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Technology Impact on Long term Care Pharmacy at Home | Pharmacy Tech Trends; PrimeRx · Pharmacy Podcast Network

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Speaker 3: to us and just go to primarx dot io. Once again,
1:41
Speaker 3: that's primearx dot I. Today we are talking long term
1:49
Speaker 3: care pharmacy at home. And I know that you've heard
1:53
Speaker 3: about this on the network before. You know that we've
1:55
Speaker 3: been talking about this. I think we used to call
1:57
Speaker 3: this combo shop enough to remember the old common Hey,
2:01
Speaker 3: are you running a community pharmacy?
2:04
Speaker 4: Are yeah, a little bit of long term care? Uh huh,
2:06
Speaker 4: you're doing any in a little assisted living? Yes, I am,
2:09
Speaker 4: you're running a combo shop. Well, now we're calling it.
2:13
Speaker 3: With the evolution of technology and patient monitoring and therapy
2:19
Speaker 3: monitoring and remote monitoring, we're now moving to the term
2:23
Speaker 3: long term care pharmacy at home and what does that
2:26
Speaker 3: mean for our patients and our communities that are desperate
2:30
Speaker 3: for those services? Before I bring on my special guest, who.
2:34
Speaker 4: Is the I don't know.
2:35
Speaker 3: I think he could be known as the godfather of
2:39
Speaker 3: long term care pharmacy at home, and maybe he and
2:43
Speaker 3: I can argue about that. But rural America is facing
2:47
Speaker 3: a critical healthcare crisis driven by provider shortages. Hospital closures
2:52
Speaker 3: and geographic isolation, with over sixty six percent of primary
2:57
Speaker 3: care healthcare professional shortages in the areas located in rural regions.
3:03
Speaker 3: I thought that throughout the country, and that means that
3:06
Speaker 3: residents are often facing forty mile, forty miles or greater
3:11
Speaker 3: travel distances for specialized care, leading to higher rates of
3:15
Speaker 3: chronic illness and preventable mortality. With that stage set, Paul Shelton,
3:24
Speaker 3: do you I know you'll never call that yourself because
3:27
Speaker 3: you're too humble, but.
3:30
Speaker 4: Would you dawn that.
3:32
Speaker 3: Honor is the godfather of long term care pharmacy at home?
3:36
Speaker 5: Well, it's probably there for an argument, tide, because we
3:41
Speaker 5: were thinking about this back in the early twenty teens.
3:43
Speaker 5: But I know there were some pioneers before me that
3:45
Speaker 5: were doing it very well in the early two thousands,
3:49
Speaker 5: So specifically in Nashville, they had a couple of pharmacies
3:52
Speaker 5: that were absolutely doing this before it was cool, if
3:55
Speaker 5: you will, before they were getting any additional reimbursement for it,
3:58
Speaker 5: because it's good for and so yeah, I think I
4:02
Speaker 5: would have to say, well, there's probably somebody else there,
4:05
Speaker 5: but you know, it's definitely I could probably take at
4:08
Speaker 5: least a little bit of a claim to it.
4:11
Speaker 6: Somebody thanks for thanks for having me on the episode today.
4:15
Speaker 3: Somebody in your position, Paul, can't be the person that
4:20
Speaker 3: is bottlenecking an entire effort to change some things from
4:27
Speaker 3: the ground up. And you need someone that is in
4:31
Speaker 3: a consultant role who understands the data, where we came from,
4:35
Speaker 3: where we're going, how margins are shrinking, and how the
4:39
Speaker 3: realm of being reimbursed as a long term care pharmacy
4:45
Speaker 3: is different, and you're expected to do things slightly differently.
4:50
Speaker 3: But like you said, many of our community independent community
4:52
Speaker 3: pharmacies are already doing a lot of the services without
4:55
Speaker 3: being paid for it. We just heard at the end
4:59
Speaker 3: of the year from Skilled Nursing News, one of the
5:02
Speaker 3: biggest publications in Skilled nursing and it says, and I quote,
5:06
Speaker 3: it says, long term care pharmacy crisis. It could affect
5:10
Speaker 3: eighty percent of nursing home residents throughout the country. And
5:14
Speaker 3: it goes on to kind of give some reference and
5:17
Speaker 3: some data from even the American Society of Consultant Pharmacists
5:21
Speaker 3: to shout.
5:21
Speaker 4: Out to the ASCP. But this is major.
5:25
Speaker 3: This isn't to the point that were like like I
5:28
Speaker 3: when I opened up, I was talking about combo shops, right,
5:31
Speaker 3: and that was kind of like whatever opportunities were coming
5:34
Speaker 3: up in the community. The community independent Community Pharmacy was saying, Okay,
5:39
Speaker 3: I can do some assists of living, I can do
5:41
Speaker 3: some long term care services. But now that's become heightened
5:45
Speaker 3: by the stats, by the closures of pharmacies, by the
5:48
Speaker 3: closures of physicians groups, by the closures of hospitals. I
5:53
Speaker 3: need you to define for our audience, our listeners before
5:56
Speaker 3: we get going, what is long term care for pharmacy.
