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Editor’s Note: Cardinal Health at-Home Solutions plays an instrumental role in providing patients and caregivers critical tools they need for care in the home. This article is part of an ongoing series on the innovations, products and services the business delivers directly to patients’ doorsteps on behalf of its 5 million customers nationwide.
The need for more collaboration in healthcare is increasing as Americans experience greater levels of chronic conditions than ever before. An estimated 129 million people in the United States have at least one chronic condition, according to the Centers for Disease Control and Prevention (CDC). Common chronic conditions include heart disease, diabetes, hypertension and obesity – to name a few. The CDC reports that nearly half of those – or about 54 million people – with chronic conditions have more than one.
“It’s a simple equation: The more patients we have to treat, the more connected our healthcare system needs to be,” said Rob Schlissberg, president – Cardinal Health at-Home Solutions, which delivers medical supplies directly to patients’ homes to aid in the management of these types of conditions.
The idea of a more connected approach to healthcare with a greater emphasis on patient outcomes is part of an emerging healthcare landscape called value-based care. And, according to a McKinsey report titled, “Investing in the new era of value-based care,” it’s a distinctly fast-growing model. In fact, McKinsey reports that value-based care may be on track to reach $1 trillion in enterprise value as it matures.
The Centers for Medicare and Medicaid Services (CMS) reports that value-based care not only has the potential to improve patient outcomes, it can advance health equity in a number of ways by focusing on personalized treatment plans, encouraging screening for social determinants of health and connected people to resources like food banks and transportation services. It’s also playing a role in tracking outcomes across populations to identify disparities.
In a value-based approach to a person’s care, everyone is responsible for that patient’s health outcomes – from the physician to the insurance provider, all the way to home medical equipment suppliers (HMEs) like Cardinal Health at-Home Solutions and pharmacists. HMEs provide the supplies a patient needs to manage long-term conditions from home, whereas a pharmacist may supply medication and other services and supplies to support patient needs.
“Independent retail pharmacists especially are uniquely positioned to thrive under a value-based care model – they are already a center of care for their communities, especially if they’re in a rural area that may lack various health resources,” Schlissberg said. “As chronic conditions continue to rise and healthcare maintains its shift into the home, it wouldn’t be surprising if local pharmacies start to see patients turn to them more often for services and support beyond a traditional pharmacy scope.”
As more patients are prescribed medical supplies to manage their chronic conditions from home, they may take it to their local pharmacist to fill these prescriptions, just like they would a medication. However, filling a prescription for medical supplies – like a continuous glucose monitor, diabetic test strips, lancets and syringes, for example – differs from filling a prescription for a medication. And the way these scripts are filled and reimbursed varies depending on your insurance plan.
For example, if a patient is on Medicare, those medical supplies prescriptions are often covered under Medicare Part B. Part B billing can be a difficult task, especially for independent pharmacies – it involves complex, oftentimes changing rules, documentation and paperwork. Not to mention, the reimbursement amount today doesn’t always cover the costs for pharmacies to bill for these types of prescriptions. Instead, when a pharmacy receives a prescription for something covered under Part B, it can send it to Cardinal Health at-Home Solutions’ mail-order medical supplies delivery business, Edgepark. Edgepark then collects necessary documentation, bills insurance plans and delivers that prescription directly to the patient’s doorstep. “This can give pharmacies the time and resources back to focus on patient care,” Schlissberg said.
Wimberly Gayle
To hear firsthand about the future of independent retail pharmacies and the role they play in home-based care, we sat down with Wimberly Gayle, a 1994 graduate of the University of Mississippi School of Pharmacy who owns and runs Curry Pharmacy in Clinton, Louisiana, with her family. Curry Pharmacy offers more than just your typical pharmacy services, including wellness classes and programs, patient education, medication synchronization services, diabetes support programs, smoking cessation support and more.
Q. How long have you been an independent retail pharmacist?
Wimberly Gayle (WG): Wow – it’s been 30 years. I moved back home to Clinton, Louisiana, after graduating college and went to work for the local independent pharmacy, Curry Pharmacy. Curry Pharmacy was opened in 1975 by William Huber and Lamar Curry. My husband and I bought that independent pharmacy in 2001, and we decided to keep its original name when we purchased it because, well – it’s Curry Pharmacy: This is the pharmacy that took care of us while we were growing up. Now, we’re passing on the love we all have for this community and its people. We are a small, rural town where family and friends come first. Everyone in town knows my staff and that we can be reached any time – day or night – when they need us. And yes, that means most of Clinton has my cell phone number (or knows someone who does).
Q. What do you see as the future of independent retail pharmacies?
WG: I think it’s helpful to look at what happened during the COVID-19 pandemic to help predict the future. When the pandemic hit, we all had to change direction and plans on the fly. Independent retail pharmacies saw a need and opportunity to service their community in new ways – and we stepped up to the plate. Collectively, we knocked it out of the park.
What we do best is take care of patients like they are our family while keeping our heads up and eyes open to new opportunities that may fall out of the evolving umbrella of care. The future is looking the brightest, especially, for independent retail pharmacies as healthcare continues to shift into the home. I think there’s incredible opportunity with community care at-home programs, chronic care management and meds-to-beds programs, to name a few.
Q. What is the greatest benefit of being a local pharmacist in your community?
WG: Caring for generations of families is something truly special. If you live in Clinton, chances are I’ve cared for you, your parents – and I’ll take care of your children and your grandchildren. Additionally, working with local healthcare providers who value my knowledge and are appreciative of my input – and even take time to listen to my questions – deeply benefits my community’s health and well-being. We all have the same priority, after all – and that’s our patient’s health.
Where I think there’s an opportunity to add more value is getting into diabetic education and contributing more to chronic care management. As always, time is the biggest challenge especially for local pharmacies like mine. Getting educated on complex billing and how to set these programs up would need to be done as a first step – but again, that falls back on the time we have available as well.
Q. Recently, Medicare passed new guidelines that expanded insurance coverage for certain Type 2 diabetes patients, making it possible for them to get continuous glucose monitors covered under their plans. Has this increased the number of patients who are hoping to fill their diabetic supplies through you?
WG: Absolutely – with the approval of CGMs for certain Type 2 diabetics, we are getting more and more requests from patients for these types of medical supplies. The problem is that we have never been able to bill for these types of prescriptions under Medicare Part B. The reimbursement we receive from Medicare didn’t cover our own costs when you include the time and documentation necessary to pass audits. So, in the past, if a patient would come in with a prescription for diabetic supplies, for example – my staff would have to say, ‘Sorry, but we don’t bill Part B.’ And we’d have to turn them away.
We needed a plan to help these patients because we couldn’t bill Part B. We are a small community – we simply can’t just turn patients away with no solution. We recently learned that, with the patient’s permission, we can transfer the patient’s prescription for the Part B medical supply to Edgepark (a business unit of Cardinal Health at-Home Solutions). Edgepark could support the patient with his or her medical supply needs through mail-order delivery. Working with Cardinal Health at-Home Solutions to ensure we could do this to provide the best care to our patients was a no-brainer and makes our offerings to our patients more inclusive of all the health conditions they may be facing.
