What’s the Best Model for the Future of Pharmacy if CVS and Walgreens are Struggling?

[Asher88]

I’ve been closely following the challenges facing retail giants like CVS and Walgreens, and it’s becoming clear that the traditional retail pharmacy model is under significant pressure. Between the shift towards online shopping, increasing operational costs, and changes in consumer behavior, it seems like we’re at a pivotal moment for the profession.

I’m curious to hear from you all—what do you think is the best working model for pharmacies moving forward?

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[projektreverb]

I think any model moving forward is going to require us upskilling ourselves (more clinically focused) and less volume (less Pharmd graduates). Let’s face it, with retail gone the need for warm bodies will be drastically reduced…

 

[PrincessSnow]

All organizations are going to follow the money. The payers are moving away from Fee for Services and are paying for Value and Outcomes and patient satisfaction. Healthcare workers overall are going to work as a interdisciplinary team and follow a panel of patients for a set population payment with extra incentive payments for better outcomes. Healthcare workers are not going to provide more services, order more tests or fill more prescriptions to earn revenue. The models are going to be Accountable Care Organizations and Patient Centered Medical Homes. Pharmacist have the same billing codes as a registered nurse in these models. All healthcare workers jobs will likely change due to the new models and payment. Either this is a positive or a negative depending on your outlook. I think pharmacist salary will go down under the new models but who knows. I know that one pharmacist where I work had to take a twenty dollar a hour pay cut to do clinical in the ICU and has to get board certified. All the new grads are talking about the pay going down (less than 100,000 year in my area). I even had a student ask if I think pay would increase with expanded role and new responsibilities for the pharmacist and I said "well a nurse can do the same job for less." Pharmacist are helping to solve the nursing shortage as well as the Clinical Nurse Specialist shortage. INTEGRATE, COLLABORATE, TEAM UP!!!!

References:

Empowering Pharmacist-Physician Collaboration​

Empowering Pharmacist-Physician Collaboration

As a pharmacist, embedding yourself in a primary care practice can have positive outcomes for both patients and your business.

www.drugtopics.com

Highlight:

Reference:

Registered Nurse Billing in Primary Care

https://www.aaacn.org/sites/default/files/documents/RNBilling.pdf

Reference:

BILLING AND REIMBURSEMENT FOR THE AMBULATORY CARE PHARMACIST

https://digitalcommons.butler.edu/cgi/viewcontent.cgi?filename=7&article=1015&context=butlerbooks&type=additional

Reference:
Pharmacist Billing/Coding Quick Reference Sheet
For Services Provided in Physician-Based Clinics

https://www.ashp.org/-/media/assets/ambulatory-care-practitioner/docs/billing-quick-reference-sheet.pdf

Reference:

Pharmacists in ACOs, Part 2: Medication Therapy Management and Annual Wellness Visits​

Pharmacists in ACOs, Part 2: Medication Therapy Management and Annual Wellness Visits

To date, medication therapy management and annual wellness visits are the primary services that have demonstrated benefits regarding improvements in health outcomes and cost savings when pharmacists are integrated specifically within an ACO.

www.pharmacytimes.com

Reference:

Pharmacists in ACOs Part 3: Chronic Care Management, Chronic Disease State Management, and Transition of Care​

Pharmacists in ACOs Part 3: Chronic Care Management, Chronic Disease State Management, and Transition of Care

After discussing the Basics of Accountable Care Organizations and Medication Therapy Management and Annual Wellness Visit services, the third and last section of the Pharmacists in ACOs series will focus on 3 more integration strategies for pharmacists within the ACO setting, including chronic...

www.pharmacytimes.com

Reference:

Expanded RN Role in Primary Team Care

https://www.hawaiilearning.org/wp-content/uploads/2018/07/ECHO-RN-Role-8.pdf

Highlights:

Reference:

Home Grown: a Colorado community health center’s success in primary care RN role expansion

https://www.nursingworkforcecenters.org/wp-content/uploads/2017/06/Clinica-Family-Health-Nurse-Workforce-Development-Presentation-6-2017.pdf

Highlight:

FOLLOW THE MONEY!!!!!!

