Lessons from the Road

DocStation: Tour de Pharmacies 2018 ?

We spent the second week of October trekking across Iowa to spend time with some of the most innovative pharmacy leaders in the country.

Fueled by our vision for value-based pharmacy, we learned first-hand how care providers are pushing keeping patients healthy and pushing clinical* *pharmacy forward.

Three Consistent Themes came up:

Platform overload — pharmacists are inundated with software, toggling multiple windows every day.
Time is precious — less time (and fewer clicks) in software means more time for patients.
Communication breakdown — care coordination between providers is painful (and relies on faxing).

Huge thanks to everyone who took time out of their busy schedules to share their current practices, highlight the pain points, and outline where the future of clinical pharmacy is headed. If we missed you on this trip and you want to know more about how DocStation is saving pharmacists from the platform overload, sign up below ?‍⚕ ?‍⚕

The Pharmacy Innovators

Meyer Pharmacy

Waverly, Iowa

Ryan Frerichs and the team at Meyer are constantly looking for new programs and revenue streams to include in their workflow but one thing is clear,

“We’re inundated with all the different platforms.”

They spend a lot of time focused on immunizations but the billing process is a major barrier to expanding into additional clinical services.

“I can give a shot faster than I can document it!” said Ryan on his way to give a flu shot in the middle of our conversation. But even before you administer a shot, it’s difficult to track down a patient’s immunization history. Third party vendors that pull in data from state registries make it easier but it’s far from streamlined.

Greenwood Pharmacy

Waterloo, Iowa

Dr. Rob Nichols has spent a lot of energy creating an integrated Transitions of Care (TOC) program in the Waterloo region. He has remote access to three different health-systems’ Electronic Health Record (EHR) platforms, which is no small feat. That gives him a more complete picture of a patient’s history and allows him to anticipate when his patients are admitted or discharged.

Even with the remote access to the EHR, the team at Greenwood has to manually monitor their patient list throughout the day to spot discharge orders from the inpatient team. Rob mentioned how nice it would be for this process to be a push instead of a pull where he constantly has to check.

Covenant Medical Center

Waterloo, Iowa

It’s hard to believe but often times, physicians end up making medication decisions in the hospital that are based on mistakes or incorrect information. When a patient is admitted to the hospital, the inpatient pharmacists are tasked with compiling an accurate medication list to aid physicians with their inpatient orders and prevent mistakes from happen. That’s a lot of work and one of the reasons why Dr. Laura Gansen and Dr. Sam Wheeler are closer to super heroes.

They walked us through the pain of using multiple platforms to compile medication data into a single “source of truth,” which takes a LOT of time. At times, the physician may finish inpatient orders or even discharge the patient before the full history has been compiled. Because of that, teaming up with Rob at Greenwood (and other area pharmacies) on a Transitions of Care program gives them quick access to a patient’s medication history at the time of admission without waiting for faxes or phone calls to be returned.

Covenant is dedicated to improving care and with the right tools (and more time), there’s so much more they‘ll be able to do. It’s impressive to see what they’ve accomplished so far and we’re eager to watch the program evolve.

Osterhaus Pharmacy

Maquoketa, Iowa

We kicked off day two with Dr. Jessie Johnson, Pharm.D. and a tour of Osterhaus Pharmacy. The Osterhaus family has been training pharmacy leaders for years though their residency program (Dr. Johnson participated before joining full time this year).

Patients flow through the point-of-sale process to private counseling booths for a conversation with a pharmacist before leaving the pharmacy. This provides a safe space for patients to talk through any issues with their medications, take a quick blood pressure, or receive an immunization.

When asking what takes up most of her day, Jessie joked about the 41 different software platforms the team interacts with on a daily basis. But, she has gotten some productivity back with her newly acquired second monitor.

Unsurprisingly, the team still spends a lot of time and brain power determining when patients are due for a blood pressure, hemoglobin A1c, or a discussion on adherence.

“Caring for patients shouldn’t be so hard.”

Hy-Vee Drugstore — 1st Avenue

Iowa City, Iowa

For day three, we were back in Samm’s Iowa City stomping grounds and our first visit was to Dr. Bridget Jermeland at the Hy-Vee Drugstore. Dr. Jermeland is passionate about mental health and depression management so her team administers PHQ-9 Questionnaires for all patients on antidepressants.

Dr. Jermeland performs these services regardless of a health plan paying for it…because “it’s the right thing to do for patients.” She casually discusses the New Med counseling, Adherence counseling, focus on immunizations, MedSync (including family syncing), Med Reviews, and all the extra work the team does to treat all patients the same regardless of reimbursement programs. And in response she just as causally highlights that “This is what’s going to get us provider status and the extra work is worth it.”

Truly inspiring. We can’t wait to work more with this group.

Towncrest Pharmacy

Iowa City, Iowa

If you’re paying attention to value-based pharmacy, then you’re well aware of Towncrest and how they’ve been using adherence packaging, MedSync, and comprehensive medication reviews to keep their patients healthy and out of the hospital. They published the study that Wellmark’s preferred pharmacy plan was modeled after when they showed savings of over $300 per member per month (PMPM) in cost savings.

