Technology-Powered LTC: How Pharmacies Can Raise the Bar
To differentiate themselves, LTC pharmacies must strategically leverage a wide range of technology and partner with vendors to drive innovation and efficiency, and deliver exceptional patient care.
By Will Lockwood | PTMR Senior Editor
The long-term care (LTC) pharmacy space is experiencing a rapid evolution, driven by the increasing integration of technology, even as market forces put continued pressure on operations. Here we’ll explore how pharmacies are powering up and leveraging technology to enhance their services and differentiate themselves in a competitive market. By embracing technology, LTC pharmacies can streamline operations, improve patient care, and position themselves for future success.
Technology As An LTC Pharmacy Differentiator
There’s really no way to run an LTC pharmacy and be competitive without a strong technology platform, ranging from a modern pharmacy management system to electronic document and workflow management; facility and patient portals and apps; support for electronic medication administration records (eMARs); delivery management; and adherence packaging automation.
What can LTC pharmacies do to make all this technology a real differentiator rather than just a basic necessity?
Morgan Honeycutt, Pharm.D., is president of Mac’s LTC Pharmacy Solutions, a closed-door long-term care pharmacy with two locations — a headquarters in Knoxville, Tenn., and a second location outside of Atlanta — that serve over 80 facilities with assisted living, personal care, and memory care patients. Dedication to technology and automation has been at the core of Mac’s LTC Pharmacy Solutions’ growth, according to Honeycutt. “We made a strategic decision early on,” he says, “to invest in cutting-edge technology to remain competitive with larger chains and improve efficiency and deliver a high level of customer service.” Operations are currently powered by technology from SoftWriters, starting with the FrameworkLTC pharmacy management system. “The desire at Mac’s LTC Pharmacy Solutions is to be nimble and adaptable as technology advances,” says Honeycutt. “We have built a comprehensive technology suite around FrameworkLTC, with a tracking system that uses barcode scanning, image capture, and automated alerts to give us a precise view of the medication journey, from prescription entry to delivery. This makes us different in the eyes of the patients and facilities we serve.”
A strong adherence packaging process is another example of a potential differentiator, according to Rick Munger. Munger bases this view on his experience as founder of DosePlanner, which provides software designed around patient safety and medication adherence. “My initial goal with DosePlanner was to help pharmacies deliver medications to patients with less confusion,” he says. “Pharmacy can be the resource for packaging that helps caregivers administer medications to patients without confusion.” Pharmacies that have the ability to take on a number of coordination tasks differentiate themselves by making life simpler for patients and caregivers, notes Munger. “DosePlanner software is built to excel at calendaring and organizing medications within blister cards,” he says. The software integrates with pharmacy systems to ensure accurate medication updates and can also be used as a standalone operation for specific client groups.
“Pharmacy can be the resource for packaging that helps caregivers administer medications to patients without confusion.” – Rick Munger
“In the IT world,” says Munger, “we’re always looking for the root cause of a problem so that we can eliminate it.” The first step a pharmacy can take in identifying addressable gaps within packaging workflows is to assess its current level of involvement in medication adherence. Next, Munger emphasizes the importance of viewing adherence packaging as a separate product line, distinct from vial filling and requiring dedicated resources within the pharmacy. “Pharmacies have to be able to synchronize medications,” says Munger, “and have staff skilled in managing medication schedules. They also need to have a system in place to manage and calendarize the entire medication adherence process.”
Perhaps the biggest differentiator, though, is creating and leveraging a symbiotic relationship between technology and human expertise. The more you can automate routine tasks, notes Morgan Honeycutt, the more time you free up for pharmacy staff to focus on more complex and patient-centric responsibilities.
Samantha Oryhon agrees, and emphasizes the crucial role that data analytics and dashboards from Net-Rx™, an MHA Solution, play at Medication Management Partners, a long-term care pharmacy founded in 2010 and serving assisted living and memory care communities across the country. ”From day one, our mission was clear: to establish ourselves as industry thought leaders and experts in the senior living pharmacy space,” says Oryhon, vice president of finance and human resources. “Data-driven insights from Net-Rx have increased our capacity to be experts. It gives us the ability to differentiate by ensuring that the communities we partner with can pick up the phone and quickly reach our staff when support is needed.”