6:01
Speaker 5: That's a great question, Todd, And honestly, this is one
6:03
Speaker 5: of those that's fine because had you asked me that question, frankly,
6:08
Speaker 5: a bunch of our customers did. In two thousand and
6:10
Speaker 5: eleven and twelve, long term care pharmacy had a completely
6:14
Speaker 5: different definition. I mean, if you were not performing pharmacy
6:18
Speaker 5: services for institutionalized patients. Those are patients that are in
6:21
Speaker 5: either skilled nursing facilities, assisted living facilities, or intermediate care
6:25
Speaker 5: facilities for the electional and developmentally delayed. If you weren't
6:29
Speaker 5: servicing those institutionalized care facilities, you were not performing long
6:33
Speaker 5: term care pharmacy. There were some innovators or some early
6:36
Speaker 5: adopters of compliance packaging to the community and some of
6:40
Speaker 5: that type of concept, but those weren't considered LTC pharmacies
6:45
Speaker 5: at the time. As the definition has kind of shifted,
6:50
Speaker 5: you also see I guess it's fair to include. In
6:52
Speaker 5: twenty twelve, you were also seeing palliative and hospice care
6:55
Speaker 5: patients being treated by long term care pharmacies, as well
6:59
Speaker 5: as some correctional facilities being treated by long term care
7:03
Speaker 5: or institutional closed door long term care pharmacies. So you
7:07
Speaker 5: fast forward to twenty twenty one and CMS put out
7:10
Speaker 5: some guidance on December fifteenth of that year that basically
7:13
Speaker 5: stated that it was appropriate for plans and plan sponsors
7:17
Speaker 5: and through them, their PBMs, to pay for patients receiving
7:21
Speaker 5: a long term care equivalent level of service in their
7:24
Speaker 5: own home, and that really opened up the definition of
7:28
Speaker 5: what could be a long term care pharmacy or who
7:30
Speaker 5: could be treated by a long term care pharmacy. It's interesting,
7:34
Speaker 5: you know, there's different estimates on total number of patients
7:37
Speaker 5: impacted a year, but if you look at all of
7:39
Speaker 5: the patients that passed through either a skilled nursing facility
7:42
Speaker 5: an assisted living facility, a group home or similar. In
7:46
Speaker 5: a year, that's roughly four million patients. And depending on
7:49
Speaker 5: the source you look at, it's between three point eight
7:51
Speaker 5: and four point two million, but let's call it four
7:53
Speaker 5: million patients just for grins and giggles. When you look
7:57
Speaker 5: at how that expands with that ce MS guidance twenty
8:01
Speaker 5: twenty one, it goes from four million patients up to
8:05
Speaker 5: a total of you know, north of twelve million total patients.
8:08
Speaker 5: And so what's remarkable is you've got these patients who
8:11
Speaker 5: are you know, their home and community based waiver patients.
8:14
Speaker 5: There e SRD waiver patients, in stage renal disease waiver patients.
8:19
Speaker 5: These are patients on social security disability who have you know,
8:23
Speaker 5: been basically given long term care services and supports in
8:25
Speaker 5: their own home. We see age blind, disabled, traumatic brain
8:29
Speaker 5: injury patients. Those are all patients that could potentially automatically
8:32
Speaker 5: qualify for LTC at home. And then you've got the
8:35
Speaker 5: patients that are in their own home that qualify through
8:38
Speaker 5: level of service. These are patients that have two that
8:41
Speaker 5: need support with two or more activities of daily living.
8:43
Speaker 5: Those can be either I A d LS or B
8:45
Speaker 5: A D ls and I think that's about sixteen total tasks.
8:49
Speaker 5: And then from there it's do they have three or
8:52
Speaker 5: more chronic conditions? CMS has defined those chronic conditions very well,
8:57
Speaker 5: so there's there. There's a great list of them on there.
9:01
Speaker 5: If you go to the LTC at Home Quality Commission website,
9:04
Speaker 5: there's an approved attestation form you can pull from there.
9:08
Speaker 5: It's public domain information. Great great tool that's been used
9:11
Speaker 5: in several tens of millions of dollars of audits and
9:14
Speaker 5: been successful, so we know that's a good solid attestation form.
9:19
Speaker 5: After that, the patients must be taking three or more
9:22
Speaker 5: medications for those chronic conditions. And then the most important
9:27
Speaker 5: piece of this is the patient has to have difficulty
9:30
Speaker 5: leaving the home independently. So, as an example, if a
9:33
Speaker 5: patient can drive themselves to the pharmacy and they are
9:36
Speaker 5: not a waiver patient, then they are by definition not
9:39
Speaker 5: an LTC at home patient because they have the ability
9:41
Speaker 5: to transport themselves safely to the pharmacy. However, if they
9:44
Speaker 5: have to have a caregiver get them to the pharmacy,
9:46
Speaker 5: they meet those other criteria. It's an LTC at home patient.
9:49
Speaker 5: And so it's really vastly expanded who can qualify for
9:52
Speaker 5: LTC at home or LTC pharmacy services. And what's been
9:57
Speaker 5: interesting is traditional closed door long term care pharmacies have
10:00
Speaker 5: not done a great job of expanding services into that space.
10:03
Speaker 5: There's been a few very successful, large volume kind of
10:09
Speaker 5: regional players that have done a good job of supporting
10:12
Speaker 5: patients nationwide with compliance, packaging, delivery you monthly medication, reconciliation,
10:18
Speaker 5: transportation assistance, communication between the pharmacy and their providers. But
10:24
Speaker 5: generally speaking, those traditional closed door institutional pharmacies have not
10:28
Speaker 5: expanded into the space even though there's eight million patients
10:31
Speaker 5: out there that need the service, and so it's been
10:34
Speaker 5: a great opportunity for community pharmacy in many cases are
10:37
Speaker 5: already doing this work to step in and look at
10:41
Speaker 5: a different model of pharmacy that allows them to provide
10:45
Speaker 5: better care for their patients. It allows them to have
10:48
Speaker 5: better outcomes for their patients, and in some cases allows
10:51
Speaker 5: them to increase the reimbursement they're receiving for those patients.