Reference:

CMS introduces new ACO Primary Care Flex model​

CMS introduces new ACO Primary Care Flex model

Five-year test starts in 2025 to promote innovative, proactive approaches to care.

www.medicaleconomics.com

Reference:

ACO Primary Care Flex Model Model Overview Factsheet

https://www.cms.gov/files/document/aco-pc-flex-fs.pdf?hashed_user=ada9223f29afed54d27f5a2d8c8d91a2

Highlight:

Reference:​

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models​

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models

The pharmacist integration model filled in gaps in care that appeared to positively affect MIPS and PCMH quality measures.

www.pharmacytimes.com

 

[PrincessSnow]

Reference:

A Portrait of the Pharmacy Profession Globally: Pharmacist Universal Professional Identity and Establishment of Global Pharmacy Council​

A Portrait of the Pharmacy Profession Globally: Pharmacist Universal Professional Identity and Establishment of Global Pharmacy Council

The roles of pharmacists are transforming throughout history and modern pharmacist has a crucial role in ensuring the efficacy and safety of applied drugs. It is a wonder that the pharmacy profession is still being viewed through an antiquated lens ...

www.ncbi.nlm.nih.gov

 

[lord999]

Pharmacy will go the way of physical therapy. A roller coaster of oversupply, a permanent part-time labor force, and a production numbers approach keeps everyone fighting for work and being underpaid for it. There is no viable model for sustainable growth at this point for the retail side, that's why the focused chains are suffering. The older model of front end covering for the low margin no longer works given the shrink and crime rate that is only going up. In places where there is low shrink and low crime, the customers are much less apt to buy the high profit junk in the store.

Hospital pharmacy's luck will run out the same time as hospitals, when everyone figures out that the debt financing is more than the hospital can bear, everything gets cut. It's kind of funny that hospital pharmacy is paid more than retail in many markets now given its position when I started.

Us academics are still sitting pretty with industry money, but we're now stashing it away for some lean times ahead. I'm running cash around 6-8 turns ahead of my annual budget right now for a bad grant season. That'll keep me flush enough for the rest of my career.

 

[PrincessSnow]

Everyone is chasing the money and wanting to get paid but the payers want everyone to do more and more with less it seems. The pharmacist and the nurse will be doing the doctors work, the LPN, nurse aide, medical assistant and pharmacy tech will be doing the RN and RPh work. You can view it which ever way you like but I think it is a race to the bottom and not evolutionary. My manager says I need a board certification to have a job at all!!! Well why do I need a board certification to do something like AWV as a pharmacist when I can do the same job as a RN. I think the Certifications is to compete with the Master's degree Clinical Nurse Specialist who do research in a population such as ER and ICU and write policy, procedure, and protocols. It is a management position.

FAQ: Basics of Ambulatory Care Pharmacy Practice
Date of Publication: July 2019

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/basics-of-ambulatory-care-pharmacy-practice.pdf

ASHP Implementing Solutions

https://wellbeing.ashp.org/-/media/wellbeing/docs/Implementing-Solutions-Report-2023.pdf

Changing an imperfect system of care​

Changing an imperfect system of care

American Nurse Journal, the official, clinically and career-focused journal of the American Nurses Association (ANA).

www.myamericannurse.com

We Keep Waiting: Developing Advocacy Skills in Your Nurses at the Organizational Level to Advance State & Federal Conversations (Leadership SIG)​

We Keep Waiting: Developing Advocacy Skills in Your Nurses at the Organizational Level to Advance State & Federal Conversations (Leadership SIG)

Medical assistants (MA) and licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) have seen the expansion of their scope of responsibility that often does not align with their training and education—and RNs usually have oversight of these roles…

library.aaacn.org

Registered Nurse Billing in Primary Care

https://www.aaacn.org/sites/default/files/documents/RNBilling.pdf

3 ways the ANA is advocating for nurse reimbursement​

3 ways the ANA is advocating for nurse reimbursement

For decades, nursing's economic value has gone unrecognized according to the American Nurses Association. Now, it is pushing for key changes to restore the profession's reimbursement value.

www.beckershospitalreview.com

• Increase use of the National Provider Identifier as a unique nurse identifier, which allows providers and Advanced Practice Registered Nurses to bill CMS for their services to patients. The NPI must be registered by a provider, but using it raises the visibility of what nurses do.
  
  
• The ANA advocates for the direct reimbursement of nurses and calls for funding and grants to be allocated to nurse-led projects and research. The association's foundational arm also provides grants for this purpose.
  
