We’ve touched on Clinical Services previously.  In that blog we discussed some of the basic thoughts around implementation and some of the potential pitfalls.  Today we want to think a little more in detail about how to begin implementing some of the opportunities that you may have available by following a case study from a real-world community pharmacy example.   

 

This Pharmacy is an independent pharmacy located in Pennsylvania.  They serve a primarily small town and rural population.  They have faced many of the struggles that we see with most independent pharmacies over the past few years: declining reimbursements, reduced revenue, increased cost and declining profitability.  Through diligent work and purposeful change, the pharmacy has eliminated waste, streamlined operations, improved workflow and implemented robust immunization and LTC at Home programs.  They have controlled their dispensing of brand name medications, maximized their use of secondary wholesalers and have added some additional sources of front-end revenue.  In short, they have worked hard to do all of the right things but are still looking for additional profitability.

 

One area in which their success has been lacking has been in the meaningful implementation of clinical services and the capture of that revenue.  Being in Pennsylvania, they are enrolled with CPESN and PPCN, the national and state clinically integrated networks.  This allows them access to payer programs that can generate revenue for their pharmacy.  Their opportunity in this space is approximately $3,000 per month.

 

This pharmacy processes on average 400Rx per day with 1.5 FTE of Pharmacist time per week, which allows for some overlap Monday through Friday.

 

We examine a few factors here to determine how we might implement clinical services:

  1. Is the additional revenue potential large enough to warrant designating resources for this project?  Is the POTENTIAL ROI positive AND at a meaningful level?  In other words, is the juice worth the squeeze?
  2. What additional resources in the form of personnel, technology or other investments are going to be needed?  How will this impact the ROI?
  3. How can we maximize the profitability of this endeavor and create a system that is sustainable and scalable in the long term?

 

Is the Juice Worth the Squeeze?

An additional $3,000 per month or $36,000 per year would add meaningfully to the bottom line of the pharmacy, provided that the revenue here can be captured without adding to the additional operating cost.  Seeking to maximize this service is really only meaningful if the pharmacy does not have to hire to capture the revenue.  So, the added clinical work must be done with the current staff.

 

Additional Resources Needed

Based on the current setup of the pharmacy (staff levels, technology vendor etc.) no additional resources are required to implement these services.  However, deployment of the current resources may need to be managed in a different way.  We need to examine how to maximize the allocation of resources to avoid the problem discussed above.  If we need to add additional staff or staff time to capture this revenue, then the juice isn’t really worth the squeeze.

 

Simple ROI

We don’t need to complicate things.  We know that $36,000 in additional PROFIT for the pharmacy would be meaningful for a year.  So, we need to make this opportunity as close to 100% profitable as possible.  This means we redeploy our resources in such a way that we are able to achieve that.  We think it can be done in this case given a high proportion of MedSync patients, well trained staff and already existing pharmacist overlap.  Without MedSync and trained staff, the problem is much more challenging.  If this were the case, we would work to build that foundation FIRST, then focus on the clinical programs.

 

Bit Size Implementation

The volume of potential patients (about 70 in this example) can be a bit daunting for some pharmacists to grasp: “you want me to do 70 clinical interventions and still do all the other things I need to do?”  The short answer is YES.  But not all at once.  We need to set some simple goals and make them easily achievable.  We also need to recognize that it isn’t the PHARMACIST alone who will be dedicating time to this program, it is the whole PHARMACY TEAM that is responsible.  By spreading the work out, dividing work into pharmacist work and technician work, the work is manageable.  Doing math, this comes out to about 3 interventions per day.  This IS manageable, especially with pharmacist overlap, but even without, that is still a doable number.  We eat the elephant, one bite at a time.

 

What might this look like?

The first step is to leverage the MedSync program, as MedSync is what allows the pharmacy to operate in an efficient and controllable manner.  By identifying those patients eligible for clinical programs who are also already enrolled in MedSync, there is already a point of contact with them through their regular MedSync call.  That point can be used initially, via a technician phone call, to explain the program, assess the patient’s willingness to participate and then schedule a time for the pharmacist to call the patient (appointment-based model).  The technician can also use this time to assess any barriers to adherence to medications and communicate that to the pharmacist via the Pharmacy Management System so that when he/she contacts the patient, those issues can be resolved as part of the intervention.  This approach can be used for ALL clinical opportunities (Think:  Outcomes, EQuIPP etc.).

Next is to leverage technology.  That means using prebuilt templates for the encounters and billing.  This ensures that the pharmacist doesn’t have to go looking for additional resources when it’s time to see the patient, and that all of the necessary information is captured for both quality of care and accuracy of billing.  This lowers the roadblocks and stress of the encounter for the pharmacist, thereby setting him/her up for success.

Finally, the pharmacist must close the loop and establish a follow-up routine for each encounter.  Doing so will optimize patient care and ensure maximal revenue each month.  At this pharmacy, one of the major weaknesses in previous trials of clinical services was a “dart board” approach – engagement in clinical services was something that was “fit in” as opposed to a scheduled task.  By actively scheduling a follow-up at the end of each encounter, the patient knows when his/her next appointment is (this can even be scheduled on the same date as their next sync call to further improve efficiency) and the expectation is set that this is pharmacy care, not a one-off service. 

A similar approach is used for non-MedSync patients: a technician conducts the initial outreach and scheduling and then the pharmacist conducts the intervention, scheduling follow-up and, ideally, enrolling them in MedSync.   By growing the MedSync program, further operational efficiencies are achieved.

 

Key points

This small bite approach works best when built on an already solid foundation of good operations, well-trained staff and adequate volume of MedSync.  It’s walking before running.  Trying to establish additional clinical services without the foundations in place is significantly more difficult and is more likely to lead to either the need to hire additional staff, which eats into profits, or outright frustration and failure.

The second key point is that this is a whole pharmacy approach, not just one person who is responsible for “special projects”.  By building a culture of clinically minded approaches to care, everything changes and the pharmacy provides better service in a more efficient manner.

 

The PEAK Solution

PEAK Pharmacy Solutions is ready to help you take the necessary steps so your pharmacy can thrive in 2026.  This is what we do - helping pharmacies upgrade and transform their business to meet today’s challenges and succeed.    We have relevant pharmacy-related knowledge and experience working with community pharmacies, including many top performing pharmacies.   Let PEAK help you take your pharmacy performance to the next level.