Data Analytics In LTC Pharmacy
Data in fact can be both a bane and a boon in LTC pharmacy, depending on your capacity to manage and learn from it. Clarest Health Chief Technology Officer Jason Cohen sees big benefits from meticulously analyzing prescription data, for example. Clarest Health is one of the nation’s largest providers of long-term care pharmacy services, including through its Remedi SeniorCare and ProCare LTC components. Clarest also offers an end-to-end solution in the home care market and medication management therapy software solution. “Pharmacies can gain invaluable insights into patient care from their data,” he says. “We can evaluate performance with precision and identify areas for improvement in efficiency.”
“For example,” offers Cohen, “you can use your data to look at dispensing and ask: How often are we on time and how often are we able to service the client in the time frame they need?” Cohen sees a lot of value from applying this thinking across pharmacy operations, from prescription filling and inventory to toting, deliveries, and returns. “Of course the ultimate question,” says Cohen, “is how does the patient benefit? Well, the more we can leverage our data to better manage our inventory, for example, the better our cost control is and the more resources we have to work diligently to do everything we need both in front of the patient and behind the scenes to make sure we are taking care of our patients.”
“We are tracking how our mix of payers is changing over time. A one-point change in reimbursements can be pretty significant to the company’s bottom line.” – Samantha Oryhon
“We have so much data,” says Samantha Oryhon, “so having the tools to really cut through to find the signal in the noise is critical. I need to be able to parse through millions and millions of lines of data to find the answers to our business-critical questions. This goes beyond being a savvy Excel user doing pivot tables and lookups."
Oryhon offers several examples of how Medication Management Partners uses Net-Rx to develop a clear understanding of its business. For one example, Oryhon uses a dashboard to track reimbursement flows from payers. “We are tracking how our mix of payers is changing over time,” she says. “A one-point change in reimbursements can be pretty significant to the company’s bottom line.”
She is able to view financial performance by individual community. “We operate in multiple states,” she says. “We can see our overall margins and understand how saturated a market is all the way down to delivery routes, among other things.” Another area that is essential is brand versus generic mix. “Brands are expensive and low margin,” says Oryhon. “Generic drugs are the opposite: lower cost and higher margin.”
Oryhon can also dive into the impact of significant events in the market, like the price cap applied by the Inflation Reduction Act (IRA) to insulin. “One of the big changes that has happened this year is that the cost of insulin has gone down,” says Oryhon. “This is great for patients. But there’s an impact on the pharmacy’s bottom line, because without changing anything else, a price cap results in a loss to gross margins. “In this case, Oryhon reports that she used Net-Rx to analyze the pharmacy’s prescription and payer data and put a specific dollar figure on the impact of this change, “allowing for better strategic planning, budgeting, and cash flow management,” she says.
Embrace Partnerships
While individual elements of technology enable LTC pharmacies to excel, there’s tremendous value in integrating systems. For instance, Medication Management Partners is able to easily analyze the impact of something like the IRA price caps because data flows freely through an integration with the pharmacy management software, in this case FrameworkLTC from SoftWriters. This same integration also supports using Net-Rx to reconcile third-party claims, according to Oryhon. “This integration makes reconciliation much more efficient,” she says.
Clarest Health’s Jason Cohen also understands the importance of integrating dispensing and workflow platforms to improve overall efficiency and effectiveness in the LTC pharmacy space, and takes it one step further. Not only do you want your technology to work together seamlessly, but you also want to develop strong partnerships with your technology vendors. “LTC pharmacies should always be building on their partnerships with technology vendors,” says Cohen. “This is how we understand each other’s opportunities to improve. When technology vendors and pharmacies really walk alongside each other, that’s a performance enhancer.”
Morgan Honeycutt, for one, is actively involved as a pharmacy partner. He has recently become a member of SoftWriters’ artificial intelligence (AI) cohort, a group of industry leaders brought together to provide feedback on the development of AI-driven solutions for long-term care pharmacies. “SoftWriters reached out to leaders of different-size pharmacies across the country with the goal of hearing the pathways they should focus on as they begin to implement AI directly into the SoftWriters suite of products,” says Honeycutt. “They are genuinely listening to us, and I expect that this collaborative approach will ensure that the AI tools being developed will align with pharmacy’s needs and be relevant and effective when implemented.” Of note, Honeycutt is on the speaker program on the topic of AI at the 2024 SoftWriters FrameworkLTC User Conference, with the goal of providing valuable insights for his colleagues.