  
• Elevate the economic value of the nursing profession with extended research efforts into different ways to quantify the impact of nursing as a whole and present that data to Congress for garnering legislative visibility and support. This effort is being led by the ANA Enterprise Research Council.

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models​

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models

The pharmacist integration model filled in gaps in care that appeared to positively affect MIPS and PCMH quality measures.

www.pharmacytimes.com

****A family member had a recent AWV and it was done by a registered nurse and not a clinical pharmacist in this case*****
References from AAACN:

Strategies to Improve Annual Wellness Visit Completion Rates and Enhance to Role of the RN in Primary Care

Background: The annual wellness visit (AWV) is a benefit established by Medicare for its beneficiaries in 2011…

library.aaacn.org

In-Brief Sessions: Medicare Wellness Visits: A New Role for the Registered Nurse in the Ambulatory Care Setting; The Role of the RN Care Manager in the Geriatric Assessment Clinic: Our Unique Medical Home

Medicare Wellness Visits: A New Role for the Registered Nurse in the Ambulatory Care Setting: Medicare annual wellness visits are now a covered benefit for seniors. This session focuses on meeting CMS requirements and the process used to identify the screening tools…

library.aaacn.org

RN-Led Medicare Wellness Visits – Nurses Providing Value in Meeting Your Organization’s Important Medicare Quality Metrics

This session outlines the impact to quality metrics and steps to implement an RN-led annual Medicare wellness visit within an organization…

library.aaacn.org

Building Capacity for RN-Led Medicare Annual Wellness Visits in a Federally Qualified Health Center: A Story of an Academic-Clinical Partnership in Ohio

Background: The need for registered nurses (RNs) in primary care settings has never been greater…

library.aaacn.org

The Affordable Health Care Act Annual Wellness Visits: Nurse-Run Clinics and the Effectiveness in Screening Adherence to Mammograms and Colonoscopies

Contact hours available until 4/18/17…

library.aaacn.org

 

[GrandTheftAutumn]

What struggles? Opportunities are literally doublin' according to these experts

 

[GrandTheftAutumn]

Jokes aside, I'd imagine a lot of maintenance meds will shift to mail order and central fill model.
More closure of retail locations.
Specialty meds will be where the money is at.
Perhaps more clinical involvement for pharmacists.

 

[Script1992]

Jokes aside, I'd imagine a lot of maintenance meds will shift to mail order and central fill model.
More closure of retail locations.
Specialty meds will be where the money is at.
Perhaps more clinical involvement for pharmacists.

Speciality Pharmacy, PBM pharmacy, and Pharmacist in Industry I think will survive.

 

[PharmDminus]

mail order is the future, with fewer physical locations, and those that do exist will be high-volume.

 

[lord999]

https://www.wsj.com/health/healthcare/cvs-board-conducts-strategic-review-of-company-81dc996f?mod=breakingnews

Well, CVS actually thinks they can break up.

 

[PrincessSnow]

Is it a pharmacist job? lpn job? RN job?

Transition of Care Management - SoNE HEALTH

Transition of Care Management In the role of Continuum Care Specialists, our team of licensed practical nurses make telephonic outreach calls to patients within two business days of returning home from a hospitalization. During the outreach call, nurses assess a patient’s Transition of Care by...

sonehealthcare.com

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/billing-quick-reference-sheet.ashx?la=en&hash=8074CF55F7B84C0741CD0E73A64F47CB22CFF4AE

Team-based health care: A win for patients, staff and physicians

Avoiding physician burnout is one of the reasons medicine is turning to team-based health care. Empowering medical assistants and other staff helps put patient back at center of care.

www.ama-assn.org

 

[clarkbar]

Everyone is chasing the money and wanting to get paid but the payers want everyone to do more and more with less it seems. The pharmacist and the nurse will be doing the doctors work, the LPN, nurse aide, medical assistant and pharmacy tech will be doing the RN and RPh work. You can view it which ever way you like but I think it is a race to the bottom and not evolutionary. My manager says I need a board certification to have a job at all!!! Well why do I need a board certification to do something like AWV as a pharmacist when I can do the same job as a RN. I think the Certifications is to compete with the Master's degree Clinical Nurse Specialist who do research in a population such as ER and ICU and write policy, procedure, and protocols. It is a management position.

