Pharmacies

How Medication Synchronization Makes a Difference

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Medication synchronization, the process of coordinating all of a patient's chronic medications to be filled at the same time each month, is the most valuable program for patients and staff I've ever implemented in my flagship store, Moundsville Pharmacy in Moundsville, West Virginia.

In fact, due in large part to implementation of medication synchronization, we have achieved double-digit increases in prescription volume annually over the past two years. What's more, we've been able to replicate our success at a second location, Sistersville Pharmacy, where prescription volume is up 11 percent since implementing synchronization in January 2015.

Each pharmacy has achieved 5 Star performance in the Centers for Medicare and Medicaid Services' Star Ratings adherence measures or has reached the Top 20 percent threshold for medication adherence performance measures. And with over 800 patients enrolled in our medication synchronization program at our Moundsville location and over 325 enrolled at our Sistersville location, we proactively process approximately 55 percent of our prescription volume through the synchronization process.

Let's drill down on why medication synchronization is so important from both the patient and pharmacy perspective.

Adherence matters to patients
It's common sense - and widely accepted - that medications don't work in patients who fail to take them.1 Pharmacists need to help patients by finding solutions to improve medication adherence.

Academic research shows a net gain for the health care system when patients become more adherent on medications for treating chronic disease. Even when drug costs increase due to increased adherence, medical costs and hospitalization risk decrease among chronic disease patients, according to a landmark 2005 study.2

Additionally, multiple studies conclude that 80 percent adherence is the level at which patients receive benefits from chronic medications to improve outcomes with a reduction in the risk of complications. In practical terms, that means patients with chronic disease would take their medications as prescribed at least 6 days per week and would fill a 30-day supply at least 10 times throughout the year.

However, 2016 Medicare Star Ratings Medication Adherence quality measures reveal that an average of only 3 in 4 patients being treated with diabetes, hypertension or cholesterol medications reach the minimum 80 percent adherence level.3 In other words, nearly 1 in 4 of the chronically ill patients that visit a pharmacy are at increased risk for complications and higher healthcare costs due to less-than-optimal adherence.

Patients become non-adherent for a variety of reasons: Many simply forget to take their medications, call in refills or pick up their prescriptions; weather conditions or limited transportation prevent them from making it to the pharmacy; medications may be too expensive or the patient may not budget properly to afford refills; and complex drug regimens may hinder the patient's ability to organize medications or complete the refill process.

Synchronization addresses each of these potential barriers. It also leads to better patient satisfaction by making prescription filling simple, convenient, efficient and not worrisome.

Pharmacy impact
Thus far, I've emphasized the patient impact of proper adherence, but it's also imperative to examine how medication synchronization enhances pharmacy operations and improves pharmacy workflow.

First, synchronization improves pharmacy efficiencies by enabling staff to work on prescription refills in advance. Outreach calls to patients - either prior to or after filling prescriptions - result in fewer incoming phone calls. The pharmacy also experiences fewer patients waiting for refills and reduced patient checkouts. The technician and pharmacist access patient profiles less frequently, and prescription deliveries or mailings can be consolidated.

Second, synchronization helps the pharmacy develop more structure and enhance workflow by assigning team members to designated processes, tasks and responsibilities. The pharmacy proactively schedules time for prescription processing rather than being reactive with refills.

Third, as experienced at my pharmacies, synchronization delivers the financial benefit of more prescriptions per patient over time. A study conducted by the National Community Pharmacists Association found that synchronization adds an average of 3.4 more refills per prescription per year. With the average patient of the 1,300 in the study taking 5.9 chronic disease medications, the net effect was an overall lift of 20 prescriptions per patient enrolled in a synchronization program.4 Moreover, the previously noted staff efficiencies enable the pharmacy to cut filling expenses per prescription. By processing refills proactively the pharmacy can carry less inventory and more effectively schedule staff.

Fourth, synchronization enables the pharmacy to pursue performance improvements, such as scheduling time for medication therapy management (MTM) sessions and addressing additional Star Ratings clinical quality measures. The pharmacy therefore may be eligible for higher performance bonuses and can communicate their patient care practices and outcomes with local prescribers to encourage partnerships for patient care. More time can also be spent on immunizations, OTC recommendations and durable medical equipment sales after medication synchronization has evolved the pharmacy's prescription-filling process.

Program options and implementation
A medication synchronization program can be designed with variable options in the following areas:

  • Days supply dispensed (28- or 30-day cycle)
  • Workflow schedule (daily or scheduled)
  • Manner and timing of patient call (prior to or after prescription fill)
  • Method of dispensing (vial dispensing or compliance packaging)
  • Patient interaction (appointment- or non-appointment-based model)
  • Documentation (paper-, software- or platform-driven)

Click here to access my Good Neighbor Pharmacy webinar explaining each of these options in detail.

A pharmacy new to medication synchronization should start with a discussion among pharmacists and staff members regarding the design options that appeal to the team and best fit the store's operations and technology capabilities. The simplest approach for beginners would be to adopt vial dispensing, non-appointment-based scheduling, and paper-driven documentation.

After deciding on process options, the pharmacy should set a training date and goals. Team members must understand the desired impact of the program on the pharmacy and how it will affect future workflow, as well as the specific processes and procedures that will be involved.

The pharmacy will then be ready to enroll patients. Initially, when a pharmacy is trying to enroll as many patients as possible, we have found it reasonable to expect that 9 out of 10 patients will agree to sign up for synchronization at the point of checkout. As the program gets more established and includes a larger proportion of patients, the rate of enrollments will naturally slow down. In any event, pharmacies should set quarterly enrollment goals and may consider financial staff incentives tied to attainment of those goals.

The pharmacy should also create checkpoints for progress of the program. One way to do that is to compare the number of patients enrolled in the synchronization program to the adherence measure performance reports from EQuIPP. There should be a correlation between increased synchronization patient enrollment and pharmacy performance - and that connection should be explained and demonstrated to staff. Such analysis will enable the pharmacy to adjust processes and workflow as the synchronization program continues to grow.

Finally, it's crucial for the pharmacy to market the synchronization program through various channels: press releases, signage and bag stuffers, advertisements, community talks and provider visits. The message should educate the community and providers on the advantages the pharmacy can offer to improve adherence and create healthier patients.

Time to be proactive
Independent pharmacy has the opportunity to lead improved adherence performance with medication synchronization. At the individual store level, this new standard of prescription processing will improve customer service, pharmacy workflow, and adherence scores.

Pharmacies that have adopted a medication synchronization program have experienced increased prescription volume, more engaged staff and streamlined workflow, greater organization, increased ability to complete services such as MTMs, more references from physicians, and happier and healthier patients.

1. Quote from former U.S. Surgeon General C. Everett Koop, MD, Adherence to Medication, New England Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMra050100
2. Impact of medication adherence on hospitalization risk and healthcare cost. http://www.ncbi.nlm.nih.gov/pubmed/15908846
3. Medicare Part C and D performance data. https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/performancedata.html
4. Patients benefit from pharmacy-provided medication synchronization programs. http://www.ncpanet.org/newsroom/news-releases/2014/01/15/patients-benefit-from-pharmacy-provided-medication-synchronization-programs
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