How to beat CVS Metrics?!

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RDL042

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I've read several threads on tips and tricks on navigating the system and using that as leverage to make workflow easier. The system has updated from some of the original posts so thought I'd retouch the topic.

I wanted to create this thread to compile specific ways to beat CVS Metrics! Prescriber Calls, NSPU calls, MCP, etc.

I have devoted so much time to tackle prescriber calls just to yield 25% on the success on the week's WeCare. I make the calls and generate from the request as well but never correlates to the score. I gave up until I find some Intel.


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I've read several threads on tips and tricks on navigating the system and using that as leverage to make workflow easier. The system has updated from some of the original posts so thought I'd retouch the topic.

I wanted to create this thread to compile specific ways to beat CVS Metrics! Prescriber Calls, NSPU calls, MCP, etc.

I have devoted so much time to tackle prescriber calls just to yield 25% on the success on the week's WeCare. I make the calls and generate from the request as well but never correlates to the score. I gave up until I find some Intel.


Sent from my iPhone using SDN mobile

I'm by no means an expert but for WeCare the key is QT time and ready when promised. The two are obviously highly correlated and together are worth 60% of the score. At the end of the day you need good techs and workflow to maximize this score... but the number one most important thing the pharmacist can do, in my opinion, to improve this score is work as back-up for QT. When the pharmacist is watching QT constantly not only does QT time improve, but ready when promised goes up and the whole day just goes a lot better. Usually in the morning the pharmacist will print and pull a nice stack for production... once tech #3 shows up they print and pull in between customers and the pharmacist for the most part doesn't pull anymore and keeps a very close eye on QT. Ideally production rarely has to stop counting to print and pull and QT never exceeds a few lines.

Properly set waiter expectations is worth 10% of the score and is pretty much a free 10 points, just make sure no waiter is entered with a promised time of over 15 minutes and you get almost all of the points (the script must also obviously be verified in time). Apparently even if you put W15 and verify it on time you could STILL get no credit if the pick-up time isn't "close to verification time" and if the pick up time is significantly later the script isn't even counted towards this metric. I'm guessing if they pick it up an hour later you lose points, whereas if they pick it up the next day you don't lose points but you also don't get points (just counted as a normal script). Kind of beyond your control but the bottom line if don't put anything in as a waiter for more than 15 minutes, and don't put anything as a waiter if you know the customer won't be back for an hour because even if you do W15 and verify it on time it could count against you if they pick it up in, say, an hour. I guess the purpose of this rule is so that the metric isn't exploited by putting scripts in as waiters that aren't.

Action note follow through is worth 15 points. Obviously you just have to make these calls, but there are a few tricks I use to improve this score. Firstly, when an OTC isn't covered it's stupid to call the patient, so you can either put in a discount card to eliminate the prompt for a call or choose "chose not to call" which removes the opportunity from the denominator. Selecting "choose not to call" will remove the call from your score but they do track how many times you select this option so I wouldn't go much past 10%. It states that is is acceptable to select "choose not to call" for readyfill out of stocks and for scripts that are regularly filled as cash. Secondly getting as many people as possible enrolled in texting is very helpful because you can just press "T" can get credit for the call, and also save yourself a minute or two by not having to make the call. For people that need updated insurance you can try to call them when it prompts you, and if the line is busy/invalid phone number/voicemail full I just press escape, run it through a discount card, and put an action note on the bag.

Voicemail is 5 points... you just have to retrieve them in under 15 minutes. I've heard of people just playing the voicemail and replaying it later to actually get the script just to get the points... I'd not make this a regular thing because it just wastes more time.

