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A new survey shows that more than half of health system pharmacy leaders believe retailers and technology companies are having either a moderate or strong influence on their hospital's pharmacy strategy, according to research released today by the Center for Connected Medicine (CCM) at UPMC and KLAS Research.

Health systems are investing in new technologies for their ambulatory pharmacies, using vendors such as McKesson, Epic and others.听

Health system pharmacy leaders surveyed said their organizations are planning to invest over the next two years in new digital tools, with the top-cited solutions being integration with patient portals, in-app prescription fill and refill requests, adherence-reminder outreach systems and online or in-app payment technology, according to the "Ambulatory Pharmacies at Health Systems: Technologies and Strategies to Boost Consumer Engagement."

A top-mentioned reason organizations have invested in ambulatory pharmacies is enhanced patient access, the top challenge for health systems in 2021 and 2022, according to the CCM and KLAS research.

Patients' lack of access to technology and online portals hampers their ability to manage prescriptions and be informed about their medication status, the report said.听

Owning pharmacies helps health systems achieve greater patient engagement, retain patients and improve outcomes, quality of care and medication adherence.

Health systems can use their EHRs to clearly view what other medications their patients are being prescribed throughout the system. This reduces the risk of adverse drug events and medication discrepancies or errors.听

Enhanced continuity of care also helps with chronic disease management when these conditions require long-term medication therapy.

"The most important reason we offer pharmacy services is we want our patients to leave with their medications and not have to go looking for them. For specialty medications, patients don't have to wait for days or weeks before they get them, so their therapies can start sooner," said one chief pharmacy officer quoted in the report.

Respondents mentioned three main barriers to patients using ambulatory pharmacies: access, affordability and technology. The lack of physical accessibility is the top-mentioned barrier. This includes transportation issues, limited hours of pharmacy operation or inconvenient pharmacy locations.

"From the pharmacy, we don't see a lot of access barriers that are related to social determinants of health barriers until patients fall off their medications," said one senior director of pharmacy.

WHY THIS MATTERS

Improving revenue capture is another common reason for having an ambulatory pharmacy, although most organizations did not cite it as their primary goal, the report said. Owning a pharmacy can also benefit their 340B programs.

"There are cost benefits for both us and our patients. Having our own retail pharmacies definitely benefits us from a 340B program perspective, and we are able to provide better costs," said one CIO quoted in the report.

Competition from established retailers, such as Walmart and CVS, and technology giants like Amazon threaten to disrupt the patient and health system relationship by potentially offering more convenient and innovative services and digital tools, the report said.

This "retailization" of healthcare has been ongoing as companies scale up a fast-food model of convenience and accessibility.

But many respondents said pharmacy retailers and technology companies entering the pharmacy space exert only a moderate amount of influence on their strategy. Most respondents downplayed the role of competition, saying their health systems would have pursued owning ambulatory pharmacies regardless of encroachment from nontraditional healthcare players.

Health systems believe they can better serve their customers by being more readily accessible and offering service and support in a way that competitors can't, the report said.

"We aren't in the business of trying to chase high-volume competitors," said one chief pharmacy officer. "We are more customized to the level of quality that we are known for. If someone is spending $5,000 per month on some specialty medication, they want the necessary follow-up and expertise from a pharmacy who knows them as a patient. I don't want population health; I want individualized medicine because I think that is the direction we are going. I don't think those larger companies can provide a high level of service for the volume of work they do. They can't offer individualized medicine, and that is okay."

The two biggest challenges mentioned by pharmacy leaders are recruiting and retaining qualified staff and limitations around the government's 340B drug discount program.

THE LARGER TREND

The report focused on ambulatory pharmacies, which are any hospital- or health system-owned retail or walk-in-style patient pharmacy. It did not include inpatient pharmacy services.

All health systems whose leaders participated in this research report owning and operating at least one ambulatory pharmacy, with 4.5 as the median number of pharmacies owned and seven being the average. These numbers indicate organizations have significantly invested in expanding their pharmacy network.

To collect the data, the CCM partnered with KLAS Research to contact pharmacy leaders at U.S. hospitals and health systems that own and operate ambulatory pharmacies. KLAS interviewed 25 pharmacy executives, directors and managers by phone in August and September 2023.

ON THE RECORD

"At UPMC, we see tremendous value in delivering the highest level of quality, convenience and technology to our ambulatory pharmacy consumers. It is essential that health systems proactively engage patients in their care, and the pharmacy is one of the best places to have an impact," said Becky Taylor, Pharm.D., vice president of the pharmacy service line at UPMC, a founding partner of the CCM.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

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