10:55
Speaker 4: So an extension.
10:58
Speaker 3: Of the services that are being provided based on the
11:01
Speaker 3: criteria of which you just shared. And to be a candidate,
11:06
Speaker 3: tell me how durable medical equipment fits into this too,
11:11
Speaker 3: how oxygen providing oxygen texts and how kind of expand
11:15
Speaker 3: upon that. Because I start looking at setting up special
11:21
Speaker 3: instrumentation in the home for remote patient monitoring, I think
11:25
Speaker 3: of bathroom safety mechanisms and technology. I'm thinking of medical supplies,
11:31
Speaker 3: respiratory equipment, even mobility aids talk to us about that
11:36
Speaker 3: part of it, and.
11:37
Speaker 5: So all those are great indicators of a potential to
11:39
Speaker 5: see at home farm patient because again, what they're what
11:42
Speaker 5: you're looking for patients that need long term care services
11:45
Speaker 5: and supports and pretty much everything you just mentioned there
11:48
Speaker 5: falls into that LTCSS category. So if you have mobility aids,
11:52
Speaker 5: ease of access to the home, that's the vast majority
11:56
Speaker 5: of what CMS is paying for. Look at number of patients,
11:59
Speaker 5: not number of dollars, but number of patients impacted by LTCSS.
12:02
Speaker 5: It's primarily things like that. It's mobility aids, it's DM
12:05
Speaker 5: it's getting access to some of those tools. Whi's been
12:08
Speaker 5: really interesting in the last twenty four months is the
12:11
Speaker 5: rapid expansion of remote therapy management and remote patient monitoring.
12:15
Speaker 6: Capabilities and possibilities in the market.
12:18
Speaker 5: I mean, we've seen five or six new companies launch
12:21
Speaker 5: that are really interesting models. They're doing some really fun
12:25
Speaker 5: stuff where they're partnering with local pharmacies to identify patients
12:30
Speaker 5: that can be serviced by RTM and RPM and in
12:34
Speaker 5: some cases Chronic Care Management so CCM. Basically all of
12:39
Speaker 5: those are It's a great opportunity for pharmacy to be
12:43
Speaker 5: that extension of a physician group or of a local
12:46
Speaker 5: practice to really help change how their patients are being
12:50
Speaker 5: seen being treated.
12:52
Speaker 3: Paul I love to look into the catalog of the
12:54
Speaker 3: super Nerdy Qualifier and like the Remote Therapy Monitoring billing
13:01
Speaker 3: codes and CPT nine eight nine seven five is the
13:06
Speaker 3: initial setup nine eight nine seven seven is the device
13:10
Speaker 3: supply in monitoring for respiratory an in system of monitoring
13:15
Speaker 3: for thirty days. That's forty three dollars, right, the initial
13:19
Speaker 3: setup is twenty bucks. The first twenty minutes of treatment
13:22
Speaker 3: is fifty dollars. I'm like, come on, like, there is
13:26
Speaker 3: a modelator that you and I both know that if
13:29
Speaker 3: you start thinking, hey, I'm going to really go hard
13:32
Speaker 3: on supplying these services, marketing these services, talking to my
13:36
Speaker 3: physicians about these services, talking about to my state representatives
13:40
Speaker 3: about these services, that you.
13:42
Speaker 4: Could really build a significant business. You have a suite.
13:45
Speaker 3: Absolutely, you have a sweet spot patient number that you
13:49
Speaker 3: and I talked about one time.
13:51
Speaker 4: Kind of talk to me about the numbers.
13:53
Speaker 5: Yeah, even without the RPM r TAM, which does require
13:57
Speaker 5: a collaborative practice agreement in most cases with the local
14:00
Speaker 5: physician or with a physician that has a treatment relationship
14:04
Speaker 5: with the patient. So just looking at the LTC at home,
14:07
Speaker 5: reimbursement changes. A great example is my local pharmacy here.
14:12
Speaker 5: Very dear friends of mine run a community pharmacy in
14:14
Speaker 5: central North Carolina. We moved thirty two patients that they
14:17
Speaker 5: were already providing compliance packaging too, they were already delivering
14:20
Speaker 5: to They're already providing monthly medication, reconciliation and coordination of care.
14:24
Speaker 5: So they're literally doing the required tasks for the pharmacy.
14:28
Speaker 5: They met the criteria of an LTC pharmacy by meeting
14:31
Speaker 5: the ten CMS criteria. We moved thirty two patients and
14:34
Speaker 5: the increase in reimbursement was thirty six hundred dollars a month.
14:38
Speaker 5: Those weren't cherry picked patients. There's like actually one that
14:41
Speaker 5: went in the other direction in reimbursement due to a
14:43
Speaker 5: nuance in the program. But you think about thirty two
14:47
Speaker 5: patient conversion, thirty six hundred dollars of real dollars. Now,
14:52
Speaker 5: when you start layering in these other processes, these other opportunities,
14:58
Speaker 5: it gets to be quite remarkable. I mean, you're adding
15:00
Speaker 5: in another couple thousand dollars a month with our pm RTM,
15:03
Speaker 5: depending on the partner that you work with. And that's
15:06
Speaker 5: on the basics, right. And so when we when we
15:09
Speaker 5: look at and talk to pharmacies who are exploring this
15:12
Speaker 5: LTC at home model, the starting point is very low.
