Case Study: Clinical Programs Solution
Executive Summary
Within 12 months of implementing
McKesson’s Adherence Performance
Solution into their daily process, the
pharmacy realized each of their
corporate-wide objectives for adherence
for their patient population, including:
• Increased CMS Star performance rating
for diabetes, going up one full star rating.
• Earned back a portion of DIR
withholdings from certain plans
• More than a 12% increase in the average
PDC in all three CMS Star adherence
categories (diabetes, hypertension, and
cholesterol).
• Increased fills by almost 5 scripts per
patient across all three tracked categories.
• Enhanced patient engagement by
delivering value-added clinical services
and counseling
• Improved staff and operational
efficiencies by having the clinical
application in workflow
“
As a result of collective,
targeted efforts, our
goal was to increase the
quality of care delivered
to our patients through
improving the process
by which they receive
their medication. Doing
so will lead to increased
adherence and thus
better patient outcomes,
improved Star Ratings,
and a reduction in
”
DIR fees.
Pharmacy Chain Increases
Bottom Line and Enhances
Patient Engagement
Boosting clinical services and patient adherence serves
as differentiator for the regional pharmacy chain
Key Organizational Challenges
Tackled by Targeting One Initiative:
Medication Adherence
As with most chain pharmacy
organizations, different internal functional
roles must meet different objectives;
addressing each of these performance goals
simultaneously can be a challenge.
• Leadership wants to look more attractive
to payors and reduce DIR fees;
• The operations team is focused on
improving process flow and ways to
improve store efficiencies; and
• At the retail store level, it’s all about
finding ways to deliver clinical value to
enhance patient care.
The chain decided that all these objectives
could be met by focusing on a single
initiative across the chain: medication
adherence.
According to the pharmacy chain’s
manager, “We were feeling the pressure
from PBMs and third-party payors to help
improve their CMS Star ratings, so one
of my initial projects was a study of the
medication synchronization program to
determine how it was affecting adherence
rates and workflows within the stores.”
“As we gained a better understanding
of how adherence, Star ratings, and DIR
fees related to each other, we saw that the
adherence numbers and measures were
directly tied to the DIR fees and could
adversely impact our reimbursement rates.”
“As a result of collective, targeted efforts,
our goal was to increase the quality of care
delivered to our patients through improving
the process by which they receive their
medication. Doing so will lead to increased
adherence and thus better patient
outcomes, improved Star Ratings, and a
reduction in DIR fees.”
A Targeted Approach to Boost
Adherence with a Single, Integrated
Clinical Solution on the EnterpriseRx
Pharmacy Management System
With a mission of providing an exceptional
experience that advances customers’
health, happiness and wellbeing, the
pharmacy is an advocate of using techno-
logical advances to achieve their goals.
1
They began by targeting a single disease
state for adherence across all chain stores: Pharmacy Chain Adherence Results*
diabetes. Increase in Average PDC and STAR RAtings (in 12 months)
“Our diabetes score had typically been our 80 75 75 76
+13 +12 +13
lowest, so the initial goal was to improve by 70
at least one Star rating measure.” 62 63 63
60
With multiple stores each filling hundreds
50
of scripts per month, they took a cautious
approach and did not want to introduce too 40 Pharmacy Chain Adherence Results*
many additional workflow steps that would Increase in Average PDC and STAR RAtings (in 12 months)
30
put undue pressure on stores too soon. 80 75 75 76
20 +13 +12 +13
Because of this, they chose to use 70
McKesson’s robust Clinical Performance 10 62 63 63
60
Solution (CPS) which is a fully integrated, 0
Diabetes Cholesterol Hypertension
clinical platform that operates within the 50
EnterpriseRx pharmacy management Measurement Period:
40
Total Patients Measured* “We have moved up to a * Results based on a study
• Dec 2017 – Dec 2018 Across 67 Sites: 2-star and are almost at a of 67 chain stores over a
system. • Diabetes: 1305 3-star rating for diabetes, 12 month period.
30 • Cholesterol: 4075 which has surpassed our
origial goal.”
They implemented the Adherence • Hypertension: 3801
20
Performance Solution (APS) within CPS,
which helped them identify and track non- 10
adherent patients. With CPS integration, APS Pharmacy
The significance of the increase
0 Chain in
in fills is evident Adherence Results*
the increased revenue and
provides real-time visibility of non-adherent profitability realized across theIncrease
Diabetes chain including:
Number of Fills Per Patient & Hypertension
Cholesterol
patients directly through an interactive, • Measurement
Prescription Increased
refills increased
Total Patients
Pharmacy
by almost
Measured*
Revenues
5 scripts
“Weper
have
(in 12 months)
patient
moved up across
to a all three
Period: * Results based on a study
online dashboard. •tracked categories,
Dec 2017 – Dec 2018 Across 67 Sites: 2-star and are almost at a of 67 chain stores over a
9 3-star rating for diabetes,
12 month period.
8.4 • Diabetes: 1305
• Incremental revenue of• Cholesterol:
more than $145,000
4075 from these
which increased
has surpassed our number of fills
Using APS on EnterpriseRx helped them 8 • Hypertension: 3801
origial goal.”
improve adherence, enhance efficiencies, +2.3
• Incremental profitability potential of more than $25,000.
7
and improved patient engagement across all 6.4 6.5
6.1
6
their stores. 5.4
+1.3 Results*
5.1 Adherence
Pharmacy Chain +1.1
5
Workflow efficiencies have prompted the Increase Number of Fills Per Patient &
pharmacy staff to get out from behind the 4 Increased Pharmacy Revenues (in 12 months)
counter, according to the pharmacy “it’s 93
8.4
Diabetes Cholesterol Hypertension
helping our pharmacists make a transition to
8
becoming providers, by offering information +2.3
7
and adherence counseling that allow them to Total Patients Measured* Total Patients Measured* 6.4 6.5
6.1
Across 67 Sites: • Diabetes: Adult age 18 or older • Hypertension: Adult age 18 or * Results based on a study
practice at the top of their license.” 6 older with 2 or more fills of of 67 chain stores over a
• Diabetes: 1305 with 2 or more fills of oral
diabetes medication.5.1 +1.3 5.4 12 month period.
• Cholesterol: 4075 (Does not CMS designated hypertension
meds
+1.1
• 5Hypertension: 3801
include people on insulin)
Data-Driven Adherence Results Improve • Cholesterol: Adult age 18 or
older with 2 or more fills of
Financial Performance Across Chain 4 statins