The last one is prescriber follow up worth 10 points with in my opinion is a pain in the ass. From my understanding the metric is only measuring whether or not you make the call to the prescriber's phone number that is on record for the script. Multiple scripts/patients for a single prescriber only requires one phone call, so I would priortize these because you are essentially getting more points per call. Even with a score of 25% you might still be pulling in ~5 of the 10 possible points, so I personally wouldn't be wasting an hour of my day for this if you have room to improve on QT time which will have the trickle down effect of also increasing ready when promised. I'm thinking maybe if you delete some of the refill requests out of the QR before they drop into the QV you might be able to lower to total number of calls, effectively increasing the value of the calls that you make by lowering the denominator. I'm honestly not sure if deleting them before they go red will remove them from the metric or count against it though. In the big picture though this metric offers the least value in terms of the effort it requires compared to the points it's worth so I wouldn't get too hung up on it. For example, if your ready when promised target is 90 and you get 80, you are losing over 10 points in WeCare (probably 12-13). You have to verify the script whether it is red or not, so you are really shooting yourself in the foot here, especially if it's because you are chasing 5 points for prescriber calls.
 
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Thanks Idiot

I definitely leverage QT in the morning to where two technicians are producing in the AM while I am watching QT. The overall WeCare score has never been a problem. We are a 83 avg. store but just the fact that a 10 point metric which takes up more valuable time than anything is not achieved the most frustrating. I'm extremely content with never reach the full 10/10 on prescriber outreach but I just want to know what others are doing to leverage it to their favor.

Any insight on NSPU calls? I've learned to get our team coached up on generating a new rx from a previous one if they have already taken the medciTion before. Any other thoughts besides making the call and hoping they pick up the med?


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Thanks Idiot

I definitely leverage QT in the morning to where two technicians are producing in the AM while I am watching QT. The overall WeCare score has never been a problem. We are a 83 avg. store but just the fact that a 10 point metric which takes up more valuable time than anything is not achieved the most frustrating. I'm extremely content with never reach the full 10/10 on prescriber outreach but I just want to know what others are doing to leverage it to their favor.

Any insight on NSPU calls? I've learned to get our team coached up on generating a new rx from a previous one if they have already taken the medciTion before. Any other thoughts besides making the call and hoping they pick up the med?


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There's not much else you can do. We just make the calls and hope for the best. I've heard of people manually returning them ahead of time but again in my opinion this just isn't worth the time. For myPatientCareOutcomes the main thing is adherence outreach. It's not only worth the most points but it's something that middle management is really pressured on (from what I can tell) because of the deal with Caremark. Definitely make sure you knock out PCQ.

With prescriber like I said before I'm pretty sure the system is only looking for an outbound call to the number connected to the script. It's not actually measuring if you get the script or if they pick it up. Some have speculated that the call must last for at least 30 seconds (for ANFT as well) but I'm not sure if this is true. But regardless if you call and they are out to lunch/you get voicemail/wrong doctor or location is on file I'm pretty sure you get credit so just drop the script into the QT and let the tech tell the patient to reach out to the doctor. I've also read on old thread on people calling all of the number while putting the phone on speaker and muting the volume, lol. I'm pretty sure crap like this can get you fired and I can't imagine the offices wouldn't notice this trend after a few weeks.

I might have to test the 30 second thing for myself. Whether it's true or not I know the call doesn't register until either someone picks up or the voicemail recording starts so you can't just let it ring twice and hang up.
 
for NSPU i think if you pull them from the bins and do RTS on those, it will remove them from the call list.
 
I'm by no means an expert but for WeCare the key is QT time and ready when promised. The two are obviously highly correlated and together are worth 60% of the score. At the end of the day you need good techs and workflow to maximize this score... but the number one most important thing the pharmacist can do, in my opinion, to improve this score is work as back-up for QT. When the pharmacist is watching QT constantly not only does QT time improve, but ready when promised goes up and the whole day just goes a lot better. Usually in the morning the pharmacist will print and pull a nice stack for production... once tech #3 shows up they print and pull in between customers and the pharmacist for the most part doesn't pull anymore and keeps a very close eye on QT. Ideally production rarely has to stop counting to print and pull and QT never exceeds a few lines.

