Prater's Pharmacy

Practice Setting

The Prater's Pharmacy Group serves several local communities in Southwest Missouri, with populations ranging from 1,500 to 10,000 residents. Our goal is to increase access to clinical services for our communities. Between five pharmacies, we employ seven pharmacists, one nurse and 19 technicians. Recent collaboration with St. Louis College of Pharmacy and University of Missouri Kansas City led to us have our first group of pharmacy students to precept. The majority of the time, patient interactions are face to face, however our pharmacists do offer counseling over the phone for patients and local nursing facilities.

Why was the pharmacy service developed? (Describe any compelling data collected prior to implementation)

Prater's Pharmacy strongly believes that any time you have interaction with a patient, it should be a clinical opportunity. We wanted to expand the clinical aspect of patient care that you see in the inpatient setting to our retail setting. Most retail settings follow a strictly dispensing model greatly under-utilizing a pharmacist's ability. The goal of our clinical services model was for our pharmacists to practice at their highest skill level. Using this mindset, we have now expanded access to non-traditional pharmacy services, such as providing accredited education programs, medication adherence programs, immunizations, and point of care testing for our patients. Knowing the importance of healthcare collaboration to give patients the best possible health outcomes, we felt drawn to developing a Clinical Services department comprised of a pharmacist who completed a PGY 1 residency focusing on treating chronic disease states and a nurse working in an inpatient setting to provide optimal healthcare for our patients.

What training, certification, credentialing, and practice agreement is utilized by the practice setting pharmacist(s)?

For diabetes education, we chose to obtain accreditation through the American Association of Diabetes Educators (AADE). We have obtained a CLIA waiver to perform point of care testing. We have a collaborative practice agreement with a local physician for immunization services.

What outcomes are being measured to evaluate the model's success? (Clinical metrics, revenue, cost-savings, patient satisfaction, etc.)

We monitor the specific revenue earned through clinical services, while collecting data of cost-savings for both the patients and the pharmacy. We monitor our clinical metrics for our diabetes education class using a Continuous Quality Improvement (CQI) plan that tracks weight loss, A1c decrease, and fasting blood glucose of patients. This CQI project is being updated frequently and reviewed with our Advisory Committee (comprised of a local physician, nurse, and civilian living with diabetes) annually to provide the best clinical outcomes and track patient satisfaction with our service. We use Equipp scores to measure compliance with our adherence program. Our adherence program has a built-in component to include Medication Therapy Review. This ensures that all of our patients are on indicated guideline therapy and up to date on immunizations. Although not formally measuring patient satisfaction, since the implementation of adherence support we have noticed improvement. Less gaps in therapy and care are occurring with monthly adherence monitoring provided by pharmacists and technicians.

How have you made this service sustainable? (Include billing, reimbursement, etc.)

We currently bill Medicare, Medicaid and private payers for immunizations. We have been attempting to credential with private payers for DSME, however have ran into roadblocks due to lack of recognition for pharmacists as a provider. As more states gain provider status for pharmacists, this will help sustain our clinical services. Our adherence program, though not a directly billable service, is able to generate revenue by means of improving Star Ratings and offsetting DIR fees. This service has increased patient satisfaction and promoted health and wellness within our patient group.

How did you gain support of administrators, providers, and other key stakeholders to implement your practice model?

The wonderful thing about independent pharmacy is that you have the ability to make your practice site what you want it to be. We work hard to foster relationships with local providers by always keeping them up to date on new services being offered at our pharmacies.

What are some lessons learned while implementing your practice model that you would like to share with other pharmacists?

Understand that you will encounter hurdles when pioneering new programs. Things will go wrong, so don't be surprised when that happens. Plan to adapt and don't be afraid of pushing the envelope. HOW you communicate is often more important than what YOU communicate. Motivating your team is key to being successful, you can not initiate and maintain a program by yourself.