As those who read this blog routinely… you know that I am semi-retired and on Medicare.. so I am at the mercy of the FEDS.
As a RPH.. this concept concerns me for our profession…
There is a whole lot of talk about “quality care”… but who determines what is the adequate level of “quality care”.. does this measurement include the pt’s perception of “quality of life” particularly with those patients that have subjective diseases ( pain, depression, anxiety, mental health, etc, etc).
These ACO’s sounds much like the HMO’s that were tried in the 70’s.. and I am not aware of any pharmacy/chain that tried to work under a capitation reimbursement system… renewed their contract.. at the expiration of the first contract.. Other than Kaiser on the west coast… HMO’s seemed to give comedians a lot of material, but weren’t that successful otherwise.
from the article:
“The way I like to describe it is as a physician-led plan where we’re an active partner,” Kang says. “They’re the quarterback who creates the treatment plan. We can be care extenders who help implement and execute the plan.”
I will get out my crystal ball… and read between the lines of what Kang said… The doctor will diagnose (treatment plan) and we will decide what drugs the pt is to get…
We will not have to worry about DAW’s,PA’s and brand names.. because our computers and clinical dept will have computer generated therapy based on the diagnosis. This will be just another “metric” that we can control/manage. We are .. after all .. a FOR PROFIT COMPANY.. with stock holders to please. The pts have basically turned their health over to the ACO… and pt input is not really welcomed… we will assure them that our computer generated therapy is the best to optimize our profits their therapy and quality of life.
our ARNP’s, NP’s, PA’s & RPH’s will have access to the pt’s entire electronic medical records and will continue to monitor these pts with chronic conditions… Once we get our “hooks” into these pts, we will encourage them to come back for basic medical needs..
From the article
They have begun to handle basic health care, like vaccination and preventive check-ups, right in the store, which could prevent more costly diseases down the line.
Pharmacy stores are open every day of the year, making them a more accessible point of contact than most doctor offices.
We will be much more convenient that the normal doctor’s office hrs.. we will eventually have 24/7 “nurse-in-a-box”.. we may even need multiple nurses in a single box at some locations… we will be competing directly with the doc’s and ER for pts visits. Eventually we can justify increasing our per-cent of the pt’s premiums.
We will develop a pt driven auto-refill.. we will text/email/call a pt 7-15 days before they should be out of medication and request that they respond if they want it to be refilled now.. if they say NO.. we will ask them how many doses they have on hand and recalculate the date needed.. These will all be handled in a central fill/mail order highly automated facility… we already have two states (AZ & FL) where these are up and running… we have been refining the process for nearly 5 yrs… expanding this concept is a no-brainer.
We are studying the concept of repositioning some of our 24 hr stores and eliminating others as 24 hrs… We may be able to reduce the remaining stores’ Rx dept to a 60 hr week… because we have redone our front end product mix to make the store more of a convenient store and may not need the Rx dept open all those hrs as a customer draw. Pts will just have to travel a few exta miles to one of our 24 hr stores… to get the Rxs they need at hours our 60 hr Rx depts are not opened.
I am sure that there will be an appeal process to get products/services provided or not provided… but.. typically those that are the highest cost pts.. are the ones who are the sickest and have neither the mental/physical strength to fight the system..
Any time that you put a “bean counter” between you and the healthcare services that you want/need… guess who is going to come out ahead ?
Filed under: General Problems
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