Properly set waiter expectations is worth 10% of the score and is pretty much a free 10 points, just make sure no waiter is entered with a promised time of over 15 minutes and you get almost all of the points (the script must also obviously be verified in time). Apparently even if you put W15 and verify it on time you could STILL get no credit if the pick-up time isn't "close to verification time" and if the pick up time is significantly later the script isn't even counted towards this metric. I'm guessing if they pick it up an hour later you lose points, whereas if they pick it up the next day you don't lose points but you also don't get points (just counted as a normal script). Kind of beyond your control but the bottom line if don't put anything in as a waiter for more than 15 minutes, and don't put anything as a waiter if you know the customer won't be back for an hour because even if you do W15 and verify it on time it could count against you if they pick it up in, say, an hour. I guess the purpose of this rule is so that the metric isn't exploited by putting scripts in as waiters that aren't.

Action note follow through is worth 15 points. Obviously you just have to make these calls, but there are a few tricks I use to improve this score. Firstly, when an OTC isn't covered it's stupid to call the patient, so you can either put in a discount card to eliminate the prompt for a call or choose "chose not to call" which removes the opportunity from the denominator. Selecting "choose not to call" will remove the call from your score but they do track how many times you select this option so I wouldn't go much past 10%. It states that is is acceptable to select "choose not to call" for readyfill out of stocks and for scripts that are regularly filled as cash. Secondly getting as many people as possible enrolled in texting is very helpful because you can just press "T" can get credit for the call, and also save yourself a minute or two by not having to make the call. For people that need updated insurance you can try to call them when it prompts you, and if the line is busy/invalid phone number/voicemail full I just press escape, run it through a discount card, and put an action note on the bag.

Voicemail is 5 points... you just have to retrieve them in under 15 minutes. I've heard of people just playing the voicemail and replaying it later to actually get the script just to get the points... I'd not make this a regular thing because it just wastes more time.

The last one is prescriber follow up worth 10 points with in my opinion is a pain in the ass. From my understanding the metric is only measuring whether or not you make the call to the prescriber's phone number that is on record for the script. Multiple scripts/patients for a single prescriber only requires one phone call, so I would priortize these because you are essentially getting more points per call. Even with a score of 25% you might still be pulling in ~5 of the 10 possible points, so I personally wouldn't be wasting an hour of my day for this if you have room to improve on QT time which will have the trickle down effect of also increasing ready when promised. I'm thinking maybe if you delete some of the refill requests out of the QR before they drop into the QV you might be able to lower to total number of calls, effectively increasing the value of the calls that you make by lowering the denominator. I'm honestly not sure if deleting them before they go red will remove them from the metric or count against it though. In the big picture though this metric offers the least value in terms of the effort it requires compared to the points it's worth so I wouldn't get too hung up on it. For example, if your ready when promised target is 90 and you get 80, you are losing over 10 points in WeCare (probably 12-13). You have to verify the script whether it is red or not, so you are really shooting yourself in the foot here, especially if it's because you are chasing 5 points for prescriber calls.

That is a very good post. Can you be my partner?
I wish i could say it better. You put in writing what i have been telling my pic for so long.
 
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As idiot pointed out, to improve wecare focus on these metrics;
1) verify on time
2) qt
3) voice mail very easy to get
4) action note very easy to get
 
My store has gotten 100 in Wecare multiple times. Once your staff is aligned and knows what to do daily/weekly the only real challenge is RWP at 88% target.

1. 30 points for QT, target is 95% for full points. QT should almost never be red. If multiple queues are red, the first thing to do is QD and type all the scripts that needs to be typed, then back to QT to handle the rejects as they take more time. There's no point in spending even 30 seconds on an insurance reject when you can type 3 E-rx's in that time before they go red. .

2. 10 points for Properly Set Waiters Expectations, target is 90% of the time. All staff should be utilizing W for waiters at all times. That's a guarantee for 100%. I can't vouch for W15 because we let the system decide on the wait time based on the queue.

3. 10 points for MD Request calls, target is 45%. The bulk of it drops in on Weds AM around 9am. Target is 45%, but if you miss the bulk of it on Weds, game is over. Make sure you attempt to call each and every one of them that drops into QV. My store reached 65% at the highest when all RPh's do these calls as soon as it's in QV. It surprises me how often MD offices do not get our faxes even though it's sent through electronically or faxed successfully, and only through these follow-up calls do we get a response.

