3 ways technology is advancing patient care, enhancing the pharmacy and driving outcomes
Standing: Tim Weippert of Thrifty White Pharmacies, Craig Norman of H-E-B, Brandon Worth of Walmart, Khan Siddiqui of higi, Jeff Key of Pioneer Rx and Philecia Avery of Kroger. Seated: Guest moderator Chris DImos of McKesson, Rick Gates of Walgreens, Josh Flum of CVS Health, Frank Maione of PerceptiMed and Jocelyn Konrad of Rite Aid.
As part of its annual Industry Issues Summit in December, Drug Store News assembled a first-class panel of retail pharmacy and supplier executives for an exclusive, in-depth discussion on leveraging technology solutions to improve pharmacy care, drive adherence and foster greater patient engagement.
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Special guest moderator Chris Dimos, SVP corporate strategy and business development at McKesson, set the table with a snapshot of how fast technology is changing health care. “Any Star Trek fans out there? Remember the Tricorder? For two-and-a-half years Qualcomm has been trying to develop a personal device called the Tricorder XPRIZE ... [for] consumers that could take up to 13 different biometric measures and diagnose up to seven or eight conditions in a handheld device that would be sold at your local retailer. ... I think it will be revolutionary ... with the patient becoming much more in control of diagnosing and determining how they’re going to manage their health care. Last year, they had seven teams working on the XPRIZE; two-and-a-half years ago it was just a concept, and it’ll be a product on the shelf ... in the near future.”
Driving behavior change
So I think one of the things that’s important to recognize is that staying adherent is hard. And the statistics bear this out. Half of patients in treatment for chronic conditions drop off therapy in the first year, with the biggest dropoff occurring in the first month.
So how do we think about helping our patients stay adherent? We think about it in a couple of different ways. The first is acknowledging that, before focusing on specific clinical interventions, we really have to coach and train our pharmacy teams in how to help patients change their behavior. So that means spending time working on enhancing the impact and influence of our teams, versus just launching new interventions and programs, and giving our teams the tools and framework to be able to create behavior change more effectively with their patients.
Then when we think about adherence programs, what we’ve learned is that it’s really a series of interventions across the continuum of care that are more effective than necessarily that one time sit-down to say, ‘Let me take you through all of your issues and create a care plan for you.’ So having the right conversation on a first fill, following that up a few weeks later by giving the patient a call and talking about how they’re doing, creating automated refill reminders or giving patients a call at certain trigger points when they become nonadherent. Following up all along that continuum of care with short, targeted interventions really does — over time — change behavior and lead to significant improvement in outcomes. — Josh Flum, EVP pharmacy services, CVS Health
We are doing it in all of our pharmacies, really focusing on medication adherence and driving those behavior changes. And we’ve learned a lot with our Rite Aid Health Alliance program in particular because we were able to take the time with patients and meet them where they were at that point of their journey, as well as in the adherence piece. We learned a lot about patients not understanding why they’re taking their medication. ... They’re told, as we’ve heard, ‘Take your medication.’ That’s what most doctors and/or pharmacists [say] all the time. However, once they understand [No.] 1, what their chronic condition is, [No. 2] ... why it is so important and [No. 3] proving to them that they can feel better after taking their medications by [doing] small things — if it’s blood-pressure medication, utilizing a higi machine or letting them know, ‘Take this for seven days, come back, check and see the results and prove it to yourself that by taking your medication, it does do something.’ ...
The tools we have been using are fabulous; we utilize apps as well as all of the devices. We [make] all of that available for our patients. But again, it’s very easy to click on an app and say you took [the medication] when you didn’t, or to ignore a lighted box because, again, you don’t know why you’re taking the medication or why it’s important for you. You have to change the behaviors of patients, and the only way you’re going to do that is to meet them where they are and step by step help change those behaviors with them hand in hand. It’s not a once-and-done thing; it’s a constant, ever-evolving change for them. — Jocelyn Konrad, EVP pharmacy, Rite Aid
... It’s very difficult to create new habits for a consumer. ... But it’s much easier to influence an existing habit or tie the behavior change you want to incentivize around an existing trigger. So, for example, there are natural triggers; you wake up, you eat breakfast, you commute, you have lunch, you commute again, you go back home, you go to sleep. These are natural triggers that happen at home, and then if you can tie what you’re trying to change with those natural triggers, those are awesome ways to add a new behavior. The second thing is, we have natural behavior in our retail environment. I’m coming in the store, so what do you want them to do when they arrive in the store that can be tied to that? Once you have identified a trigger, then it’s very important that the incentive that you’re giving them from an external point of view — whether it is some kind of reward or a coupon — also ties to the internal motivators.
It’s very important to understand what the internal motivation is for them to do adherence or anything else. So, for example, if I just look at physical activity, why do people want to be healthy and live healthy lifestyles? ... It’s, ‘I want to look good. I want to feel good. I want to do it because it’s a social activity for me.’ ...
But why do you want to take a medication? It’s because my doctor — somebody who’s an authority — told me to; I’ve seen other patients with the same disease take the medication; I’ve internalized that it is beneficial for me; and I want to see my grandkids in the future. And the last one is my belief in treatment. So if you don’t align the communication, messaging and incentives that you’re putting around why internally people want to take medication, you won’t see long-term compliance.
And the last thing I always say ... is that it has to be effortless. If you have high effort needed to do adherence, it will slowly taper off and people won’t comply with it. ... When we talk about medication synchronization, I talk about behavior synchronization; can you synchronize the medication timing with what they’re already doing in their life on a daily basis? You’ll see much higher compliance with behavior change. — Khan Siddiqui, chief technology officer/chief medical officer, higi
Differentiating the pharmacy experience
One of the things that we’re doing is we’ve taken