15:16
Speaker 5: It doesn't have to doesn't take a ton of patients
15:18
Speaker 5: to make this make sense. Really, we're looking for twenty
15:21
Speaker 5: to twenty five patients in an ideal reality, you can
15:24
Speaker 5: make a pencil at fourteen to fifteen. But one of
15:28
Speaker 5: the things that people don't really talk about, or we
15:31
Speaker 5: haven't talked about enough, I should say, is when you
15:35
Speaker 5: start converting patients into an LTC at.
15:37
Speaker 6: Home model, you're moving.
15:40
Speaker 5: Patients and workflow out of the existing kind of retail model.
15:45
Speaker 6: Our retail model.
15:46
Speaker 5: In the United States has been set up to be
15:49
Speaker 5: there and ready. You're standing there waiting for someone to call,
15:52
Speaker 5: click or walk into the pharmacy and get themselves set
15:56
Speaker 5: up with the medication they're renewing, basically calling in refills,
16:02
Speaker 5: clicking and walking in however that is. And so it's
16:04
Speaker 5: a very reactive model. Almost by definition, long term care.
16:09
Speaker 6: At home is a proactive model.
16:11
Speaker 5: And so we were doing some evaluations for a couple
16:14
Speaker 5: of our partner pharmacies, and you know one down in
16:17
Speaker 5: southeastern North Carolina that we looked at if we moved
16:20
Speaker 5: twenty seven percent of her patient volume, whether they qualified
16:24
Speaker 5: for increased reinforsement on long term care at home or not,
16:27
Speaker 5: whether they whether you know, basically, whether it made sense
16:30
Speaker 5: for them to be a true LTC at home patient
16:33
Speaker 5: if we cared for them as an LTC at home patient,
16:36
Speaker 5: meaning that we provide the compliance packaging, the routine delivery,
16:39
Speaker 5: the monthly medication reconciliation. If we converted twenty seven percent
16:43
Speaker 5: of her total patient population, it would result in eighty
16:47
Speaker 5: two to eighty three percent of her total prescriptions being
16:50
Speaker 5: filled on. Not in a reactive model, but it's a
16:54
Speaker 5: proactive model.
16:55
Speaker 6: So when we looked at.
16:55
Speaker 5: The model for her pharmacy, what we realized was we
17:01
Speaker 5: could reallocate three technicians out of direct fulfillment operations who
17:06
Speaker 5: are most of the time standing there waiting for someone,
17:09
Speaker 5: you know, not truly waiting.
17:10
Speaker 6: They're busy because it's retail.
17:12
Speaker 5: Pharmacy, like every other retail pharmacy, they're run around hair
17:14
Speaker 5: on fire because they're taking a phone call here, they're
17:16
Speaker 5: walking into a patient here. But there's context shifting that's occurring,
17:20
Speaker 5: which is inherently inefficient. And so by modifying the workflow
17:25
Speaker 5: in the pharmacy pretty dramatically to this heavy LTC at
17:28
Speaker 5: home type of pharmacy fulfillment, we could remove three technicians
17:33
Speaker 5: from workflow and put them into the outbound calling campaign
17:37
Speaker 5: and grow the pharmacy by five hundred to six hundred
17:40
Speaker 5: patients without adding any additional labor. Which in this space,
17:45
Speaker 5: so you talked about this type of patient, five hundred
17:47
Speaker 5: to six hundred patients depending on the mix, could be
17:50
Speaker 5: forty five hundred to six thousand prescriptions a month. That's just,
17:55
Speaker 5: I mean, pretty huge for any community pharmacy.
17:58
Speaker 4: I think it is huge.
17:59
Speaker 3: It's it's also you know, our co producer Pia Meta
18:06
Speaker 3: gave us a shout out before we started and she's like,
18:08
Speaker 3: you know what I was researching, and not just seniors
18:11
Speaker 3: are being taken care of these long term care facilities
18:14
Speaker 3: that we just don't have enough of them, but mental
18:18
Speaker 3: disability homes that have twenty fifty sometimes they build campuses
18:24
Speaker 3: and they run out space. These people need direction, they
18:27
Speaker 3: need consultation, they need absolutely hands on from a medical
18:32
Speaker 3: medication professional. And it would help to save money from
18:37
Speaker 3: our emergency room visits. And you just got done saying
18:40
Speaker 3: before we started recording your emergency room in your community,
18:44
Speaker 3: what was it up to six hours?
18:46
Speaker 5: Yeah, up to six hours depending on the day and
18:48
Speaker 5: the staffing model. And it's not because they don't want
18:51
Speaker 5: to provide exceptional service, because I know every person in
18:54
Speaker 5: that C suite and their mission is to reduce that
18:57
Speaker 5: wait time. Their problem is that we're in oral in
19:00
Speaker 5: North Carolina. Finding qualified professionals to work in that space
19:03
Speaker 5: they're willing to work in that space is very challenging.
19:07
Speaker 5: You know, we were talking about as well. You know,
19:10
Speaker 5: you mentioned mental health and behavioral health. There's a ton
19:13
Speaker 5: of evidence based, you know, a ton of evidence that
19:17
Speaker 5: a pharmacy professional engaging with a mental or behavioral health patient,
19:22
Speaker 5: along with compliance packaging for oral solids, has an incredible
19:26
Speaker 5: reduction and overall cost of care for those patients. And
19:30
Speaker 5: it's interesting because you think about patients that are on
19:32
Speaker 5: long acting injectables right there. These are generally, if everything
19:38
Speaker 5: is fine, if they're taking their medications as prescribed, everything
19:41
Speaker 5: is fine, fully functional members of society. They can be
19:45
Speaker 5: very engaged. You probably have someone that you know that
19:48
Speaker 5: takes in LAI and you have no idea because they
19:50
Speaker 5: manage your medication as well. What happens when they forget
19:54
Speaker 5: to or they start feeling better and they say, you
19:55
Speaker 5: know what, I'm not going to take that medication today.