Getting Out on The Cutting Edge
AI is certainly a major area of focus these days across the business spectrum, and not least of all in healthcare and pharmacy. Jason Cohen suggests that long-term care pharmacies will benefit significantly from leveraging cutting-edge technologies built with AI. “AI can automate routine tasks, predict patient needs, and personalize interventions,” Cohen says. For example, he points to the potential for using natural language processing (NLP) for analyzing patient information, medical records, and data. “We’re still in the exploratory phase with this kind of technology, and there are challenges,” he continues, “but I think there are big opportunities for using these technologies to understand LTC market needs, emphasizing value and outcomes, and optimizing reimbursement strategies.” Cohen views long-term care pharmacy as well positioned to embrace AI-driven technological advancements, although broad adoption will require a shift in mindset and a commitment to innovation.
“AI can automate routine tasks, predict patient needs, and personalize interventions.” – Jason Cohen
Morgan Honeycutt sees an immediate use for existing AI tools such as ChatGPT to generate marketing materials or brainstorm ideas for new programs. AI-generated content provides a solid foundation that can be refined and customized by the team. “This is a very common use case right now,” he says. “But what I’m really excited about is exploring how AI can be applied more directly to improving daily care for seniors in nursing homes and assisted living facilities.”
Returning to data analytics, Cohen believes that AI will also likely usher in a new world of predictive tools. Successful LTC pharmacies have long been leveraging technology to automate repetitive tasks and analyze data more effectively, and AI should unlock a significant opportunity for pharmacies to take the next big technology-driven leap in handling large and complex data sets with efficiency and accuracy. “AI will be able to apply predictive analytics to vast amounts of data,” he says. “For example, think about the impact of AI-driven analytics for looking through data from tens of thousands of prescriptions and answering a question such as: What will our 30-day inventory look like?”
Algorithms And AI
The greatest benefits will come when vendors are able to use AI to introduce entirely novel tools that boost pharmacy operations and help pharmacies level up the rules-based process that’s already out there.
“We already use a lot of algorithms, such as processing prescriptions based on barcodes and document management systems that can automate data entry and workflow queue management,” notes Morgan Honeycutt, “and they are very useful.”
But there are limitations to existing rules-based workflows, and Honeycutt is eager to see how AI can be applied to a long list of currently labor-intensive areas of pharmacy. For example, electronic prescriptions and new admissions now require staff to copy information from one document into another. And then readmissions require staff to analyze medication lists and identify changes in the patient’s treatment plan. Can vendors develop AI tools to reduce this workload?
Honeycutt would like to see AI tools that process and manage a wide range of incoming communications and automatically extract relevant patient information. “This will significantly reduce manual labor,” he says, “and allow staff to focus on reviewing the AI-generated data and intervening only when necessary.”
“I’d like to see AI automate tasks like gathering the necessary information, scheduling appointments, and disseminating information to communities efficiently. This would free up pharmacy staff to focus on clinical decisions, patient care, and medication reviews.” – Morgan Honeycutt
Honeycutt further suggests that AI could play a role in clinical reviews, analyzing patient information to make recommendations, such as suggesting the appropriate level of care. Or it could be tasked with triaging incoming orders, prioritizing time-critical ones such as antibiotic prescriptions or emergency medications. “An AI-enabled STAT orders queue could be a very effective timesaver and ensure we’re taking care of critical orders right away,” says Honeycutt. For example, when a patient is placed on hospice care and a new order is faxed to the pharmacy, AI could recognize this and put this into a STAT queue for immediate attention.
Similarly, Honeycutt sees AI applications in delivery management. “We have the challenge of coordinating 80 daily deliveries,” he says. “What if AI could dynamically provide real-time optimized routes and prioritize urgent orders to ensure they are on the road to patients as soon as possible?”
Finally, Honeycutt sees potential for AI to streamline administrative tasks, such as scheduling and organizing community outreach events for flu and COVID-19 vaccination clinics. “I’d like to see AI automate tasks like gathering the necessary information, scheduling appointments, and disseminating information to communities efficiently,” he says. “This would free up pharmacy staff to focus on clinical decisions, patient care, and medication reviews.”