4. 15 points Action Note: target is 50%. Call on all OOS, except for readyfills. Call if there's insurance expired, PA's required, not covered or a high out of pocket med. Basically call on things that will save a patient a trip to the pharmacy in which they won't get or WANT to get their meds when they're there.

5. 5 points of MD voicemail retrieval <15 mins, target is 85%. I tell my staff to get it at the 10 min mark. Most of these are acute meds that eventually gets expedited, so just check them and get it ready before the patient comes to the register and gets told to come back after expediting it. During rush hours though, maybe once a week, I will dial and let it play until the vmail indicator on the QV screen disappears (~15 seconds in), then save it and come back to it later. Downside is that you might forget about it and no one really checks a saved voicemail, and then you get the complaints "I was right there when my MD called it in".

1. My store is normally at 96% for triage with usually nothing more than 5 at the 0-15 mins window and never more than 1 red before a second person taps in.
2.RWP is the hardest to reach target. The highest we've reached is 89% of 88% target. If you print out the RWP report from M1, the store % is actually ~10% higher than actual RWP. So you may see RWP on the report being 95% when in reality it's only 85%.
3. MD Request calls, sometimes we're at 65%, other times 35%. But it's YTD that counts.
4. Action Note: easiest metric as long as you call people as mentioned above.
5. Retrieves voicemails at 100% for most weeks. You can change the voicemail setting to ring-back so it reminds you when there's a vmail. It's easier to see voicemails in QV when you'r caught up with the queue also if you're not looking for the blinking light.

With that said, WeCare at 100 is very doable as long as our staff is aligned with the same behaviors week in and week out.
 
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My store has gotten 100 in Wecare multiple times. Once your staff is aligned and knows what to do daily/weekly the only real challenge is RWP at 88% target.

1. 30 points for QT, target is 95% for full points. QT should almost never be red. If multiple queues are red, the first thing to do is QD and type all the scripts that needs to be typed, then back to QT to handle the rejects as they take more time. There's no point in spending even 30 seconds on an insurance reject when you can type 3 E-rx's in that time before they go red. .

2. 10 points for Properly Set Waiters Expectations, target is 90% of the time. All staff should be utilizing W for waiters at all times. That's a guarantee for 100%. I can't vouch for W15 because we let the system decide on the wait time based on the queue.

3. 10 points for MD Request calls, target is 45%. The bulk of it drops in on Weds AM around 9am. Target is 45%, but if you miss the bulk of it on Weds, game is over. Make sure you attempt to call each and every one of them that drops into QV. My store reached 65% at the highest when all RPh's do these calls as soon as it's in QV. It surprises me how often MD offices do not get our faxes even though it's sent through electronically or faxed successfully, and only through these follow-up calls do we get a response.

4. 15 points Action Note: target is 50%. Call on all OOS, except for readyfills. Call if there's insurance expired, PA's required, not covered or a high out of pocket med. Basically call on things that will save a patient a trip to the pharmacy in which they won't get or WANT to get their meds when they're there.

5. 5 points of MD voicemail retrieval <15 mins, target is 85%. I tell my staff to get it at the 10 min mark. Most of these are acute meds that eventually gets expedited, so just check them and get it ready before the patient comes to the register and gets told to come back after expediting it. During rush hours though, maybe once a week, I will dial and let it play until the vmail indicator on the QV screen disappears (~15 seconds in), then save it and come back to it later. Downside is that you might forget about it and no one really checks a saved voicemail, and then you get the complaints "I was right there when my MD called it in".

1. My store is normally at 96% for triage with usually nothing more than 5 at the 0-15 mins window and never more than 1 red before a second person taps in.
2.RWP is the hardest to reach target. The highest we've reached is 89% of 88% target. If you print out the RWP report from M1, the store % is actually ~10% higher than actual RWP. So you may see RWP on the report being 95% when in reality it's only 85%.
3. MD Request calls, sometimes we're at 65%, other times 35%. But it's YTD that counts.
4. Action Note: easiest metric as long as you call people as mentioned above.
5. Retrieves voicemails at 100% for most weeks. You can change the voicemail setting to ring-back so it reminds you when there's a vmail. It's easier to see voicemails in QV when you'r caught up with the queue also if you're not looking for the blinking light.

