Scaling Community Pharmacy Transformation with the 'Flip the Pharmacy' Implementation Model: Program Origins.

The rising costs of healthcare, increased chronic illnesses, and healthcare provider burnout has led to an environment desperate for scalable solutions to ease practice burdens. With a projected shortage in the number of primary healthcare providers available to provide team-based care, community-based pharmacy practitioners are accessible and eager to assist. In order to provide enhanced patient care services to aid their clinician colleagues, community-based pharmacists will have to transform their practices to support the provision of enhanced services and medication optimization in value-based payment models. The purpose of this article is to define how multiple factors in pharmacy, healthcare, technology and payment models aligned to create an opportunity for the Community Pharmacy Foundation and CPESN® USA to implement a nationwide community pharmacy practice model called 'Flip the Pharmacy'. This new model aims to scale community pharmacy practice transformation and move beyond filling prescriptions at a moment-in-time to caring for patients over time through a 24-month step-wise program paired with in-person pharmacist coaching. Preliminary observations from the first six months of the program highlight community pharmacy as a site of care with community-based pharmacist practitioners providing and documenting targeted patient care interventions.

Workplace-based cardiovascular risk management by community pharmacists: impact on blood pressure, lipid levels, and weight.

STUDY OBJECTIVE: To assess the effectiveness of a community pharmacist-delivered cardiovascular case-management program by comparing body mass index (weight), systolic and diastolic blood pressure, and full lipid profile at the beginning of the program with these outcome measures at the end of the program. DESIGN: Retrospective data analysis using billing data submitted between July 1, 2001, and October 31, 2004, with a pre-post design in which subjects served as their own controls. SETTING: Manufacturing workplace in rural Iowa. PARTICIPANTS: Fifty-six workers with risk factors for cardiovascular disease (mean age 40.67 yrs), 37 had diabetes mellitus and 19 did not. INTERVENTION: During visits to the workers, pharmacists provided education about cardiovascular disease, identification of drug therapy problems, and importance of routine blood pressure, pulse, and weight measurements; they communicated with participants' physicians as needed. MEASUREMENTS AND MAIN RESULTS: The number of pharmacist visits/participant ranged from 1-13 (mean +/- SD 6.97 +/- 3.05). Outcome measures were weight, systolic and diastolic blood pressures, full lipid profiles (in patients with diabetes), and percentage of patients achieving treatment goal by the end of the 3 years. Statistically significant differences between the first and last visits were achieved for both systolic (124.12 +/- 11.07 and 120.36 +/- 14.39 mm Hg, respectively, p=0.016) and diastolic (80.4 +/- 9.01 and 77.43 +/- 9.14 mm Hg, respectively, p=0.019) blood pressure. The 19 patients without diabetes showed a statistically significant improvement in diastolic blood pressure (p=0.039), but the 37 patients with diabetes did not show a significant difference. A nonsignificant increase was seen in the percentage of patients with diabetes achieving low-density lipoprotein cholesterol (LDL) level goal between the first and last visits (p=0.06). CONCLUSION: A cardiovascular case-management program delivered in the workplace to middle-aged working adults by community pharmacists improved blood pressure and reduced LDL levels. The program was not effective, however, in weight reduction.

Financial analysis of cardiovascular wellness program provided to self-insured company from pharmaceutical care provider's perspective.

OBJECTIVES: To perform a retrospective financial analysis on the implementation of a self-insured company's wellness program from the pharmaceutical care provider's perspective and conduct sensitivity analyses to estimate costs versus revenues for pharmacies without resident pharmacists, program implementation for a second employer, the second year of the program, and a range of pharmacist wages. DESIGN: Cost-benefit and sensitivity analyses. SETTING: Self-insured employer with headquarters in Canton, N.C. PATIENTS: 36 employees at facility in Clinton, Iowa. INTERVENTIONS: Pharmacist-provided cardiovascular wellness program. MAIN OUTCOME MEASURES: Costs and revenues collected from pharmacy records, including pharmacy purchasing records, billing records, and pharmacists' time estimates. METHODS: All costs and revenues were calculated for the development and first year of the intervention program. Costs included initial and follow-up screening supplies, office supplies, screening/group presentation time, service provision time, documentation/preparation time, travel expenses, claims submission time, and administrative fees. Revenues included initial screening revenues, follow-up screening revenues, group session revenues, and Heart Smart program revenues. RESULTS: For the development and first year of Heart Smart, net benefit to the pharmacy (revenues minus costs) amounted to dollars 2,413. All sensitivity analyses showed a net benefit. For pharmacies without a resident pharmacist, the net benefit was dollars 106; for Heart Smart in a second employer, the net benefit was dollars 6,024; for the second year, the projected net benefit was dollars 6,844; factoring in a lower pharmacist salary, the net benefit was dollars 2,905; and for a higher pharmacist salary, the net benefit was dollars 1,265. CONCLUSION: For the development and first year of Heart Smart, the revenues of the wellness program in a self-insured company outweighed the costs.