1. The Work System of Value-Based Programs in Pharmacy: A Multi-Case Study
Joel Hoyman, Samantha Johnson, Matti Mason & Michael Parisi-Mercado
Preceptor: Dr. Bill Doucette

2. Background Evolution of pharmacy in Iowa
Change in the role of the pharmacist
Iowa Pharmacy Association (IPA) New Practice Model
Community Pharmacy Enhanced Services Network (CPESN) Iowa
Focus on providing clinical services
Lower payments forcing pharmacies to seek other revenue streams
Purpose: discuss changes that pharmacies across the state of Iowa have made to expand their offering of clinical services
Utilize the System Engineering Initiative for Patient Safety (SEIPS) work system model
Focus on 5 work system areas
Tools & technology, people, tasks, organization, environment

3. The work system affects processes and outcomes, however, we mainly focused on the work system highlighted in red.
Systems Engineering Initiative for Patient Safety (SEIPS) work system model

4. Determine how many pharmacies utilizing the New Practice Model or members of CPESN have addressed changes in their work system to be successful in this new value-based program.
i.e. : changes to provide new services, technology, staff organization
Identify strategies these pharmacies used that aided in their success, as well as what obstacles may have impeded their success in the new program.
i.e.: medication therapy management (MTM) , immunizations, Medication Synchronization (MedSync)
Objectives

5. Methods Qualitative study List of pharmacies 106 pharmacies contacted
IPA New Practice Model Participants
CPESN Iowa Members
106 pharmacies contacted
Letter via
Recorded phone interview with willing pharmacy participants
Utilized an interview guide
Semi-structured interview focused on five work system areas of interest
Interviews transcribed, coded
Matched responses to work system area
Methods
We used semi-structured interviews with open-ended questions centered around the work system
Had 2 people coding each interview

6. Case 1 Chain Pharmacy 700-800 Rx/week Pharmacists: 2 Technicians: 3
Tools & Technology
Eye-Con Pill Counter
Dispensing software: ComputerRx
Documentation: ComputerRx
Looking at utilizing Prescribe Wellness as well
Tasks
Medpacks
MedSync
Immunizations
MTMs
Adherence Packaging
People
1 clinical pharmacist, 1 staff pharmacist
New Practice Model pharmacy
Case 1
Chain Pharmacy
Rx/week
Pharmacists: 2
Technicians: 3
Population: 60,000
Spoke to main pharmacist
No robot used
Switched to computerRx ~4 years ago
Medpacks = optimae (mental health group home)
Medsync = 150 pts that use it
Immunizations → local school district, surrounding businesses, nursing homes
MTMs = usually over the phone, sit down
Adherence packaging = technician-run
New Practice Model = utilize tech-check-tech

7. Case 1 Chain Pharmacy 700-800 Rx/week Pharmacists: 2 Technicians: 3
Environment
Private counseling room
Also utilized for immunizations, long-acting injections
Transition of care program with local hospital
Good physician--pharmacist relationships
Organization
Technician-run adherence packaging
s, quarterly reviews
Chain Pharmacy
Rx/week
Pharmacists: 2
Technicians: 3
Population: 60,000

8. Case 2 Chain Pharmacy 1500 Rx/week Pharmacists: 3 Technicians: 4
Tools & Technology
Eye-Con Pill Counter
Refill App
Central Fill
Documentation: Patient Reporting Software
Tasks
MedSync
ReadyRefill
Adherence Packaging
Immunizations
MTM
People
One new experienced tech hired; mostly just trained current employees.
New Practice Model Pharmacy
Case 2
Chain Pharmacy
1500 Rx/week
Pharmacists: 3
Technicians: 4
Population: 8,000

9. Case 2 Chain Pharmacy 1500 Rx/week Pharmacists: 3 Technicians: 4
Environment
Private Counseling/Immunization Room
Great physician--pharmacist relationship
Local hospital main clinic will often call with drug questions, etc.
Organization
Memos, bi-annual meetings
More counseling on refills than in the past
Face-to-face patient interaction/communication
Techs checking prescriptions frees pharmacists
Chain Pharmacy
1500 Rx/week
Pharmacists: 3
Technicians: 4
Population: 8,000

10. Case 3 Independent Pharmacy Prescriptions: 2,000 per week
Tools & Technology:
ScriptPro robot
Electronic faxing
Omnifiller for MedSync program
Tasks:
MedSync
Adherence packaging
Immunizations
Point of care testing
Shared duties between pharmacists
Technicians involved in inventory management, entering and filling prescriptions, answering phone
People:
No new hires
No changes in staffing or scheduling
Case 3
Independent Pharmacy
Prescriptions: 2,000 per week
Pharmacists: 4
Technicians: 5
Population: approximately 24,000
Person interviewed: pharmacy manager
Pharmacists: 3 full time, 1 part time
Technicians: 3 in a 5-hour shift, 5 total
Services provided: consultations, MTM, immunizations (flu, shingles, pneumonia, tetanus), POC testing (A1c), medsync, adherence packaging
ScriptPro added 6-8 years ago

11. Case 3 Independent Pharmacy Prescriptions: 2,000 per week
Environment:
Room with table and chairs where they provide immunization
Consultation area
Organization:
Not enough communication when informing of changes
Will implement monthly meetings
Independent Pharmacy
Prescriptions: 2,000 per week
Pharmacists: 4
Technicians: 5
Population: approximately 24,000
Challenges: insurance plans, need improvement in workflow, staffing, space
Biggest success: personal service

12. Case 4 Independent Pharmacy 1,400 Rx/wk Pharmacists: 3 Technicians: 8
Tools & Technology:
Parata Robot
Eye-Con Pill Counter
Phone system automatically calls patients when prescriptions are ready
Using QS1, not very MTM friendly
Tasks:
MedSync
MTM’s
Free Vitamin Program for children
People:
Recently hired a pharmacist
In charge of MTM’s
Technicians do the bulk of the MedSync
Case 4
Independent Pharmacy
1,400 Rx/wk
Pharmacists: 3
Technicians: 8
Pop. 4,000

13. Case 4 Independent Pharmacy 1,400 Rx/wk Pharmacists: 3 Technicians: 8
Environment:
Standard counseling area
New room for immunizations and private counseling
Prescribers call at any time of the day
Organization:
Technicians are in charge of all portions of filling except checking
Doing much more calling patients than in the past
Independent Pharmacy
1,400 Rx/wk
Pharmacists: 3
Technicians: 8
Pop. 4,000

14. Results 8 Pharmacies responded & completed an interview 5 independent
3 chain
Initial Findings:
Multiple clinical services offered: MTMs, MedSync, Immunizations
Many are giving more responsibilities to technicians
Not many changes in staffing
*still in progress*
Probably cutting this table out??

15. Strengths & Limitations
Coded interviews in pairs
Use of a proven conceptual framework
Use of semi-structured interviews
Sample of pharmacies from the CPESN and IPA New Practice Model should be more progressive.
Limitations:
Wasn’t face-to-face, on-site
Limited sample size
Didn’t do a checkback process
Different people did interviews
We did do a training interview with Dr. Doucette to attempt to standardize our interview process
Limited Sample size- Respondents might be more progressive

16. Next Steps Write a case report for each case More thorough comparisons
Develop quantitative approach
Survey questions
Gain larger study population

17. questions?