With that said, WeCare at 100 is very doable as long as our staff is aligned with the same behaviors week in and week out.

Is it true that RWP calculates based on origional promised time for OOS and/or scripts that you edit the promised time (e.g. customer says 1 hour then says actually he will get it tomorrow after you just processed it?) If this is in fact true could you get around it by putting the script on hold and then reprocess it (or just go by the time you entered obviously) or for OOS's put it on hold and then put it directly into QT when you reprocess?
 
Is it true that RWP calculates based on origional promised time for OOS and/or scripts that you edit the promised time (e.g. customer says 1 hour then says actually he will get it tomorrow after you just processed it?) If this is in fact true could you get around it by putting the script on hold and then reprocess it (or just go by the time you entered obviously) or for OOS's put it on hold and then put it directly into QT when you reprocess?

Partly true. If someone comes in and you out them for a waiter and then they say they will be back in an hour, if you had processed the script it will hold the original time. If they didn't, everyone would just chnage the time and there would be no red rxs. If your doctor sends an e-script and you process it for 2PM and it rejects as too soon and you put it on hold for next Tuesday at 10AM, the promised time and the Wecare time will be 10AM next Tuesday.
 
I've read several threads on tips and tricks on navigating the system and using that as leverage to make workflow easier. The system has updated from some of the original posts so thought I'd retouch the topic.

I wanted to create this thread to compile specific ways to beat CVS Metrics! Prescriber Calls, NSPU calls, MCP, etc.

I have devoted so much time to tackle prescriber calls just to yield 25% on the success on the week's WeCare. I make the calls and generate from the request as well but never correlates to the score. I gave up until I find some Intel.


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Beat? You mean "cheat" the metrics, right?
 
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How do you do PCQ calls? Target is 29% of those adherence calls come to pick up the scripts, not just saying yes and never come to get it. I have trouble reaching that number because most people will say they use mail order now or they want to call in their refills. We make 3 attempts every week, but only get around 25%.

Also, on adherence call with no refill, do we get point when we send the refill request to the doctor, or when dr approve and patient has to come pick up that new refill?
 
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How do you do PCQ calls? Target is 29% of those adherence calls come to pick up the scripts, not just saying yes and never come to get it. I have trouble reaching that number because most people will say they use mail order now or they want to call in their refills. We make 3 attempts every week, but only get around 25%.

Also, on adherence call with no refill, do we get point when we send the refill request to the doctor, or when dr approve and patient has to come pick up that new refill?

You get points when they pick it up.....

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How do you do PCQ calls? Target is 29% of those adherence calls come to pick up the scripts, not just saying yes and never come to get it. I have trouble reaching that number because most people will say they use mail order now or they want to call in their refills. We make 3 attempts every week, but only get around 25%.

Also, on adherence call with no refill, do we get point when we send the refill request to the doctor, or when dr approve and patient has to come pick up that new refill?

Inactivate mail order and no refill scripts.


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How do you do PCQ calls? Target is 29% of those adherence calls come to pick up the scripts, not just saying yes and never come to get it. I have trouble reaching that number because most people will say they use mail order now or they want to call in their refills. We make 3 attempts every week, but only get around 25%.

Also, on adherence call with no refill, do we get point when we send the refill request to the doctor, or when dr approve and patient has to come pick up that new refill?

25% is good I wouldn't sweat it
 
So there are points for phone calls to docs? This may explain the number of calls i get that i never answer
 
So there are points for phone calls to docs? This may explain the number of calls i get that i never answer

You do want us to reach out to you for refills right? Although I know most psychiatrists do not do refills over phone/fax and will respond accordingly with their front desk or voicemails.
 