19:57
Speaker 5: I'm not going to do this. I'm not going to
19:59
Speaker 5: follow my doctor because I feel.
20:01
Speaker 6: Great and I don't need that anymore.
20:03
Speaker 5: I'm better. Well, then you have a spiral, a rapid
20:06
Speaker 5: decline in healthcare, and in some cases it goes from
20:09
Speaker 5: being a medical issue to a law enforcement issue where
20:12
Speaker 5: you have patients acting out, you have patients basically removing
20:17
Speaker 5: themselves from the community. And so the type of care
20:21
Speaker 5: we're talking about with LTC at home can be very
20:24
Speaker 5: specifically for you know, twenty thirty forty year olds who
20:28
Speaker 5: need that next level of care. And then when you
20:30
Speaker 5: think about the IDD space, the whole mission with intellectually
20:35
Speaker 5: and developmentally delayed patients is to provide them a lifestyle
20:39
Speaker 5: in a livelihood that allows them to be as independent
20:41
Speaker 5: as possible when possible. Right, So, our goal is if
20:45
Speaker 5: I have a patient that with just a little bit
20:48
Speaker 5: of extra care, I can nudge from being in a
20:51
Speaker 5: group home to being into a community based care setting
20:55
Speaker 5: where they're able to maybe go to workshop every day
20:57
Speaker 5: but live semi independently. That's a huge win for that patient,
21:01
Speaker 5: not just because it's a lower cost of care, which
21:04
Speaker 5: it is. More importantly, they get to be independent, they
21:07
Speaker 5: get to participate in life in a different way, and
21:10
Speaker 5: it's just a fundamentally better outcome for the patient. And
21:13
Speaker 5: so this type of care, this type of really engaged
21:17
Speaker 5: community based long term care pharmacy at home, can can
21:20
Speaker 5: really change how those patients react and respond to their
21:24
Speaker 5: overall care, overall care just generally.
21:28
Speaker 3: So Paul just to shout out for the listeners to
21:32
Speaker 3: understand opportunities from a nation's perspective, and this is specifically
21:37
Speaker 3: mental disability housing expansion throughout the nation. In the state
21:42
Speaker 3: of California, there's a there's a program called home Key.
21:47
Speaker 3: Just like it sounds all one word, home key, and
21:51
Speaker 3: it's a program that they're investing two point two five
21:54
Speaker 3: billion dollars of new funding that is all about serving
21:58
Speaker 3: mental health patients in their homes and they need medication
22:04
Speaker 3: expertise for that. In New York, forty five million dollars
22:08
Speaker 3: in funding was announced in June of twenty twenty five
22:11
Speaker 3: for supportive in home medical services. Connecticut, the state is
22:16
Speaker 3: expanding supportive housing with new projects coming online with nearly
22:21
Speaker 3: thirty million dollars of funding. Florida, an eleven million dollar
22:25
Speaker 3: project just in Sanford alone is building eight duplex units
22:31
Speaker 3: with adults for serious mental illness that will need a
22:35
Speaker 3: drugover site in medication management. I could just keep going
22:40
Speaker 3: on and on. South Carolina has a big initiative, so
22:43
Speaker 3: there is no lack of opportunity that if you are poised, prepared,
22:48
Speaker 3: technology in place, workflow system ready. Primar ex is ready.
22:53
Speaker 3: By the way, this platform has all the checks and
22:56
Speaker 3: balances of you being able to build your workflow specific
23:00
Speaker 3: different than your community pharmacy workflow, and all of a
23:04
Speaker 3: sudden you shift the gear, same system and now you
23:07
Speaker 3: have workflow for your long term care pharmacy at home.
23:10
Speaker 3: This is big, big bucks and big opportunity.
23:13
Speaker 5: It's a huge opportunity tod and you know, like you
23:16
Speaker 5: you know, we're actively working with North Carolina as one
23:19
Speaker 5: of their managed Medicaid organizations to expand into this behavioral
23:23
Speaker 5: health mental health care, you know, through access to long
23:27
Speaker 5: term care at home pharmacies and you know, be able
23:29
Speaker 5: to expand care, increase three enbursement for a Medicaid patient,
23:33
Speaker 5: which is just basically unheard of, and but there's dollars
23:38
Speaker 5: available for it. There was a fifty billion dollar fund
23:41
Speaker 5: pushed out at the end of this past year. Every
23:45
Speaker 5: state in the country received some funding. I think in
23:48
Speaker 5: North Carolina it was two hundred and eleven and sixteen
23:50
Speaker 5: million dollars. Indiana Upper too, you know, upper one hundreds
23:54
Speaker 5: just sh I have two hundred million dollars. But those
23:57
Speaker 5: those dollars are specifically for enhancing rural health care and
24:03
Speaker 5: community pharmacy is uniquely situated to enhance at rural healthcare,
24:07
Speaker 5: plug into some of these programs we're talking about, and
24:09
Speaker 5: really help patients stay happy, healthy and at home as
24:11
Speaker 5: long as possible.
24:13
Speaker 6: I love it.
24:14
Speaker 3: I love it because it really gives a whole layer
24:19
Speaker 3: of quality health care that's being delivered. And now there's
24:22
Speaker 3: new revenue opportunities to up game and pull in revenue
24:27
Speaker 3: once again. Services that's your prop already offering your communities, Paul,
24:33
Speaker 3: Let's do a kind of a checklist for a second,
24:37
Speaker 3: for the for the listeners, what's the technical checklist of
24:44
Speaker 3: my patient that I have to make sure that they
24:46
Speaker 3: hit this criteria so that I know that I'm a
24:50
Speaker 3: long term care pharmacy at home opportunity.
