By Madeline Camejo, Pharm.D., VP of Pharmacy Services & Chief Pharmacy Officer, and Sara Panella, Pharm.D., Clinical Manager, Baptist Health South Florida
In the current state of the world and the COVID-19 pandemic, many healthcare providers have turned to virtual platforms to care for their patients. What about pharmacy services and pharmacists? Considered the most accessible healthcare provider, pharmacists’ skills often tend to be undervalued and underutilized in the ever-growing evolution of technological delivery of healthcare. Although there has been an exponential growth of pharmacists based in ambulatory settings, such as clinics and physician’s offices, there is still an opportunity to include pharmacy services into current practices. Pharmacists at every point of the patient journey can harness technology to positively impact patient outcomes.
Pharmacists are the medication experts and should be utilized in telehealth to provide clinical services surrounding medication management. Medication management requires engagement by the patient and/or caregivers to ensure that patients are on the most appropriate and accurate medications. This includes evaluations of the patient’s current disease states and how well controlled by their current medication regimen. This includes an assessment of how adherent the patient is to their medications. Pharmacists have the ability to review and optimize therapies and identify duplications and omissions of medications.
The COVID-19 pandemic has created more opportunities and growth for pharmacists. The Coronavirus Preparedness and Response Supplemental Appropriation Act opened up telehealth regulations to enhance patient access to care, including expansion of technologies and flexibility in billing opportunities. Pharmacists, considered “auxiliary staff,” are able to bill through incident-to a Medicare-eligible provider, and “direct supervision” of this encounter can be done virtually, which has created more flexibility in workflow.
Pharmacist and pharmacies role is not limited to the conventional video-telehealth platform. There are several other platforms available to have pharmacy staff to aid in the continuum of care.
Pharmacists are leveraging all types of technologies to enhance both direct and indirect patient care. For example, clinical pharmacists have successfully utilized video telehealth services to discuss and review medications with patients. Patients are able to virtually display their medication to the pharmacists, perform medication reconciliation, enforce education surrounding medication regimens and adherence, especially around medications delivered through a device such as insulin pens and inhalers. Since these visits by pharmacists are billable, it allows extension of Medicare-eligible provider services and enhanced patient care. Services could include, but not limited to wellness visits, chronic care management and transitions of care.
Transitions of care is a crucial point in a patient’s care that a pharmacist can be involved in through telehealth. Pharmacists are able to follow up with patients post-discharge, as this is typically a time that is overwhelming for patients and/or their caregivers. Pharmacists are able to educate patients on their new medications, review any changes made in their regimens, and assist them in obtaining new medications that they may have cost or transportation barriers to. The pharmacist uses this opportunity to link their patients back into their primary care doctors and aid in transferring medical information to them. Technologies exist to assess if a patient was able to pick up medications post-discharge and overall adherence to medications that the patients have been on previously. It is also an opportunity to ensure that the care plan placed for the patient on discharge is continued appropriately. For example, prior to admission, medication may have been changed or discontinued due to an issue identified during the hospitalization. The patient may not have been aware of those changes, and they may have picked that medication up from the pharmacy with the rest of their new medications.
In addition to ambulatory care management, pharmacists in the acute care setting can also use telehealth to provide medication management services. For example, remote monitoring of pertinent labs for disease management can allow the pharmacist to provide insight on enhancements of medication management, including, but not limited to glucose monitoring, blood pressure, anticoagulation, and even vasopressor management for patients in the Intensive Care Unit.
Pharmacist and pharmacies role is not limited to the conventional video-telehealth platform. There are several other platforms available to have pharmacy staff to aid in the continuum of care. For example, platforms are available to support refill management that pharmacy staff is able to manage and maintain for the providers and their patients. This helps alleviate the burden from the providers’ offices and their staff and allows for centralized services. As this is protocol-driven, pharmacist extenders like pharmacy technicians and interns can be utilized in this space.
In addition, a pharmacy can provide background support in urgent care telehealth visits. Issues arise such as failure of the prescription transmission and/or lack of access to the medication due to coverage issues or not being in stock. The pharmacist can play an integral role in aiding these programs in resolving these issues, which includes clinically discussing opportunities with the providers on alternative therapies that may be better suited for the patient. Pharmacists can also be utilized to provide additional medication education to these patients.
Overall, the COVID-19 pandemic has driven healthcare to re-evaluate and expand the use of telehealth services, as well as many different technology platforms. Artificial intelligence (AI) and machine learning will likely play a bigger role in health care in the years to come. Robotic Process Automation (RPA) is a software-based automation service that uses AI, relying on robotic software to perform daily repetitive tasks and processes with higher accuracy and speed, allowing the person to focus on higher clinical decisions and tasks. By reducing human errors, pharmacists can harness the power of this technology to address pharmacy revenue cycle, 340B tasks, Clinical Documentation, enhance financial outcomes and improve the patient care experience and quality outcomes.