Winn-Dixie MTM Program Off to a Flying Start

DAN ALAIMO

BOSTON — In the first nine months of its Medication Therapy Management program, Winn-Dixie Stores, Jacksonville, Fla., had 68% of its pharmacies participating, Daniel Rodriguez, professional services manager, told a workshop at the recent Pharmacy & Technology Conference here of the National Association of Chain Drug Stores, Alexandria, Va.

This is a total of more than 3,000 personal interventions for a period ending in June, he said. Looking ahead a year, Rodriguez told SN, “I basically want to see that number double.” The chain has 401 pharmacies in its 525 stores, he said.

“It takes some time and some investment, but you can get people going where you want them to if you've got the right ideas behind the program,” he said.

This is representative of the high level of interest supermarket pharmacies have shown in MTM programs. The Food Marketing Institute's recently issued Pharmacy Trends 2007 study showed that 72% of supermarket pharmacies either currently offer, or plan to offer, medication therapy management services.

Although MTM caught the industry's attention when it was identified as a part of Medicare Part D, it can be part of any medical plan, and even paid for by individuals who desire it. It generally involves a comprehensive review of a patient's medications, usually involving someone who takes multiple drugs.

Winn-Dixie provides MTM to a number of providers, plans and individuals, including Medicare and Medicaid recipients, Rodriguez said.

Pharmacists have been doing this informally for years, Rodriguez noted. Now they have the opportunity to do it more professionally and get reimbursed for their time, work and knowledge.

It's widely accepted in medical circles that “if you don't charge people for a service, they don't attach a value to it. So we had to establish a value for the MTM services that the pharmacist provides on a daily basis,” he said.

Beyond that, the reimbursement was a way to get the attention and support of top management while doing a good thing for customers that pharmacists had been trained to do.

MTM-type services are not optional for pharmacists, in Rodriguez's view. He quoted from the pharmacists' oath: “I will embrace and advocate change in the profession of pharmacy that improves patient care.”

Mentioning this often forgotten part of the oath had the effect of building support for MTM. “Bringing in the oath was a logical step to remind people why we got into this profession,” he said.

Winn-Dixie has found that, although reimbursement is a concern of pharmacists, it rapidly becomes the least important motivator once they get involved in counseling. “For the ones who really feel motivated and impassioned to offer these services, money is not something that is at the top of the list,” Rodriguez said.

‘NOT JUST ABOUT REVENUE’

“This is not just about the revenue that you can bring in directly from MTM, it's about how you can build your business by offering these services by increasing your customer count, your script count, and the number of patients that are looking for you,” he said.

“There's something in it for everybody. If you take care of the customer, I just know you are going to have a win on the money side. The day that you recommend a product to a patient that is in the interest of some other organization, you are dead in the water,” Rodriguez said.

Retailers have taken different approaches to MTM, with some using specialists to do the counseling, and others relying on the pharmacists in the stores. Winn-Dixie wants all its druggists involved, but has trained a group of 55 to 60 pharmacist “subject matter experts” to help others at store level get comfortable with MTM.

Rodriguez said using outsiders to counsel patients “sends the wrong signal to the patient,” who already have a relationship with the store pharmacist. Some customers will even open up more readily to a pharmacist than a physician, who might intimidate them, he said.

“Those customers that know you offer these services, and that you have their best interests at heart, trust you implicitly. They don't mind telling you that they are not taking their medication correctly,” Rodriguez said.

“We put together our own internal training manual for every pharmacy, so that every pharmacist had an opportunity to look through and see what the training program was.” Additionally, “we created a job description for the subject matter experts,” he said.

This was all part of creating a consistent program design. “We knew that if we didn't standardize it, we would fail,” he said.

“As an industry, we will not be successful with these programs unless everybody comes together and agrees on a standard for identification, execution and billing for these services. We need that standardization, and we are moving there,” he said.

Documentation is tracked carefully — “if it isn't documented, it never happened,” he said — but the majority of it, along with the billing, is handled centrally. “We let the pharmacist provide the service, and then we take care of all the back-end details,” Rodriguez said.

Winn-Dixie does track how its pharmacies perform in terms of the percentage of “opportunities” — that is, “comprehensive medication patients who are eligible for medication reviews” — they complete. Such opportunities are generated by a headquarters review of pharmacy data, and at store level. The chain has also set up incentives and competition to keep everybody motivated, Rodriguez said. It comes down to a team effort, he added.

The question is often raised as to how pharmacists can make time for MTM, but Rodriguez pointed out that Winn-Dixie's busiest stores are also the ones that are most successful at MTM. “Your busiest stores sometimes will be your best operators, because they are used to the increased workflow. They know how to manage the team, they proactively identify obstacles and they deal with them,” he said.