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Situation: Fast Growth Caused Outgrowth

Our client provides pharmacy benefits management services to hospices. These services include:

  • Accepting new patients and their medications.
  • Having a pharmacist review these medications for necessity, efficacy, coverage under the Medicare hospice benefit, and drug combinations having undesirable side effects not anticipated by doctors.
  • Registering patients and medications with a prescription clearinghouse, enabling patients to begin receiving their prescriptions at any pharmacy nationwide.
  • Reporting medication usage, costs, and other statistics to the hospice.

Opportunity: The Chance to Do Things Right

Our client was experiencing rapid growth, which caused a major problem – their pharmacists could not keep up with the number of reviews required for new patients, let alone updated reviews of existing patients periodically requested by the hospices.

As a stopgap measure, our client retained contract pharmacists to help process the backlog – however, this was neither a desirable nor affordable long-term solution.

Solution: Building a Solution Focused on Efficiency & Effectiveness

After analyzing the pharmacists' processing and time required for each step in the process, we believed we could cut out over 50% of the current time being spent. In numbers, it took about 10 minutes for a pharmacist to get a patient folder, review the list of medications, hand-write review notes, and then physically fax the review to the hospice.

We focused on ways to take time out of every step in the process, by embedding improved processes into a custom-developed application.

  • Pharmacy technicians now enter the patient information and medications into the system, using source documents from the hospice. This information is then placed in a queue for review.
  • Pharmacists work the queued items in order, with all the necessary information presented neatly on screen.
  • The system has "learned" and stored the most frequent comments for a specific drug, and retrieves and populates them as the pharmacist begins typing.
  • The pharmacist marks the review as completed – the system then immediately archives the review in PDF format.
  • The pharmacist can press a button to review the PDF, and press another button to have it faxed electronically to the hospice.
  • A final button permits the pharmacist or pharmacy technician to send the patient and medication information to the prescription clearinghouse.

Pharmacy Benefits Management System Input Screen

Screen Shot of Input page on Client's web interface Callout-Buttons-w-Explanations

Pharmacist Review As a PDF

The new system presents the user-selected medication list for the pharmacist's review. All medications are shown, as well as vital information on the patient and the diagnoses.

Pharmacist Review

Results & Benefits: Streamlining the Most Expensive Process

Our single-minded focus to reduce time for the pharmacists yielded impressive results – what had taken 10 minutes per review now takes about 2 minutes, for an 80% reduction in time. Furthermore, the process improvements and technology usage significantly reduce the chance of errors and provided detailed audit capabilities.

The simplicity of the pharmacy review screen belies its power – and its cost savings. Just this one feature yielded about $140,000 savings in the first year. As volume increases in future years, the savings will increase even more.

Conclusion: Fast Growth Now Easily Supported

Instead of completing patient reviews by hand, our client's pharmacists can now do it electronically with

  • greater accuracy,
  • more detailed review notes,
  • in a fraction of the time, and
  • with an audit trail of work done and reviews faxed.

The first-year savings attributed to this single screen more than paid for the entire project.

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