24:53
Speaker 5: Absolutely, So there's two sets of criteria here. One is
24:56
Speaker 5: the pharmacy criteria. I mean, this is what does the
24:59
Speaker 5: pharmacy have to do to be an LTC at home
25:01
Speaker 5: or an LTC pharmacy. And this is either an institutional
25:05
Speaker 5: TC pharmacy or a community based LTC pharmacy, doesn't matter.
25:08
Speaker 6: There's still ten criteria from.
25:09
Speaker 5: CMS, most of which are actually several of which you
25:13
Speaker 5: can meet by having just a modern prescription management system.
25:17
Speaker 5: So they like the forums and checklists and that type
25:20
Speaker 5: of thing. Those all qualify. Those are all in the
25:23
Speaker 5: ability of a modern prescription management platform like primar x.
25:26
Speaker 5: So what you need in addition to that is you
25:29
Speaker 5: need to be able to deliver to your patient. You
25:32
Speaker 5: need to have twenty four to seven access to a pharmacist.
25:35
Speaker 5: You can do that through one of two ways. One
25:37
Speaker 5: is that one of your pharmacists don't called twenty four
25:40
Speaker 5: to seven from a life from a life balance standpoint,
25:44
Speaker 5: sometimes that gets a little challenging. So we do recommend
25:47
Speaker 5: having as an alternative, having an answering service that answers
25:51
Speaker 5: and then when there is a medical emergency or emergency
25:53
Speaker 5: that a pharmacist needs to respond to, they then contact
25:56
Speaker 5: that pharmacist who'se onn call. Greatly reduces the number of
25:59
Speaker 5: touches at the pharmacy pharmacist receives. Additionally, you're gonna need
26:03
Speaker 5: compliance packaging. So the compliance packaging is defined as not
26:07
Speaker 5: a vile. So we get a question all the time.
26:09
Speaker 5: It's like, oh, Paul, I've got a patient, but they don't.
26:11
Speaker 5: They just want to have vials, but they're they're LTC
26:14
Speaker 5: at home. It's like that those are mutually exclusive. If
26:16
Speaker 5: you're not getting your medication and not in something other
26:19
Speaker 5: than a vile, you're not an LTC, not an LTC
26:21
Speaker 5: customer patient. You do need the capacity to provide emergency
26:26
Speaker 5: logbooks and emergency drug kits, and so what that means
26:30
Speaker 5: for the average community pharmacy is you have a tackle
26:32
Speaker 5: box that is empty in your pharmacy with an emergency
26:35
Speaker 5: logbook in the top of it, and if you ever
26:37
Speaker 5: serve a facility that needs that emergency drug kit, you
26:41
Speaker 5: go to your state regulations, identify what is authorized in
26:45
Speaker 5: the DK, put that in there, and provide it to
26:47
Speaker 5: the to the facility.
26:48
Speaker 6: If you're just.
26:49
Speaker 5: Doing LTC at home, it is important that you have
26:52
Speaker 5: that empty tackle box in your in your pharmacy to say, yes,
26:55
Speaker 5: I can meet that criteria, but you're not actually providing
26:57
Speaker 5: an e DK to a facility. So you do, but
27:00
Speaker 5: you need to have the capacity to do that, and
27:05
Speaker 5: like I said, you also will need to need to
27:08
Speaker 5: have access to custom compounded and IV formulation. Now there
27:13
Speaker 5: are two options here as well. Option one go build
27:15
Speaker 5: one hundred and fifty thousand dollars clean room the USP
27:17
Speaker 5: seven nine to seven, USB eight hundred compliant if those
27:21
Speaker 5: are being enforced in your state, and be able to
27:24
Speaker 5: do all the custom compounds and ivs you want to.
27:27
Speaker 5: That seems expensive, so we do recommend utilizing a pharmacy
27:30
Speaker 5: a backup pharmacy network. We have several that we've identified
27:33
Speaker 5: that are very solid as backup pharmacy networks can help
27:38
Speaker 5: you get access to those. Alternatively, you can also partner
27:40
Speaker 5: with your local hospital if they do have sterile compounding
27:43
Speaker 5: capability through memory and of understanding. So that's on the
27:46
Speaker 5: pharmacy side. On the patient side, again, it's a waiver patient,
27:49
Speaker 5: a patient that's been discharged from skilled nursing facility in
27:51
Speaker 5: the last six months, where a patient who qualifies through
27:55
Speaker 5: the add testation, and again that's two or more activities
27:58
Speaker 5: of daily living support, three chronic condition, multiple medications for
28:01
Speaker 5: those chronic conditions, and inability to leave the home independently.
28:07
Speaker 5: There are some new softwares coming out very soon that
28:11
Speaker 5: we'll be able to so a couple of different programs
28:13
Speaker 5: that will actually be able to help identify home and
28:15
Speaker 5: community based waiver patients at the pharmacy as part of
28:18
Speaker 5: an eligibility check. So really excited to see that development occurring.
28:22
Speaker 5: That's actually been in the works for I've been trying
28:25
Speaker 5: to get that developed for about two years. I think
28:27
Speaker 5: we're within thirty days of being able to launch that.
28:29
Speaker 5: Really excited about that.
28:31
Speaker 6: Being able to get out into the market.