While the opportunities for applying AI in pharmacy look wide open, that very fact can lead to anxiety among pharmacy staff. “We’re all trying to understand what AI means for us,” says Samantha Oryhon. “I think AI can seem very scary in pharmacy. Will we truly be able to rely on AI tools to be accurate and effective?” Oryhon is optimistic, however, that there are many functions and processes in pharmacy that AI can handle. And while she doesn’t expect a fast pace of change, she will be keeping an eye on how software providers are advancing the use of AI in pharmacy systems.
Future-Proofing
Pharmacies need to be engaged in a constant search for the latest technology that can raise the bar for patient care and operational excellence, and Jason Cohen emphasizes the importance of a thoughtful and mindful approach. “When we talk about implementing something like AI or other cutting-edge technology in long-term care pharmacies,” he says, “we have to stress that these advances should be presented as tools that enhance human capabilities rather than replace them. We need to be careful about the potential for negative perceptions. The focus should be on demonstrating how technology improves care, quality, and efficiency, rather than highlighting the technology itself.” It is by strategically implementing emerging technologies that Cohen sees long-term care pharmacies being able to future-proof themselves and provide even higher quality care.
Perhaps the biggest differentiator, though, is creating and leveraging a symbiotic relationship between technology and human expertise. The more you can automate routine tasks, the more time you free up for pharmacy staff to focus on more complex and patient-centric responsibilities.
Pharmacies should also ensure they’ve learned one of the lessons of the massive supply chain disruption that occurred during the COVID pandemic. For example, LTC pharmacies frequently invest in technology that supports a variety of packaging automation options, in large part because different LTC facilities prefer different kinds of packaging, notes DosePlanner’s Rick Munger. “But pharmacies should also consider how flexibly they can switch between types and even brands of packaging,” says Munger. “Being able to support multiple brands was particularly valuable during the pandemic when supply chain disruptions affected medication packaging availability. We saw the value of this among our pharmacy customers, because our software’s flexibility allowed them to quickly switch between different brands of medication packaging, minimizing disruptions to patient care.”
Samantha Oryhon strongly encourages LTC pharmacies to keep an eye on their finances as they look ahead. “We all know that there’s a constant pressure on pharmacy gross margin,” she says. “You need to ensure you have a way to understand how to put hard numbers on the impact a development like the IRA price caps has on your pharmacy. Just using the IRA as an example, we are working every day with our Net-Rx tools to make informed decisions that address cost saving and boost productivity.”
LTC Pharmacy Action Plan
So what’s the action plan for an LTC pharmacy looking to raise the bar? Clarest’s Jason Cohen emphasizes the importance of bundling services and collaborating with other healthcare providers to offer comprehensive care in the long-term care market. “Pharmacies need to differentiate themselves by focusing on patient-centric care, medication therapy management, and providing end-to-end solutions that address patients’ needs throughout their healthcare journey,” says Cohen. There will be a premium on adherence management as a means for improving patient outcomes and reducing costs. “It’s our goal at Clarest Health to become more driven to serve the patient along their whole journey by offering a comprehensive suite of services,” he says. This is an approach that he sees as crucial for all LTC pharmacies that want to position themselves as essential partners in the healthcare ecosystem.
At Mac’s LTC Pharmacy Solutions, Morgan Honeycutt will be keeping his focus on streamlining administrative tasks to ensure staff are able to focus on clinical tasks and patient care. “This ultimately leads to improved patient outcomes and a safer practice,” he says. “Pharmacies are in a tough, and maybe unique, situation, where we have so little control over prices for our primary product, medications. So we have to look at what we can control, and operate as efficiently as we can to maintain high-quality care even in the face of declining revenue and margins.”
DosePlanner’s Rick Munger suggests that pharmacies can be hesitant to enter or expand in the LTC market because of labor-intensive standards of practice such as adherence packaging. “LTC pharmacy can seem like too much work,” he says, “but you can take a phased approach. In the case of adherence packaging, it’s OK to start with manual filling and gradually transition to automation as needed.” He emphasizes that pharmacies should further consider space requirements for filling stations and delivery operations. Still, he notes, investing in automation early will yield results that help pharmacies scale up their medication adherence services quickly.
Medication Management Partners’ Samantha Oryhon encourages pharmacies not to be overwhelmed. “Managing an LTC pharmacy can seem like drinking from a fire hose,” she says. “So the biggest thing is being able to prioritize what’s important at the moment. You can use your data to help with this. You just need the right tools to efficiently analyze it and bring trends to the forefront. Then your analytical mind can dig in and find answers to important questions.” PTMR