Genoa Healthcare are a few of the pharmacy services organizations that are working with behavioral health providers.

Because they are located inside community mental health centers (CMHCs), the pharmacy staff becomes integrated into the whole treatment team and its plan for the consumers. Jim Smith, CEO of QoL Meds, says that the pharmacists and pharmacy staff become experts on working with issues related to mental health such as the difficulties in getting prior authorizations and making sure that the consumers are being compliant with taking their medications.

Unlike staff at a neighborhood or retail pharmacy, on-site pharmacy service personnel partner with the CMHC and have a common goal—to make sure that the consumers are taking the right medication, the right amount of mediation, and that they’re taking it on time. “All of those things around adherence will provide better outcomes,” says Smith.

“The beauty of being on-site,” explains Smith, “is that we’re not concerned with anything else in the pharmacy.” For example, at a retail pharmacy such as CVS or Walgreens, a staff member might be tasked with their pharmacy duties but also other needs that arise in the drugstore. In the CMHC-located pharmacy, the staff only has to worry about the consumers, prescribers, nursing staff and case workers, in order to make sure that the consumers are treated ideally within their prescribed regimen of medications.

In addition, since the pharmacist is on-site and often working with the same consumers, he might notice that a consumer isn’t feeling or behaving the same this month as he was last month, and he will raise that issue with the doctor. Together, they can work together to change the medication regimen to make sure that it is correct. The pharmacy staff and CMHC staff are constantly communicating with one another about best practices and issues. The pharmacy staff also works with prescribers to help them track medication adherence – how often and whether consumers are filling their prescriptions and taking their medications. This has a major impact on the rate of re-hospitalization and visits to the emergency room. “Not only is it good care but it also cuts down on the costs of duplication of services,” says Don Hevey, Director of Community Development at Genoa.

Besides working with the clinicians and consumers, some of the pharmacists (like those at Genoa) work on medication reconciliation with the consumers and their families. What this means is sitting down to look at the medications that consumers are taking versus what’s been prescribed, consider possible or current adverse indications between the medications, and counsel consumers and their families about the medications’ effects.

Health reform

A common theme throughout the discussions with the pharmacy services companies was that business is going very well and increasing as time moves forward. Hevey believes that the growth would’ve happened with or without the changes taking place in the field (Medicaid expansion, insurance expansion, etc.) but he acknowledges that these things most likely accelerated the growth.

Hevey says the main opportunity in coming years that will occur as a result of the Affordable Care Act and health reform will be the emphasis on care coordination. “The ACA is putting a lot provisions in there for some financial incentives and some outcome measures to track how well all the various parts of an individual’s treatment are coordinated,” says Hevey. “I see a great opportunity for pharmacy to be more and more a part of that.”

The trends with the Affordable Care Act will be good for the CMHCs, according to Smith. Most of the centers see many low-income consumers – the main beneficiaries of the health reform. With all of the issues rolling out the website and getting individuals enrolled, it’s hard to say at this point what the actual results will be, but he believes that it will be very positive if and when the issues get worked out.

“At some point in time, there’s going to be a lot more people who are covered either by Medicare/Medicaid or by commercial insurance, so that will increase the caseloads of all the mental health centers, which in turn would increase ours as well,” Hevey says.

Early on, there will definitely be confusion surrounding the health reform. Because consumers are unaware if they have coverage and what kind of coverage they are going to have, there will be much confusion about medications and what exactly their plans cover but he says that that will settle down over time.

Hevey sees large expansion possibilities in the future and notes that a handful of the large investment firms have begun to purchase pharmaceutical companies because they recognize the potential for growth as well.

Challenges facing pharmacy services

In the entire behavioral healthcare landscape, Virgil Todd, President of North Rock Community Pharmacy, says that the biggest challenge is that consolidation will eventually happen. “If the providers we work with are not vertically integrated in some form or fashion, I’m afraid that they will be absorbed by other companies or become a part of a large hospital system,” he explains. It’s important to be prepared to take care of patients themselves and be more self-sufficient, he says.