Six Ways to Create Pharmacy Efficiencies to Redeploy Staff for Value-Based Patient-Care Initiatives
By Dave Ehlert, Pharm.D., MBA, FASHP, Vice President, McKesson Health Systems
Patient-centered care delivery. It’s top of mind for clinicians and healthcare leaders alike all across the nation. Making the switch from reimbursement predicated on a fee-for-service model to value-based care is changing everything — including streamlining clinician workflow to help ensure they are positioned to focus on improving outcomes.
This focus on efficiency is progressively applying itself to pharmacy, as pharmacists continue to look for ways to maximize the time spent on patient-care initiatives. From medication therapy management (MTM) to discharge planning, the role of pharmacy has never been more critical. However, this poses a challenge to management of day-to-day pharmacy operations when, in many cases, adding staff is not possible due to cost-containment initiatives as a result of overly stretched budgets.
Evolving Management to Focus on Care
To deliver high-quality patient-centered care, hospital and pharmacy leaders need to ensure they are considering a long-term, sustainable strategy for pharmacy operations to support overall hospital initiatives and goals. Pharmacy staff needs to be involved in supporting critical strategic mandates such as reducing unnecessary readmissions and extending the continuum of care. Specific areas of focus for pharmacy include becoming part of the discharge-planning process, improving post-discharge medication adherence through MTM, and supporting expansion of ambulatory pharmacy.
- Pharmacists and technicians need to practice to the top of their license and/or certifications so they can provide the greatest possible value. Efficiency won’t be optimized if pharmacists perform tasks that could be done by technicians and if technicians do work that could be automated.
- Pharmacies need to adopt appropriate levels of automation so pharmacy staff can focus their limited time on the highest-priority clinical initiatives.
Best Practices to Improve Pharmacy Efficiency
Many hospital leaders have already engaged with outside partners to leverage proven tools and practices to help streamline pharmacy operations and redeploy staff. Here are six practices that can be implemented with minimal time, effort and expense.
1. Leveraging technologies to simplify drug spend management. Today, creating reports to analyze drug spend or track various pharmacy initiatives is often a manual, time-consuming process. One study found that the process of creating a report that would yield meaningful information to analyze drug spend took 3.9 hours on average. Since hospital pharmacies produce 11 reports per quarter on average, pharmacy staff may spend more than 40 hours per quarter compiling and rearranging the data to create reports that have meaningful information.
Automated drug spend management technology can produce these reports when needed, requiring minimal staff time or effort. Instead, pharmacy staff can redirect their time to analyzing the results and identifying opportunities for savings, rather than producing reports.
2. Using best practices to avoid reinventing the wheel. Pharmacy staff often spends significant amounts of time producing clinical initiatives, policies and procedures, and on other administrative tasks. For example, a thorough drug class review prepared for a hospital’s pharmacy and therapeutic committee may require creation of a complex document, which can take up to 200 hours.There is a better way. By having a robust, regularly updated repository of standardized documents — created and thoroughly reviewed by multiple, experienced pharmacists — pharmacy staff can modify preexisting documents instead of developing documents from scratch. Examples of standardized documents that can be accessed include drug class reviews and interchanges, medication guidelines, competencies, policies and procedures, and much more.
Analysis among hospital pharmacies that have used such document repositories has found that on average, nine documents per quarter are accessed, saving more than 550 hours per quarter.
3. Using analytics tools to optimize purchasing. As a result of the meaningful use requirements, most hospitals have adopted or are adopting bedside barcode scanning to scan medications at a patient’s bedside before they are administered. McKesson experts estimate that currently about 80% of oral solids are packaged in unit doses with barcodes; the other 20% are not and need to be repackaged.As a result of the growing use of barcode scanning technology, an immense amount of data is being produced about the drugs being purchased and used. Analyzing this data to derive valuable insights often does not occur, however, and when it does, it is extremely time consuming, taking months of a technician’s time. But sophisticated analytical tools now exist that can make recommendations, based on analysis of the data, to help a pharmacy optimize its oral solid purchasing practices. These automated purchasing recommendations are produced efficiently and can help a health system streamline its drug purchasing.
4. Using a perpetual inventory system in concert with automated systems. Hospitals often keep their pharmaceutical inventory in various physical locations and use different systems to track this inventory. When such systems are not linked, a result is inefficient ordering and receiving processes.Using a perpetual inventory system in conjunction with automation systems means that electronic orders are processed automatically, reducing the pharmacy’s time spent creating orders by up to 75%. Such systems can help reduce the time spent receiving and restocking by 50%, can help increase inventory turns by more than 40%, can lead to a 30% reduction in inventory costs, and can help a pharmacy maintain its formulary.
5. Optimizing processes related to 340B. Managing drug purchases related to the 340B program is extremely complex. Historically, aspects of patient eligibility, drug purchasing and inventory were done manually. In recent years, software tools have helped pharmacies manage 340B patient eligibility, drug eligibility and replenishment, but those tools often have not been integrated with a health system’s drug-purchasing system.Recently, a new 340B system has been introduced that integrates patient and drug eligibility for 340B with drug purchasing systems. Users of such systems can have greater visibility into a combination of their 340B accumulation data and availability of a supplier’s inventory at their wholesaler’s distribution center. One key benefit of this level of integration is that it can help a health system better manage its purchasing for items in short supply in the market. Additionally, integration can significantly streamline the purchase of items requiring special management such as controlled substances and drop-ship items.
6. Automating the NDC update process. Keeping national drug code (NDC) information up to date within pharmacy information systems can be difficult and time consuming. But failing to do so can result in having incorrect NDC data, which can adversely affect decision-making and billing. Also, incorrect NDC information can affect nursing workflow and patient safety.Solutions now exist to automate the NDC update process, so that the NDC data used throughout a health system is accurate and up to date. Use of such a solution to help ensure accurate NDCs can reduce or eliminate NDC-related pricing errors, help ensure that barcode scan rates are maximized, and improve overall workflow and efficiency.
The Ultimate Goal
Simply realizing efficiencies from these technologies and best practices is not the ultimate goal. The goal in creating greater efficiency is to allow pharmacists to spend more time on high-value-added activities, such as direct patient care and drug therapy management across the continuum of care. These efforts support the entire health system in adapting to and succeeding in a value-based environment.
 McKesson Pharmacy Optimization Independent Analysis, 2012
 Shack, J., Tulloch, S. (2008), Integrated pharmacy automation systems lead to increases in patient safety and significant reductions in medication inventory costs [Shore Memorial Hospital] (Case Study). Fairport, NY: Shack & Tulloch, Inc.