Be a Top-Performing Pharmacy on Star Ratings Measures: Make Every Encounter Count

This is part of an ongoing series on how community pharmacies are demonstrating outstanding performance under measures that CMS uses to calculate health plans’ Star Ratings. Although pharmacies are not assigned Star Ratings, a pharmacy’s actions can have a dramatic impact on health plans’ ratings. Those ratings affect plans’ reimbursement and enrollment period.

Communicating well with providers and patients helps improve performance

Since 2006, the owners of Towncrest Pharmacies in Iowa have focused on changing their pharmacy practice from dispensing medications to optimizing patient therapy. The success of the systems they put in place over the years is evident in the pharmacies’ performance on star ratings measures.

Both Towncrest Pharmacy locations have exceeded the levels for 5-star ratings on 4 out of 5 quality measures; this encompasses everything except the number of patients with diabetes receiving a recommended blood pressure medication.

From April through September 2014, the Iowa City location scored among the top 20% of all pharmacies on the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP™) for two adherence measures, for hypertension and cholesterol medications. The Solon location was among the top 20% for hypertension and diabetes medication adherence. Medication synchronization is one of the services Towncrest offers to improve customer adherence. (See “Improve Your Refill Rates and Revenue with Medication Synchronization.”

While the EQuIPP numbers show that Towncrest still isn’t reaching the 5-star goal for the first measure, “Claims data will tell only one side of the story,” said owner Randy McDonough. Through the extensive documentation at Towncrest, the pharmacy can show, for example, not only that a patient with diabetes isn’t on a recommended medication for hypertension but also why, such as an inability to tolerate the medication.

The pharmacy keeps notes on the patient history, pharmacy recommendations to physicians, and providers’ responses. The current medications list for each customer includes space for the name of the prescribing physician and comments, as well as a section for OTC medications the person takes.

“The more information we have, the better able we are to make interventions,” McDonough said. “We never really focus on one disease state. We look at the total patient.”

Prompt Prescriber Responses

When Towncrest first began trying to work with physicians more than a decade ago, it received virtually no response for the first six months. Today the response rate is 95%.

“They [physicians] weren’t used to seeing notes from pharmacists,” McDonough said. The pharmacy had to educate physicians about the benefits of working with the pharmacy, and make the process simple for the prescribers’ offices.

How to Communicate Well with Physicians

When Towncrest Pharmacy first began faxing notes to physicians, none responded. By refining its forms and educating physicians, the pharmacy now receives responses from physicians 95% of the time.

These actions allow a pharmacy to communicate quickly and effectively with prescribers:

1. Create templates. Have all the necessary information at your fingertips. Put your pharmacy information at the top, and include spaces for all relevant patient data, including date of birth and insurance. Include the pharmacist’s name and a place for the date.
2. Be brief. Short forms are likely to receive a faster response. Try to keep everything on one page.
3. Prompt action. Make it clear what the recipient should do. Place boxes at the top of the form that allow you to indicate whether the subject is urgent, requires a reply as soon as possible, should be reviewed, or is just informational.
4. Make it easy. Design the form so the recipient can check a response, jot a short note, and fax back the same document, rather than creating a new one.

McKesson’s Physician Outreach Program is an easy-to-use, comprehensive program that helps independent pharmacies build stronger relationships with local prescribers to attract new patients and improve patient care. With access to prescriber data, marketing plan templates and customizable materiels, this program can help you establish your pharmacy’s competitive edge in your local market.

“I try to make all my notes to physicians no more than one page,” McDonough explained.

For example, the pharmacy’s Physician Communication Form, based on the SOAP note used in healthcare offices, includes a section for Subjective Findings, Objective Findings, Assessment and Plan. The physician can check a box to agree with the pharmacist’s recommendation, in which case the signed form that is faxed back to the pharmacy also serves as a 30-day prescription, or the physician can propose a modified plan.

“I don’t want to look like we’re telling the physician what to do,” McDonough said, but it is important to provide a clear recommendation that the provider can accept or reject. “You can’t soft-shoe this stuff, because then you get a garbled message.” Early on, he asked whether a physician would “consider” a change. McDonough thought an affirmative response was an order to go ahead and make the change, but the doctor said that as was requested, he had agreed to consider a change, but not necessarily to make it.

When Towncrest contacts a physician’s office, it doesn’t file the hard copy of the patient chart until it receives a response, and the chart is flagged as “Pending” in the pharmacy’s proprietary software program.

Educating Patients

For years, Towncrest has focused on identifying and resolving drug therapy issues. It began conducting early medication therapy management through Medicaid in 2006. Its staff will ask a patient questions such as, “How long have you been taking this medication? Is it working? Have you tried alternatives, or would you be willing to try something else?” When customers ask why Towncrest requests so much information, it educates them about the quality measures. The pharmacy also demonstrates how it is better able to serve customers when it has more information.

For example, when a customer received a sample medication from a provider and called the pharmacy to ask about possible interactions with other medications, the pharmacy also made a note to follow up with the patient in a couple of weeks. “We don’t want to alienate the patient or the prescriber,” McDonough said. The pharmacy is focused on optimizing therapies for its customers.

Proving Value

“Pharmacists are providing a lot of value,” McDonough said, and by collecting data they can prove it. Tentative data from a pilot project with Towncrest and BCBS/Wellmark has shown health care savings from fewer doctor and hospital visits. Total healthcare spending for high-risk patients who only went to Towncrest was $790 less per member per month than for patients who used another pharmacy. Even patients who used Towncrest along with another pharmacy still cost $310 per month less than those who went to another pharmacy alone, a six-month study found. Based on preliminary data, Towncrest’s services could save the health plan about $4 million a year.

Quality measures are one way an independent pharmacy can show that it serves customers better than its competitors. To prove your value, though, you have to document the interventions and results.

Towncrest’s strategy is working. The pharmacy has changed its practices, operations, and workflow, and is educating patients, communicating with physicians, and demonstrating value. Towncrest’s experience shows that performance and value go hand in hand.