FAQ: Basics of Ambulatory Care Pharmacy Practice
Date of Publication: July 2019

https://www.ashp.org/-/media/assets/pharmacy-practice/resource-centers/ambulatory-care/basics-of-ambulatory-care-pharmacy-practice.pdf

View attachment 391775
ASHP Implementing Solutions

https://wellbeing.ashp.org/-/media/wellbeing/docs/Implementing-Solutions-Report-2023.pdf

View attachment 391776

Changing an imperfect system of care​

Changing an imperfect system of care

American Nurse Journal, the official, clinically and career-focused journal of the American Nurses Association (ANA).

www.myamericannurse.com

View attachment 391773

We Keep Waiting: Developing Advocacy Skills in Your Nurses at the Organizational Level to Advance State & Federal Conversations (Leadership SIG)​

We Keep Waiting: Developing Advocacy Skills in Your Nurses at the Organizational Level to Advance State & Federal Conversations (Leadership SIG)

Medical assistants (MA) and licensed practical nurses (LPNs)/licensed vocational nurses (LVNs) have seen the expansion of their scope of responsibility that often does not align with their training and education—and RNs usually have oversight of these roles…

library.aaacn.org

View attachment 391774

Registered Nurse Billing in Primary Care

https://www.aaacn.org/sites/default/files/documents/RNBilling.pdf

View attachment 391771
View attachment 391772

3 ways the ANA is advocating for nurse reimbursement​

3 ways the ANA is advocating for nurse reimbursement

For decades, nursing's economic value has gone unrecognized according to the American Nurses Association. Now, it is pushing for key changes to restore the profession's reimbursement value.

www.beckershospitalreview.com

• Increase use of the National Provider Identifier as a unique nurse identifier, which allows providers and Advanced Practice Registered Nurses to bill CMS for their services to patients. The NPI must be registered by a provider, but using it raises the visibility of what nurses do.
  
  
• The ANA advocates for the direct reimbursement of nurses and calls for funding and grants to be allocated to nurse-led projects and research. The association's foundational arm also provides grants for this purpose.
  
  
• Elevate the economic value of the nursing profession with extended research efforts into different ways to quantify the impact of nursing as a whole and present that data to Congress for garnering legislative visibility and support. This effort is being led by the ANA Enterprise Research Council.

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models​

Pharmacists Can Leverage Future Roles in Outcomes-Based Payment Models

The pharmacist integration model filled in gaps in care that appeared to positively affect MIPS and PCMH quality measures.

www.pharmacytimes.com

View attachment 391777​

****A family member had a recent AWV and it was done by a registered nurse and not a clinical pharmacist in this case*****
References from AAACN:

Strategies to Improve Annual Wellness Visit Completion Rates and Enhance to Role of the RN in Primary Care

Background: The annual wellness visit (AWV) is a benefit established by Medicare for its beneficiaries in 2011…

library.aaacn.org

In-Brief Sessions: Medicare Wellness Visits: A New Role for the Registered Nurse in the Ambulatory Care Setting; The Role of the RN Care Manager in the Geriatric Assessment Clinic: Our Unique Medical Home

Medicare Wellness Visits: A New Role for the Registered Nurse in the Ambulatory Care Setting: Medicare annual wellness visits are now a covered benefit for seniors. This session focuses on meeting CMS requirements and the process used to identify the screening tools…

library.aaacn.org

RN-Led Medicare Wellness Visits – Nurses Providing Value in Meeting Your Organization’s Important Medicare Quality Metrics

This session outlines the impact to quality metrics and steps to implement an RN-led annual Medicare wellness visit within an organization…

library.aaacn.org

Building Capacity for RN-Led Medicare Annual Wellness Visits in a Federally Qualified Health Center: A Story of an Academic-Clinical Partnership in Ohio

Background: The need for registered nurses (RNs) in primary care settings has never been greater…

library.aaacn.org

The Affordable Health Care Act Annual Wellness Visits: Nurse-Run Clinics and the Effectiveness in Screening Adherence to Mammograms and Colonoscopies

Contact hours available until 4/18/17…

library.aaacn.org

until there is independent billing power, like MTM with Medicare Part D, none of this matters.
I have done a stint with managing chronic disease. I was self-taught through uptodate and guidelines. It's not that hard to manage 90 percent of patients independently, but rphs only get the difficult to treat, problem patients, then it is difficult with limited options.