According to the Association of American Medical Colleges (AAMC), the U.S. is staring down the barrel of a primary care physician (PCP) shortage to the tune of 21,000 to 55,000 primary care providers (PCPs) by 2023. This is worrisome on its own, but when paired with the current and future impact of Covid-19, it paints a potentially bleak picture of what primary care delivery might look like over the next few years.
On the flip side, for community pharmacies, it’s been a call to action to revisit the role that pharmacists can play in improving care management and consumer health engagement, especially for those with chronic conditions, in a Covid-19 world.
“An anticipated shortage of physicians, increasingly complex therapies, and people living longer with chronic conditions, could create more opportunities for pharmacists to engage in care delivery,” wrote George Van Antwerp and Greg Myers of Deloitte Consulting LLP in a recent Health Forward Blog post on the future of pharmacy. “As the dispensing of medications becomes more automated—and as artificial intelligence takes on more administrative processes like prior authorization and formulary management—retail pharmacists could have time to engage more directly with patients and clinicians,” they wrote.
Driving Value And Cost Savings From The Pharmacy
Retail pharmacy chains, increasingly seeing the value of optimizing pharmacist/patient interactions, continue to invest in technology, resources and training to help pharmacists operate at the top of their license and assume their roles as caregivers. Ryan Rumbarger, SVP of Retail Store Operations at CVS Pharmacy, explains that CVS is leveraging technology to improve coordination with a patient’s extended care team, and to give pharmacists more time to provide meaningful counsel and be there for face-to-face interactions with patients.
“Through face-to-face counseling, our pharmacists drive medication adherence, close gaps in care, recommend more cost-effective drug therapies and are committed to helping people find solutions that work for them,” he said.
From a policy perspective, pharmacists in 11 states and the District of Columbia now have clearance to prescribe and dispense birth control. Pharmacists were also given “provider status” from the current administration, enabling them to bill Medicare for COVID-19 testing.
Most recently, the Department of Health and Human Services (HHS) issued guidance that authorized state-licensed pharmacists to order and administer Covid-19 vaccines to individuals ages 3 or older. Issued under the Public Readiness and Emergency Preparedness (PREP) Act, the guidance comes on the heels of HHS’ authorization of all state-licensed pharmacists and pharmacy interns to order and administer childhood vaccinations during the pandemic.
“The authorization of licensed pharmacists to close critical gaps in care of the patients in our community is something that has been greatly helpful to expanding the role of pharmacists,” said Rumbarger, whether that’s related to chronic condition management, medication adherence, treating minor ailments or engaging in preventative care.
According to Rumbarger, “CVS is looking to redefine how people access healthcare by offering convenient, ongoing support for chronic conditions, preventative screenings and administering vaccinations. Pharmacists play an important role in this by providing expert education and counseling for patients with chronic conditions, complementing care of their primary physicians, helping avoid unnecessary ER visits, and connecting to care management programs when available,” he said.
Investing in pharmacy technology and capabilities is also a way to improve health outcomes and ultimately drive down costs, said Sam Anderegg, Chief Executive Officer of Docstation, a platform that connects pharmacists and health plans. Docstation helps health plans leverage the reach and patient relationships that pharmacists have, while providing a way for pharmacists to participate in value-based care arrangements. Anderegg emphasizes the role that pharmacists are increasingly playing a part in improving outcomes, quality metrics and returns on value-based care contracts. “With the right technology in place, pharmacists can shift their workload and outsource medication dispensing to maximize reimbursement and thus value that they’re driving back to the health plan and to the patient,” he said.
And because pharmacists increasingly can utilize technology to access data that enables them to intervene in patient care, mitigate risks and reduce expenses. “They [pharmacists] can help health plans achieve a better margin, while doing the thing that they really want to do, that they were trained to do, rather than being stuck behind the counter filling prescriptions,” said Anderegg.