We geeked out on their automation pouch packaging setup that both fills the adherence packing and verifies the contents of each pouch with very little pharmacist intervention. The efficiency gains gives the team more time to spend with patients and providing care.

But when you ask Dr. Mike Deninger and Dr. Kelly Kent about what makes Towncrest a top performer year after year, “the secret sauce is in our staffing; slack pharmacists.” If you’re unfamiliar with the term, it simply means having an additional pharmacist on the team that can focus on patients and giving the care and attention that pharmacists are capable of beyond dispensing product.

University of Iowa | College of Pharmacy

Iowa City, Iowa

We stopped by the University of Iowa to speak with Dr. Susan Vos, Director of Professional Experiences, and Dr. Jay Currie, Clinical Professor and Chair, Department of Pharmacy Practice and Science, about how the resurgence of value based care has been affecting the industry and how they’re approaching it through curriculum and experiences for their students.

According to Dr. Vos, all fourth year students are placed at a community pharmacy spending at least half of their time doing MTM, with many of the sites involving students in MTM and other clinical service 100% of their time.

Dr. Currie identifies the inflection point for clinical pharmacy when Walgreens decided to start doing flu shots. “One of the chains validated the model of providing care instead of just dispensing product,” he says before following up with “if someone wants to lose money dispensing chronic meds, let them” to drive home the point that the future of pharmacy isn’t in the razor thin margins of dispensing drugs.

It’s exciting to see the college making strides to educate students on dispensing systems, MTM programs, and other technology to make sure they’re prepared for the new model.

NuCara Pharmacy

Coralville, Iowa

Dr. Pamela Wong Wiltfang and the rest of her team at NuCara were early DocStation users and we’ve been lucky to work alongside them while developing our Pharmacy Care Program. Having worked closely with the team, it was great to see first-hand how they’re able to manage patients across multiple programs and multiple locations from a single operations center.

Dr. Robbie Schwenker gave us a tour of their new building and pharmacy of the future that he designed, which was set to open a few days after our visit. They designed the facilities from the ground up with compounding rooms front and center and lots of visibility into the pharmacists day-to-day to show that we do more than count pills.

Iowa Pharmacy Association

Urbandale, Iowa

The last day of the tour started with a light dusting of snow and the wonderful team at IPA. We ran through the DocStation payment program and reviewed a longer term roadmap before talking through all of the grants and demonstration project funding the staff at IPA have worked hard to obtain….and implement. CEO Kate Gainer and her team don’t seem to sleep and they’re clearly dedicated to taking Iowa Pharmacy to the next level.

CPESN and the eCarePlan were hot topics along with identifying ways to expand patient care services. And no surprise, the biggest complaint and source of headache according to Dr. Anthony Pudlo are the multiple platforms and juggling software throughout the day.

UnityPoint Clinic Family Medicine

Urbandale, Iowa

Dr. Craig Logemann has spent 14 years as a clinical pharmacist at UnityPoint and he was kind enough to spend time unpack their data-driven approach to patient care. With a dedicated team of data scientists, they’re constantly analyzing how outcomes change over time and identifying new opportunities to improve patient health. With that knowledge, Craig rotates between multiple clinics depending on the number of high risk patients. In addition, doctors have regular access to metrics or “scorecards,” so they know where they can improve.

Drake University | College of Pharmacy

Des Moines, Iowa

You can’t talk about pharmacy leaders in Iowa without Drake University. Dean of Pharmacy, Renae Chesnut, filled us in on their DELTA Rx Institute that encourages young pharmacists to think beyond the straightforward career paths to expand their opportunities through an entrepreneurial challenge.

In addition to the entrepreneurial nudge, professor Mike Andreski shows students the importance of data science and using it to ask questions about patient populations. Cheryl Clarke, Assistant Dean and Director of Experiential Education stresses that pharmacies shouldn’t rely on students/residents for new programs/initiatives to be profitable or worthwhile. We couldn’t agree more.

We wrapped up the conversation by agreeing that pharmacists are doing work to keep patients healthy (which ultimately saves health plans millions) and there needs to be an easier way to show that impact.

Montross Pharmacy

Winterset, Iowa

Jeff Olson wears his passion for value based pharmacy on his sleeve. Early in the conversation he expressed his goals for passing along his legacy and making sure the next generation understands the importance of value based pharmacy. Montross organizes their patient encounters around MedSync with over 800+ patients currently participating. They developed a checklist of interventions that get run through each time a patient picks up their meds.

The Montross team has worked hard to establish relationships not only with their patients but with the other care providers in their region. The linchpin to this is having every patient sign a release form, which gives Jeff and the team a green light to request any information they may need for a patient. The success of the approach is clear in his quick analogy, “The doctor is the head coach calling the shots while we [pharmacists] are the assistant coaches. This only works by building and maintaining trust.”

We couldn’t agree more. Go Hawks!