28:34
Speaker 5: From a technological standpoint, what you want to be able
28:37
Speaker 5: to do inside your pharmacy is bifurcate your workflow. So
28:41
Speaker 5: you've got your traditional retail workflow on one side of
28:44
Speaker 5: the building, you've got your long term care workflow on
28:46
Speaker 5: the other side of the building, or not I know
28:48
Speaker 5: this side the building, maybe on the back wall of your workspace.
28:52
Speaker 5: The goal is to again move as many patients as
28:55
Speaker 5: you possibly can into that workflow because it is a
28:59
Speaker 5: proactive workflow, it is a more robust workflow. I think
29:03
Speaker 5: you know the outcomes for your patients are going to
29:05
Speaker 5: be better even if they don't qualify as LTC at
29:08
Speaker 5: Home reimbursement. You can reduce your overall cost to fill
29:10
Speaker 5: by having it be a proactive or a very scheduled,
29:14
Speaker 5: intentional process.
29:17
Speaker 3: All right, listeners, just as a double check, as just
29:21
Speaker 3: a test of where you're at, where you're going, how
29:25
Speaker 3: you're growing, how you would like to grow your independent
29:29
Speaker 3: community pharmacy. I want you to head on over to
29:31
Speaker 3: lt c AH that's long Term Care at Home ltc
29:38
Speaker 3: AH dot com.
29:39
Speaker 4: And just go through.
29:41
Speaker 3: There's educational programs, the tailor resources, the mentorship and coaching,
29:45
Speaker 3: the operational support, and like Paul was saying, the network
29:49
Speaker 3: opportunities which are just gold to be able to see
29:52
Speaker 3: who's done this before, who knows how to do it,
29:55
Speaker 3: and how can I continue to extend it. That also
29:57
Speaker 3: includes long term care pharmacy at a home pharmacy operations
30:02
Speaker 3: that are already working. If you haven't reached out to
30:05
Speaker 3: Paul and his team to just do a double check
30:07
Speaker 3: and to do a quick audit on how healthy is
30:10
Speaker 3: my operations? Can I make some tweaks to get more
30:12
Speaker 3: out of this machine and do more and grow? Paul,
30:17
Speaker 3: the twenty twenty six to me is the year of
30:20
Speaker 3: becoming a profitable, sustainable, stabilized and thriving pharmacy operates restely
30:28
Speaker 3: so so that we can grow over the next the
30:30
Speaker 3: baby booms not over yet. We're still we haven't even
30:33
Speaker 3: I don't know if we've reached the crest of the
30:36
Speaker 3: population numbers or not.
30:38
Speaker 5: Wave is still getting ready to crash. It's coming in
30:40
Speaker 5: twenty thirty or so. We're going to have that for
30:42
Speaker 5: the final the last of quote the silver tsunami. And
30:46
Speaker 5: I always loved when people are like, oh, look, how
30:47
Speaker 5: many people are turning sixty five this year. I was like, okay, guys,
30:50
Speaker 5: my dad's seventy five is just about about two years ago.
30:55
Speaker 5: Opened his third small business has had an iPhone since.
30:58
Speaker 6: The day they came out.
31:01
Speaker 5: Those aren't the patients that we're trying to focus on.
31:03
Speaker 5: We're looking at the patients that are either medically fragile,
31:06
Speaker 5: that are that same age or a little bit older,
31:08
Speaker 5: who are starting to go into that I don't want
31:10
Speaker 5: to go to a skilled nursing facility. Like there is
31:13
Speaker 5: a real conversation. If you sit down at Thanksgiving and
31:16
Speaker 5: ask poll the crowd, Hey, who's ready to go to
31:18
Speaker 5: a skilled nursing facility? There's not going to be a
31:20
Speaker 5: soul that says that they want to, But most likely
31:25
Speaker 5: every many patients in the United States will need to.
31:27
Speaker 5: If they make it past that eighty fifth birthday or
31:30
Speaker 5: eighty second birthday, they're probably going to need some sort
31:33
Speaker 5: of institutionalized care at some point or very heavy in
31:36
Speaker 5: home care.
31:37
Speaker 6: And what we're seeing is that.
31:39
Speaker 5: Significant shift from institutional care to in home care. What's
31:43
Speaker 5: interesting is there are so many patients in that demographic
31:47
Speaker 5: that we're starting to see those kind of a massive
31:51
Speaker 5: dip in census in skilled and assisted living facilities in
31:55
Speaker 5: early COVID that has been almost completely recovered now and
31:59
Speaker 5: we're starting to see that census continue to climb, continue
32:02
Speaker 5: to engage, and it's just I don't think that's going
32:06
Speaker 5: to go away. I think it's going to continue to grow.
32:08
Speaker 5: And you're trying to find ways to help expand or
32:11
Speaker 5: if you will augment those existing beds with space in
32:14
Speaker 5: the community.
32:17
Speaker 3: Paul, I already talked to you about this, but just
32:19
Speaker 3: let the listeners know. For the rest of twenty twenty six,
32:23
Speaker 3: we are going to continue to come back to this
32:25
Speaker 3: subject of long term care pharmacy at home and really
32:29
Speaker 3: breaking it apart into pieces so that we can refine, discuss,
32:33
Speaker 3: bring in the subject matter expertise and the leaders in
32:36
Speaker 3: those spaces, so that our listeners, our pharmacy owners or
32:40
Speaker 3: pharmacy operators, our best in updated and informed and being
32:46
Speaker 3: able to reach out to you. It's we're coming into
32:49
Speaker 3: conferences in Paul, it's going to get crazy. It's going
32:52
Speaker 3: to heat up. If I can keep it under twelve,
32:54
Speaker 3: then I stay married. If it like I.
32:57
Speaker 6: Have my revenue that in my bone.
