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Your community pharmacy is in a unique position. Patients interact with you more than they do with any other healthcare setting. That puts you at an advantage when it comes to identifying and closing gaps in patient care—gaps that can lead to poor health outcomes and higher costs.

Let’s talk about gaps in care, how you can spot them and what you can do to close them. Finally, we’ll discuss how closing gaps in care can help both you and your patients.

Gaps in care and where they come from

In the broadest sense, a gap in care is a discrepancy between the medications your patients are currently taking and the ones they should be taking based on guidelines for their conditions or health goals. Some examples are:

  • A patient with a chronic illness who’s not on any medication for the condition
  • A patient with a chronic illness who’s on one medication but not on a second drug recommended for that condition
  • A patient with a chronic illness who’s on the right drugs for that condition but not on other drugs to prevent other related conditions from occurring
  • A patient who is taking a drug or a mix of drugs that may be harmful
  • A patient who should be, but is not, getting vaccines to prevent illnesses

The reasons why these gaps in care happen are as numerous as the types of gaps themselves.

For example, patients may know about the right drugs they should be taking for their situation. But even if they do know, they may not be taking them for any number of reasons. There could be a lack of motivation. They could have health literacy issues. There could be other barriers to access or adherence, like transportation to the pharmacy or the cost of a drug.

Prescribers can also be responsible for gaps in care. They may see a patient too infrequently to diagnose a new illness and prescribe a drug. They might miss a chronic condition when treating an acute condition that needs immediate attention. Or they may not be aware of drugs prescribed to the patient by other providers.

Your community pharmacy, too, can contribute to gaps in care. If you focus exclusively on filling the prescription in front of you and don’t look at your patient holistically, you could miss something important.

Ways your pharmacy can identify gaps in care

Now that you know what gaps in care are and why they occur, your challenge is to spot and stop them. As I mentioned earlier, your community pharmacy is in perhaps the best position of any care setting to do that, because you have the most contact with your patients.

To spot gaps in care, you need to take a systematic, team-based and multi-pronged approach to uncover problems with individual patients, because not all patients present the same way. That approach should have at least four ways to catch gaps in care:

  • Technology. Use the tools in your pharmacy management system to identify potential gaps in care. You can use programmed alerts to flag a patient who is on one drug but who may need another. Another solution you might consider is the patient outlier report from your Electronic Quality Improvement Platform for Plans & Pharmacies, or EQuIPP, system. EQuIPP tracks medication use and adherence rates of the patients you care for under your payer contracts with performance or quality metric requirements. The report flags patients whose drug use and adherence rates don’t meet the targets set by the payer.
  • Clinical programs. Clinical programs are fertile ground to spot gaps in care. One example is medication therapy management (MTM), where you counsel patients on their medications and help identify any concerns or questions. Your medication synchronization program is another great example. This allows you to see which drugs are missing when patients pick up their scripts each month.
  • Prescription fills. Every interaction with a patient is an opportunity to spot a gap in care. Most interactions happen when a patient picks up a prescription. It’s at that point when your staff should routinely ask patients about their medication use, changes in their health status, new drugs they may be taking, drugs they may have stopped taking, or changes in their drug benefits and in their prescribers. Your staff’s interactions with your patients should be standardized and consistent.
  • Prescriber partnerships. Your community pharmacy should form partnerships with prescribers that go beyond prescribing and dispensing pills. You need to have ongoing, two-way communication with your prescribers to discuss whether patients filled their prescriptions, are adherent to their drugs, are responding to their drug regimens, have experienced a change in health status, or were diagnosed with a new illness. All of this information can help you identify a potential gap in care.

Spotting gaps in care is a team sport that your pharmacy should be playing year-round.

How your pharmacy can close gaps in care

After setting up your system to spot gaps in care, it’s now time to close them and get your patients on the road to better health. So how does your community pharmacy do that? Your tactics should target the issues that cause the gaps in the first place. For example:

  • Patient education. Patient awareness of chronic illnesses and the drugs available for them can be highly variable. They don’t know what they don’t know. So you can help identify and close any patient-specific knowledge gaps. This can range from the simple like brochures and handouts to the more sophisticated like classes, depending on the level of interest from your patients.
  • Patient counseling. A step up from general patient education is one-on-one counseling with patients. You can use these sessions to discuss the benefits of being on certain drugs for their illnesses and then offer to contact their doctors for their recommendations.
  • Patient coaching. Whether during general patient education, individual counseling or other interactions, you can use motivational interviewing to identify a patient’s specific barriers to adherence or gaps in care. Then you can coach the patient and help remove whatever barriers are standing in their way. If it’s transportation, you can set up home delivery. If it’s cost, you can offer to switch them to a lower-cost alternative in consultation with their physician. You also could inform them about patient assistance programs that may be available for their drug.
  • Prescriber education. A lot of doctors don’t know that they can work directly with pharmacies to identify gaps in care and work together to fill them. You should reach out to your prescribers and let them know that you can team up on this issue.

Your strategy for each of the four tactics above should be a collaboration between you, the prescriber and the patient. That’s when your efforts to close gaps in care will be most effective.

Business benefits for your pharmacy

Closing gaps in care can help your community pharmacy from a revenue standpoint in three ways:

  • Lower DIR fees. Closing gaps in care correlates to the performance measures in your Medicare Part D and select commercial payer contracts. By meeting those targets, you can lower your direct and indirect remuneration (DIR) fees and retain more of your drug payments.
  • Bonus payments. By exceeding those performance targets in your payer contracts, you may also earn bonuses on top of your drug payments.
  • Service payments. Many of the tactics you can use to spot and close gaps in care like MTM are billable services that can generate additional revenue for your pharmacy.

When you add those three things up, it can have a meaningful impact on your pharmacy’s revenue overall, depending on the size of your pharmacy. When you consider how reimbursement pressure is squeezing your margins, that money can make a huge difference.

Closing gaps in care is a great example of how doing the right thing for your patients can also translate into better business for your pharmacy.

Related: Learn more about McKesson’s patient adherence and wellness services for pharmacies

Crystal Lennartz

About the author

Crystal Lennartz is the VP of Pharmacy Performance at AccessHealth. She leads the team responsible for managing a high-performing pharmacy network across independent and small to medium chain pharmacy segments. She has both a Doctor of Pharmacy and Master of Business Administration from Drake University, after which she completed an APhA-ASHP Accredited Residency in Pharmacy Practice with an emphasis in community care.

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