By using APS over a twelve-month 3

measurement period, they increased the Diabetes Cholesterol Hypertension

average PDC by over 12% across all Star

Rating categories (diabetes, hypertension,
and cholesterol).
An improvement above 10% generally
increases a pharmacy’s ranking by one full
Star Rating Adherence measure.
Total Patients Measured*
Across 67 Sites:
• Diabetes: 1305
• Cholesterol: 4075
• Hypertension: 3801
Total Patients Measured*
• Diabetes: Adult age 18 or older
with 2 or more fills of oral
diabetes medication. (Does not
include people on insulin)
• Cholesterol: Adult age 18 or
older with 2 or more fills of
statins
* Results based on a study
• Hypertension: Adult age 18 or
of 67 chain stores over a
older with 2 or more fills of
12 month period.
CMS designated hypertension
meds

2
Individual Store Data can be used to
Track Adherence Performance
Because APS reporting tracks at individual
store levels, the pharmacy chain can quickly
analyze the performance of each store for
evaluations and forecasting purposes.
For example, year-to-year, the top three
performing stores for Diabetes increased
prescription refills by almost 6 scripts per
patient across all three tracked categories,
leading to:
• Incremental increase in revenue of
more than $13,000 for the year (or
average $4,000/store/year)
• Incremental profitability potential of
more than $1,000/store/year.
Performing at this adherence level across
more than 60 stores could lead to a
potential incremental revenue increase of
more than $850,000 across the entire chain.
willing to engage with the other programs
and tools available because they really
understand the impact it can have.”
The Future: Continue Adopting
Innovative Clinical Solutions to Meet
Increasing Adherence Standards and
Drive Pharmacy Growth
After recognizing the impact to their
bottom line that higher adherence can
make across the entire organization, the
chain continues to focus on improving
adherence as a primary growth strategy.
With data in hand and as comfort levels
increased using APS, the chain plans to
expand to include additional adherence
categories.
They are already tracking the results of
their efforts by comparing Star ratings and
DIR fees year-over-year.
The robust nature of McKesson’s clinical
solution means that the pharmacy chain
can continue to assess enabling additional
revenue-generating opportunities beyond
adherence. The fully integrated CPS
platform offers the chain continued growth
opportunities and increased patient
engagement.
*Assumptions from Actual Industry
Pharmacy Data:
• Revenue Assumptions:
- $45/fill/patient in all 3 categories
• Profitability Assumptions:
- Diabetes: $12/fill/patient
- Cholesterol and Hypertension:
$5/fill/patient/year

“Each preferred network is contracted

Improved Adherence Also Increases
Patient-Pharmacy Interactions,
Improves Outcomes, and Strengthens
Customer Loyalty
Improved adherence has positively affected
a little differently, so we have begun to
combine reporting with specific contracts
to identify risks and opportunities to lessen
fees,” offers the pharmacy manager. “If a

patient care, helping pharmacists deliver
value with every touch. “We are really
focused on making sure we take great
care and offer the best service to those
patients we already have,” the pharmacy
manager explains. “The greatest part of APS
is the online dashboard, which provides
the means to initiate a smart, guided
conversation that can help improve patient
health. And CPS gives actionable, patient-
level detail that allows us to do proactive
outreach and engage with patients, which
they really appreciate.”
The pharmacy manager attributes these
results to the emphasis being placed on
the importance of adherence in the stores
and the improved ability to easily identify
patients to target. “There is an awareness
now of what the metrics mean and the
action steps that staff needs to do to help
improve a store’s performance on a patient-
by-patient basis. When you have an alert
telling you that this person has a PDC
“
PBM emphasizes statin use in diabetes,
we’ll utilize our tools to target these
We know it’s going to be
patients and monitor their numbers for a challenge to get to that
improvements.”
5-star amongst all disease
The pharmacy chain finds success in
every step they make towards improving states and targets, but
adherence.
that’s definitely where we
“We know it’s going to be a challenge to get
to that 5-star amongst all disease states and
want to be. We’ll get there
targets, but that’s definitely where we want by providing the best
to be. We’ll get there by providing the best
care possible for every patient, and, using care possible for every
the data and knowledge we’ve acquired patient, and, using the
along the way to reshape what we’re doing
to continue to improve overall efficiencies data and knowledge we’ve
and remain competitive in our region.”
acquired along the way to
Additionally, the pharmacy chain is
aiming to further integrate McKesson’s
reshape what we’re doing
CPS platform by interfacing CPS with to continue to improve
their MTM and Med Sync programs for
maximum patient engagement. They also overall efficiencies and
utilize IntelligentPA™ within EnterpriseRx remain competitive in

”
score of 50%, it’s a lot easier to initiate that for efficient processing of prescriptions
conversation. Our people are now more requiring prior authorization. our region.

3
McKesson Pharmacy Systems
30881 Schoolcraft Road
Livonia, MI 48150

www.mckesson.com/mps
(866) 682-8942

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2017-10