I only give prescription at appt only. I tell all the pharmacies this. I have asked for my fax and phone to be taken off numerous times
 
I only give prescription at appt only. I tell all the pharmacies this. I have asked for my fax and phone to be taken off numerous times

Man, that's awesome. You're patients must love that you care about them as a healthcare provider. Although we get graded on a metric, it doesn't negate the fact that we still attempt to keep a patient on maintenance therapy. Love you job or retire. You're a cool guy.


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Man, that's awesome. You're patients must love that you care about them as a healthcare provider. Although we get graded on a metric, it doesn't negate the fact that we still attempt to keep a patient on maintenance therapy. Love you job or retire. You're a cool guy.


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Not sure why u are being sarcastic. I follow up closely with patients. If I see them further out, I give them enough meds to get to the follow up.

I adjust meds, don't keep them on them forever.
 
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You are a role model as an sdn administrator on here but you didn't even wait to hear about the way I care for my patients before posting this snarky comment.

You are truly too kind. If I were really a role model administrator I probably wouldn't let people who are not pharmacists troll the pharmacy forums. But what can I say, sometimes it is entertaining.
 
You are a role model as an sdn administrator on here but you didn't even wait to hear about the way I care for my patients before posting this snarky comment.

Grover,

If you don't like our methods and pharmacy outreach methods, good luck keeping your patients happy. Since you must be a very respected individual who takes great care of your patients. It just so happens that the medicines that they need get dropped off at their doorstep by a stork...


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How do I get from calling or faxing me? They won't stop.
Same thing I tell everyone. Call 1-800-SHOP-CVS. They may or may not help you. Who knows. If it's anything like the corporate pharmacy help desk, I would anticipate several very fruitless calls and then just giving up eventually while accepting that this is your life now.
 
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I'm not trying to troll. I learn a lot about your field on here. I thought sdn does allow posting across fields. I see it all the time on here. We have patients posting in the psychiatry forum.

I explained how I give my patients their meds. They don't need to bother the pharmacy as I try to minimize the extra work you guys may need to do for other doctors and patients. There's no stork. Just no reason for extra work on your guys part. What a waste of time and resources. I'm sorry as pharmacists you have to waste all this extra time on metrics. I think with your educations, you have much better training than jumping these hoops.

Good luck keeping my patients happy? How does that make any sense?
You see me today. I am seeing you 2 months later. I give you 2 months of your medicine. Why does the pharmacy need to call me for a refill?
 
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I've read several threads on tips and tricks on navigating the system and using that as leverage to make workflow easier. The system has updated from some of the original posts so thought I'd retouch the topic.

I wanted to create this thread to compile specific ways to beat CVS Metrics! Prescriber Calls, NSPU calls, MCP, etc.

I have devoted so much time to tackle prescriber calls just to yield 25% on the success on the week's WeCare. I make the calls and generate from the request as well but never correlates to the score. I gave up until I find some Intel.


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Your post is about beating the metrics...
 
question from CVS/Target pharm here....this weekend we had PCQ call in QV for 3 pts for "new" meds...except each pt had been taking the med for over a year and a half and were signed up to receive texts. No need for me to call. I made notes, but couldn't delete. This is new for us. Advice from CVS pharms? thx
 
question from CVS/Target pharm here....this weekend we had PCQ call in QV for 3 pts for "new" meds...except each pt had been taking the med for over a year and a half and were signed up to receive texts. No need for me to call. I made notes, but couldn't delete. This is new for us. Advice from CVS pharms? thx

As long as you attempt to make a call and ensure that the patient picks up the medicine, you'll receive credit.

The best way to avoid this in the future is to align your technician team to generate the prescription from the same medicine that's on their profile, this will then be considered continuation of therapy and will not prompt a NSPU call.


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question from CVS/Target pharm here....this weekend we had PCQ call in QV for 3 pts for "new" meds...except each pt had been taking the med for over a year and a half and were signed up to receive texts. No need for me to call. I made notes, but couldn't delete. This is new for us. Advice from CVS pharms? thx

The first thing you are doing wrong is viewing it like the calls have a logical purpose. Welcome to the world of performing useless tasks to beat metrics, as the title indicates.


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Leave Grover alone, he trolls because he cares. Although I secretly suspect he is doing some kind of psych case study on us.


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