A Business Model for Advanced Pharmacy Services

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Value-added services are more likely to succeed with use of business planning tenets. This includes scanning the environment, identifying target markets, developing a plan and timelines, delineating appropriate markers for success, and evaluating the program against those markers you have established. This is the case in any setting or situation, and might be especially prudent when examining business opportunities in new/evolving settings and when taking on some risk as is the case in a patient-centered medical home.

Fabel et al detail this process in their description of a successful  model.1 Their primary objective was to develop a sustainable business model for pharmacist-provided comprehensive medication management (CMM) services in a patient centered medical home (PCMH). A secondary objective was to evaluate the impact the pharmacist had on clinical (A1C, LDL, and blood pressure) and economic (physician productivity and cost avoidance) outcomes. The authors describe how the interdisciplinary team undertook SWOT analyses and took stock of the greatest needs of patients in that area in developing a model that would work and be accountable to the PCMH and thrive in a semi-capitated environment. At the time, the practice employed 5 physicians and 2 nurse practitioners and served more than 20,000 patients. The pharmacist targeted patients with diabetes, lipid disorders, hypertension, congestive heart failure, obesity, polypharmacy, and/or treatment regimen nonadherence for his CMM services. The pharmacist was available for immediate consultation or referrals by appointment 5 days a week. Services provided by the pharmacist were billed as “incident to” (99211) physician evaluation and management services codes. Number of patients seen per day, revenue collected from services rendered by the pharmacist, physician productivity and payment, cost avoidance, and health quality metrics were measured to determine the financial sustainability and clinical impact of the project. The pharmacist was able to see an average of 11 patients per day, which was 72% of his capacity. The practice collected about $7400 per month for services rendered by the pharmacist. Over 70% of uncontrolled patients had an improvement in clinical outcomes, such as A1C, LDL and blood pressure.

This project detailed by the authors was successful following careful planning. It included an extensive array of benchmarks for success that could be monitored for improvement, such as the case where the capacity analysis demonstrated the pharmacist could be even better integrated into the process, thereby indicating that workflow and marketing would need to be improved for even greater success. Business planning includes many components, not just merely generating an idea and hoping it will succeed.

Additional information about Business Planning and Implementing Value-Added Pharmacy Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Fabel PH, Wagner T, Ziegler B, et al. A sustainable business model for comprehensive medication management in a patient centered medical home. J Am Pharm Assoc. 2019;59(2):285-290.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California