Partner in Population-health Management: Walgreens, Anyone?
When Robert London, MD, received a phone call from an executive recruiter who suggested that he interview for a position at Walgreens, he was flabbergasted. “I wondered what I was going to do,” he recalls. “Would I stand at the door and greet people? Let them know about a new shade of nail polish?”
As London soon learned, however, the company, which operates some 8,000 Walgreens retail pharmacies across the United States, is positioning itself not as the corner drugstore, but as a multichannel provider of health-care services. In so doing, it is collaborating with other providers, such as physicians and hospitals—which, in turn, are tackling the unruly task of managing population health. London (who now serves as national medical director for Walgreens) described several initiatives implemented by the pharmacy heavyweight during the panel discussion “Partnering For Value—Innovative Collaborations for New Product Opportunities and Improving the Economic Value of Health Care,” on November 13, 2012, at the Ninth Annual American Health Care Congress, held in Anaheim, California.
Transitioning to Compliance
In addition to operating hospital pharmacies for more than 135 health-care systems nationwide, Walgreens has established a program wherein it partners with hospitals to offer medication delivery to patients immediately prior to discharge. Known as WellTransitions, the program was designed to improve medication adherence and patient outcomes, thus reducing readmission rates.
Under the WellTransitions umbrella, pharmacists review prescriptions at admission and discharge, checking for potential interactions. A member of the Walgreens pharmacy staff brings medications to patients’ bedsides, sharing detailed information about how to take each one. Pharmacists then initiate follow-up calls to discuss medication regimens and answer any further questions that patients might have. Round-the-clock phone and online support also are provided.
“Health-care systems have been very receptive to the model,” London says. “We are working to take it nationwide.” Research undertaken by Walgreens indicates that collaboration of this kind reduces readmission by at least 50%, London claims.
In another vein, the Walgreens Take Care Health Systems subsidiary operates approximately 500 worksite health/wellness centers and about 450 Take Care Clinics at Walgreens stores. The worksite centers offer primary/acute episodic care, as well as occupational-health services; population-health management (testing, wellness coaching, and chronic-disorder management); ancillary services (including physical therapy); and on-site pharmacies.
Take Care Clinics provide primary/acute episodic care and population-health management, including screenings, and conduct the Welcome to Medicare and Medicare Yearly Wellness exams available to Medicare enrollees. The Medicare services encompass screenings for common conditions, in addition to education and counseling aimed at encouraging wellness and preventing disease.
CDC Certified
In addition, immunization-certified pharmacists at Take Care Clinics (in the 34 states where this is permitted) administer vaccinations recommended by the US Centers for Disease Control and Prevention (CDC). Biomarker tests (for blood-glucose, cholesterol, and hemoglobin levels) are administered, where permissible. Alerts pertaining to missed doses, at-risk behavior, or potentially serious adverse effects of medication are communicated to prescribing physicians. Problems are brought to patients’ attention immediately; for example, should a test reveal an excessively high blood-glucose level in a patient with diabetes, the patient is instructed to contact his or her primary-care physician right away.
“At the Take Care Clinics in our stores, we’ve brought pharmacists front and center; they are no longer sequestered in the back, counting pills,” London says. As an adjunct to general patient education, counseling, and the like, Walgreens has developed a series of six-minute consultation modules used by pharmacists at the point of sale. “Our pharmacists will stop what they are doing to go through the content, from reinforcing how a certain medication should be taken to how to administer an insulin shot,” London explains.
More than 2,000 Walgreens locations (including 28 in New York, New York alone) have been designated HIV centers of excellence; these are situated in communities highly affected by HIV (as designated by the CDC). They are staffed by specially trained pharmacists who work closely with patients to offer guidance and support for medication use, to provide refill reminders, and to help identify financial-support programs. Community-outreach initiatives executed by these pharmacists drive awareness about services accessible through the centers of excellence. Many Walgreens pharmacies also have been designated diabetes centers of excellence; they provide a similar roster of services to diabetic patients.
Collaboration is valuable all along the health-care continuum, London observes. Diabetes patients who participate in a disease-management program that involves one-on-one interaction with a pharmacist, he explains, demonstrate high levels of engagement and significantly better clinical outcomes. Pharmacist intervention (including consultation at the point of sale, in which 98% of patients participate) also has been shown to decrease certain risks, London says, and compliance rates at the HIV centers of excellence average 90%.
Up in the Cloud
For future collaborative endeavors, London says, Walgreens will harness a cloud platform to implement an electronic health record (EHR) solution, WellHealth EHR. The EHR is currently in more than 200 Walgreens stores, with chainwide rollout slated for completion this summer. Its deployment in Walgreens in-store pharmacies follows the implementation, in 2010, of an integrated EHR, practice-management, and interoperability solution in the chain’s worksite health centers.
The EHR will yield pharmacy staff a single view of each patient’s immunization and health-testing history, along with that individual’s prescription profile. Once the deployment is complete, such information will be available to pharmacists at any Walgreens location, regardless of which store actually provided the service. The solution will be scalable, thereby making later enhancements of its functions possible. For example, Walgreens will be able to integrate the EHR with an electronic-prescribing and data-exchange system that tracks patients throughout the care continuum.
For Walgreens, collaboration-oriented plans call for partnering with the pharmaceutical industry in conducting clinical trials. The first such trials will begin this year. Pharmacies and big pharma might be odd bedfellows—as might employers and pharmacies—but with these (and other) types of cooperation, “We can change the face (and improve the quality) of health care,” London concludes.Julie Ritzer Ross is a contributing writer for Health CXO.