33:00
Speaker 3: I get up around number ten, that of Todd Yuri's
33:06
Speaker 3: family starts to shimmer and shake.
33:08
Speaker 4: So yes, how many headed to you this year?
33:12
Speaker 5: I think we're probably gonna end up at around six
33:15
Speaker 5: this year, Todd.
33:15
Speaker 6: Same reason.
33:16
Speaker 5: We had several last year that we attended that were
33:19
Speaker 5: while they were they were good, it was just like, Okay,
33:23
Speaker 5: this isn't the focus. And and you know, frankly, a
33:25
Speaker 5: lot of pharmacy owners are kind of limiting their travel
33:28
Speaker 5: as well, and so we're seeing a little bit lighter
33:31
Speaker 5: attendance at some some conferences. Other conferences are absolutely slammed
33:35
Speaker 5: because of the content that they're using and the way
33:37
Speaker 5: they're communicating with patient or with a pharmacy excuse me.
33:40
Speaker 5: And so what's really interesting is what I'm finding is
33:43
Speaker 5: a lot of like the user group conferences, where there's
33:46
Speaker 5: actually like you can sit down with other people who
33:48
Speaker 5: do the same thing that you do. Those user group
33:51
Speaker 5: conferences are actually picking up steam instead of removing reducing steam.
33:55
Speaker 5: And so really excited to see how that works out
33:58
Speaker 5: for the rest of the year.
33:59
Speaker 6: But like I said, I think.
34:00
Speaker 5: We're going to probably cap it around six for me
34:03
Speaker 5: to personally intend this year, and there may be a
34:05
Speaker 5: couple others that Carli or Lindsay come to, but yeah,
34:08
Speaker 5: I think it's target is six.
34:10
Speaker 4: That's the goal.
34:11
Speaker 3: It's interesting you said that because one of the best
34:15
Speaker 3: conferences I attended in twenty twenty five was the intimate,
34:19
Speaker 3: deep down dive in Technical Technology FUSED conference called Explore,
34:26
Speaker 3: the very first user conference by primar X. And I think,
34:31
Speaker 3: in my opinion, now that I've been in I've been
34:33
Speaker 3: doing conference now what twenty two years, it's those medium sized,
34:37
Speaker 3: smaller size conferences that I get more out of than
34:41
Speaker 3: sometimes being at the mega conference. Like when you send
34:43
Speaker 3: me to HYMNS and HIMSS and you expect me to
34:48
Speaker 3: navigate between forty two thousand people and I think I
34:52
Speaker 3: took eighty steps in two days or something.
34:55
Speaker 4: It it's just like, Wow, what am I doing? What's
34:58
Speaker 4: my name? Where am I?
34:59
Speaker 6: Yeah?
35:00
Speaker 4: So, yeah, I agree with you.
35:01
Speaker 3: I think these uh, I think these smaller user conferences
35:04
Speaker 3: are are more intimate and I like.
35:06
Speaker 5: Them well, and it's much more impactful. I find it
35:10
Speaker 5: doing much more impactful for the attending pharmacy.
35:12
Speaker 6: Right. Like, so if you're going to that.
35:13
Speaker 5: Conference, everyone in that space is situated similarly to you,
35:17
Speaker 5: and so you can ask questions, Hey, I've figured this out.
35:20
Speaker 6: How did you figure this out? How did you did
35:22
Speaker 6: you do it?
35:22
Speaker 5: Did you fix this problem or fix this issue? How
35:25
Speaker 5: did you overcome this challenge with your patients, and you
35:28
Speaker 5: really have, I think an interesting opportunity to change how
35:33
Speaker 5: you're utilizing some of your tech, some of your systems,
35:37
Speaker 5: and we just I mean, there have been several that
35:39
Speaker 5: we've been to this past year and all, I mean
35:42
Speaker 5: all three of them were exceptional. So I would really,
35:45
Speaker 5: you know, if you are using a prescription management system
35:48
Speaker 5: like Prime.
35:51
Speaker 6: And they have a user.
35:51
Speaker 5: Conference, attend because there's gonna be I mean, the pharmacists
35:55
Speaker 5: that I took with me this past year to a
35:57
Speaker 5: couple of those conferences learned way more or outside of
36:01
Speaker 5: the actual conference itself, talking to their peers, talking to
36:04
Speaker 5: other pharmacy users of the same system.
36:07
Speaker 6: It was just it was remarkable.
36:08
Speaker 5: So really, those are the ones that we're looking forward
36:10
Speaker 5: to this year. There's also some, you know, a couple
36:12
Speaker 5: of the other shows where the whole focus of the
36:15
Speaker 5: show is changing your pharmacy into a more modern pharmacy type.
36:19
Speaker 5: Those are a lot of fun as well, where it's
36:21
Speaker 5: really shifting the gears of the pharmacy.
36:23
Speaker 4: So awesome, awesome.
36:26
Speaker 3: Paul Shelton, long Term Care of Pharmacy at Home Network,
36:32
Speaker 3: thank you so much for this time and for being
36:35
Speaker 3: a cond of it, to the to the knowledge that
36:38
Speaker 3: we need to expand our businesses and what you do
36:40
Speaker 3: and can't wait to see at a conference run INTE
36:44
Speaker 3: out there.
36:45
Speaker 5: Absolutely looking forward to it. Todd, thanks so much for
36:47
Speaker 5: having me on.
36:48
Speaker 3: You were listening to the Primarx podcast Portfolio We Are
36:53
Speaker 3: Pharmacy podcast, Tech Trends, Prescribing knowledge, dispensing wisdomy every episode.
36:59
Speaker 4: Thanks for listening.