Community Pharmacies As Care Destinations
Because 66% of older adults take five or more drugs per day, with 27% taking 10 or more per day, patients are often interacting with their pharmacists far more than their prescribers. In fact, the average person visits her PCP once or twice per year but may see their pharmacist more than a dozen times. With this in mind, pharmacists are often the first line of defense in patient health screenings, care guidance, and identifying when prescriber intervention is needed.
Sometimes community pharmacies are the primary care destination for patients, especially in rural and underserved communities. “You’ve got patients in rural underserved areas that are 20 or 25 miles away from the nearest primary care provider, and it takes them a month or more to get an appointment,” said Anderegg. “But there’s a pharmacy right down on Main Street where patients can walk in and talk to a clinician face-to-face about their health concerns or their medication issues.”
Recognizing and prioritizing which clinicians are best suited for specific patient needs is something that Troy Trygstad, Vice President of Pharmacy Solutions at Community Care of North Carolina (CCNC) and Executive Director of Community Pharmacy Enhanced Services Network (CPESN), deals with on a daily basis.
Trygstad, a practicing pharmacist who works in a community pharmacy on nights and weekends, talks about the moment his clinical board of 72 physicians realized the challenges they were facing in resource allocation relating to providing care for rural patients. The board flagged that they were spending a lot of money sending nurse care managers out to see patients, who were often traveling 30 miles or more to then spend half a day with patients. “Ninety percent of the issues that the care managers are running across are either directly or indirectly related to chaotic medication use, on both the cause and effect sides of the equation,” said Trygstad, reinforcing the role that community pharmacists can play and just how important their knowledge and close proximity is in keeping patients well and engaged with their health.
Concerns About Cost And Delays In Care Amid Covid-19
Expanding pharmacists’ roles as caregivers is especially timely when it comes to healthcare access, engagement and avoiding delays in care during Covid-19. According to a recent Kaiser Family Foundation poll, 48% of Americans said they or a family member has skipped or delayed medical care because of the pandemic, with 11% citing that a person’s condition worsened because of the care delay.
Though fear of contracting Covid-19 is one of the main drivers delaying care, costs may be another, with the shift to high-deductible health plans playing a role. To help ensure patients stay adherent to their care plan and medication regimen, pharmacists are helping patients identify opportunities for cost savings. Rumbarger shared that at CVS, pharmacists are trained to advise patients on ways to save money with prescriptions.
“About 83% of Americans are personally concerned about the impact of rising prescription drug prices, according to a recent national poll commissioned by CVS Health,” said Rumbarger. But because of their knowledge and expertise of comparable generics, along with direct communication with patient’s primary care physicians, “Pharmacists can help save patients money with comparable options that achieve the desired outcome of the prescribed medication,” Rumbarger said, noting that the company’s digital Rx Savings Finder tool shows pharmacy teams a patient’s prescription profile, medication history and insurance plan information, as well as available cost savings opportunities for the patient’s specific medications such as generic or therapeutic alternatives.
Trygstad also points out the important role that pharmacists can play in overcoming Covid-19, once vaccines become available. Pointing to pharmacist’s accessibility and the public’s consistently high level of trust in pharmacists, he suggests that pharmacists can play a critical role in helping to educate members of the community skeptical about vaccines. “Public health officials need to consider that it’s not just about the mechanics of distribution, but also about relationships and education,” notes Trygstad.
“There is a need for trusted conversations at a local level, where the pharmacist is saying ‘Yeah, this virus is real’ and here is what you need to do to best protect your family and your neighbors,” says Trygstad.
The Opportunity For Pharmacies And Pharmacists
What does all of this mean for the opportunities for the role of technology and pharmacy? Anderegg highlights the role that technology can play in empowering providing pharmacists with actionable data to help them to elevate the role of the profession. “Health care is super personal. It’s going to continue to be personal. No matter how much telehealth or virtualization we introduce, people want to talk to someone that they trust,” he said.
Like Anderegg, Trygstad agrees there is enormous opportunity for pharmacists, and is looking to technology to help free pharmacists up from their prescription-dispensing activities so they can better serve their community. “Patients already are accustomed to coming to the pharmacy. The question then becomes, what types of clinical services can you deliver once they’re already there?”