Utilization Management
Verify eligibility, optimize reviews, and streamline appeals and grievances.
Utilization Management
Verify eligibility, optimize reviews, and streamline appeals and grievances.
Care Management
Enable preventative care, manage medical interventions, and efficiently report on program outcomes.
Medication Management
Perform and bill medical services, ensure medications are safe and effective, and identify ways to improve care.
Quality Management
Improve outcomes, lower costs, and adhere to standards, such as HEDIS, Stars, and PQA.
Specialty Pharmacy
Tara Pfund
In the world of community pharmacy, a focus on patient care is important. Pharmacist providers are dedicated to delivering clinical services that improve health outcomes, but often, the journey to create and implement new programs in a community pharmacy can be daunting. This challenge is particularly prevalent in independent community pharmacies, where owners and managers juggle various roles, from prescription filling to team management and clinical services provision.
The common approach seen amongst pharmacists is to wait until everything is "perfect" before launching a new program. This perfectionism can mean having every detail meticulously planned out, from patient and provider forms to mastering medical claim submissions or even waiting for a few test patients. Unfortunately, this waiting game can delay the launch of crucial access to patient care by several months, which can impact both patient’s health and the pharmacy's bottom line. It's time for a change, and our patients and the pharmacy profession need us to act now!
Imagine having a centralized resource that offers customizable clinical content and support, allowing you to kick-start your clinical programs immediately. There is no need to wait until every aspect is perfectly researched and vetted or until your medical billing clinic is set up. You can begin by offering cash-based services while preparing your pharmacist provides for the next step: Medical Billing.
We want you to open appointment availability as soon as possible but there are still a few key considerations if you are brand new to expanding your traditional pharmacy to a destination of patient care. Topics that community pharmacists can benefit from support with include:
Vaccines | Asthma Management |
Medication Management | Cholesterol Management |
Travel Vaccines and Medicine | Diabetes Management |
Tobacco Cessation | Hypertension Management |
Naloxone & Opiate Risk Assessment | Urinary Tract Inecction |
COVID Test to treat | Vulvovaginal Yeast Infection |
Flu Test to Treat | Minor Burns |
Strep Test to Treat | Bee Stings |
Hormonal Contraception | Human and Animal Bites |
Long Acting Injectables |
By following these steps, you can free up time to focus on what you do best, caring for your patients. You don't need a perfect 12-month marketing plan before seeing your first few patients. Evaluate your workflow, scope, and clinic needs, and dive right in. Remember that not every detail has to be perfect as you build your clinical program(s).
As professionals, let's unite behind clinical services and advocate for sustainable reimbursement. By shifting to new workflow models that enable clinical services within our scope, we, as clinical pharmacists, can expand access to care and drive quality outcomes, aligning ourselves with the broader healthcare ecosystem.
The future of clinical community pharmacy is bright, and our commitment to patient care will lead the way. Together, we can achieve remarkable progress in delivering quality healthcare services within our communities.
Tara Pfund
PharmD, Product Manager
Ruger Stufflebeam
May 18, 2023
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