June 10, 2015
The appointment-based model of medication synchronization (ABM) is a pharmacy service that’s here to stay.
“This is an emerging methodology that allows pharmacists to take control of something that easily spirals out of control—patients’ ability to manage their own medications,” said Samuel Stolpe, Pharm.D., senior director of quality strategies at Pharmacy Quality Alliance.
ABM helps patients stay adherent to their medications by synchronizing their refills to a single day each month. The method also includes reaching out to patients regularly with pre-appointment phone calls.
Once implemented, ABM has the potential to improve much more than just medication adherence. It can transform your entire pharmacy.
“It’s a paradigm shift,” Stolpe said. “You’re changing the way you do business and the way you interact with your patients.”
“Once a pharmacy has around 50-80 patients enrolled and gets used to synchronizing patients and making monthly outbound connections with each enrolled patient, that pharmacy starts seeing substantial increases in workflow efficiency, inventory turns, patient satisfaction and pharmacist satisfaction,” he said.
Medication adherence is a huge problem in health care today. Seventy-five percent of people don’t take their medicine as directed, one-third of patients never fill their prescriptions, and 125,000 people die each year because of non-adherence.
ABM is a highly effective method for improving patient adherence and, correspondingly, overall health outcomes.
This is largely due to the pre-appointment phone call—the key feature of ABM—according to Stolpe. The pre-appointment call ensures regular interaction between patients and pharmacists, and that the pharmacist is tuned in to the patient’s treatment.
“The connection point with the patient keeps them in sync and engaged with their own health care; it helps the pharmacist and the patient work together to manage medications in a more meaningful way,” Stolpe said.
The benefits of ABM for patients are almost universal. “Any patient who’s on two or more oral chronic medications is usually a terrific fit for the program,” Stolpe said. “This constitutes the vast majority of patients who are in most pharmacies’ normal panel of patients.”
It might not seem like many patients are excited about this service, but Stolpe says this is due to lack of awareness. “Most patients value the service intrinsically, but they simply don’t know that it exists,” Stolpe said. “You need to spread the word. Explain the benefits of the program and get them enrolled.”
Stolpe suggests handing out brochures that explain the program in simplified language as an easy way to get patients to sign up. Pharmacists should also actively find opportunities to explain the service to patients during normal interactions.
“You’ll find that patients migrate to this forward way of thinking very quickly because it just makes sense with how both patients and pharmacies prefer to have care delivered.”
For pharmacists, ABM allows you to take control of your time in the pharmacy. With this model of medication synchronization in place, you’re less subject to the whims of patients who walk into your store, and you’re able to schedule more of your workday without worrying about frequent interruptions.
“Any interruption to workflow that occurs significantly increases the chance that pharmacists make mistakes,” Stolpe said. “ABM leads to efficiencies in care delivery that help reduce these errors tremendously.”
ABM takes much of the guesswork out of operations. You’ll know exactly when you need a patient’s medication in stock, and if needed, you can contact the physician in advance for additional refills or prior authorizations, instead of having to step away from your normal workflow to handle what Stolpe calls “pharmacy fires.”
“ABM allows you to resolve prescription problems during the natural lulls that occur within community pharmacy practice,” Stolpe said. “Pharmacists get to decide when they’re meeting those additional needs.”
“With ABM, you’re implementing an improvement in workflow,” he said. “It’s a no-brainer from my standpoint as a pharmacist.”
If implemented correctly, ABM can boost your pharmacy’s bottom line in more ways than one.
“Pharmacies can expect to see about three additional refills per patient per medication per year once they’re enrolled in the program. That’s a substantial sales increase for the pharmacy,” Stolpe said. “ABM is just good for business.”
A sales increase isn’t the only benefit you can expect. Being able to predict when certain medications need to be in stock means you’ll experience substantial increases in inventory turns, and it can help improve your pharmacy’s performance on CMS Star Rating quality measures.
“Improvements on Star Ratings position pharmacies to procure better contracts with health plans that are interested in having a high-performing network, and to perform better on most pay-for-performance programs’ quality measures,” Stolpe said. All of this is accomplished because ABM helps patients better adhere to their medications.
And, ABM gives pharmacists the opportunity to market additional services, such as flu vaccinations or medication therapy management. Scheduling these additional services during the pre-appointment call ensures that a pharmacist will be available to deliver the service on the appointment day, and that the patient has made time to receive it.
“This can enhance the patient’s experience and overall health, and change their entire perception of the pharmacy,” Stolpe said.
The potential for growth with this model of medication synchronization is high. Stolpe estimates that no more than 15 percent of independent community pharmacies currently have ABM in place, but he predicts this will soon change.
“I expect that this will become the standard of pharmacy practice within the next five to 10 years,” he said.
Independent pharmacies should consider implementing this model now to set their businesses apart.
“I suspect that nationwide we’ll see this be just a normal way of pharmacies doing business,” Stolpe said. “This is an opportunity for independent pharmacies to get an early leg up by making sure their patients have access to it faster than their competitors do.”
ABM may be the way of the future, but Stolpe points out that there are three things that need to happen before this model can be fully implemented into the health care system. Pharmacies need to adopt ABM, patients need to demand it, and health plans need to recognize its value and pay pharmacists for this service.
Stolpe is confident that the presence of ABM in pharmacies can only grow.
“People don’t leave this model once they get in because patients love it,” he said.
Samuel Stolpe, Pharm.D., of Pharmacy Quality Alliance explains how the appointment-based model of medication synchronization operates in a pharmacy.
1. Refill scheduling
The pharmacy aligns the patient’s medication refills to a single day
2. Patient interaction
Instead of waiting for patients to request refills, the pharmacist calls patients five to seven days before their refill pick-up day each month. This pre-appointment call serves to confirm the refill, identify any issues and offer additional services.
3. Pick-up day
The patient picks up the prescription on the appointment day and receives any additional services previously scheduled.
Samuel Stolpe, Pharm.D., is the senior director of quality strategies at the Pharmacy Quality Alliance (PQA). Stolpe is responsible for directing PQA’s research projects and educational initiatives. His most recent work includes an exploration of the effect of medication synchronization on adherence and pharmacist use of motivational interviewing techniques at the point of dispensing.