This pharmacy services company is using technology and hands-on customer service to keep up with the enormous changes in nursing homes.

Nursing homes, said Roderick Halbert, aren’t what they used to be. They used to be pretty static places—quiet, predictable environments where elderly and ill people would go to spend their last days. Folks moved in during normal business hours, and discharges were rare.

Roderick Halbert

That means vendors such as pharmacies must be on-call at all hours too. Halbert, an advocate for not trying to fit the new nursing home model into the old pharmacy model, realizes the industry is changing. As COO of Cranford, NJ-based Partners Pharmacy, he insists on keeping up with these changes and encourages his staff to anticipate what those changes may be.

Halbert said Partners’ clients are often required to admit patients at 10:00 p.m., 11:00 p.m., or later. In the past, the last delivery from Partners would go out the door at 7:00, so changes have obviously been necessary.

Halbert’s strategy is to give his staff the freedom they need to experiment as they face increased challenges from Medicaid changes, advancing IT, and the healthcare crunch.

“I’m not a micro-manager. I believe in giving my staff creative space to accomplish what I know they can. However, if they have a problem, my door is always open.”

Forming partnerships
Partners Pharmacy comprises 750 employees in New Jersey, Massachusetts, Connecticut, Missouri and, most recently, Virginia. The company was formed in 1998 and built its reputation by forming partnerships with the facilities it serves.

Among the company’s greatest challenges are policy changes brought on by Medicare Part D. “The logistics are impractical for the nursing home resident,” Halbert explained. This program, designed to subsidize prescription drugs for Medicare beneficiaries, has complicated the reimbursement process for nursing homes.

Halbert pointed out that before Part D, the prescription drug reimbursement formula was the same for the majority of nursing home residents in any given state, and it was a fairly simple process to determine whether or not a medication was covered. Today, with more than 25 plans, each with different criteria dictating how a medication is approved, reimbursement has become a labor-intensive process.

“Long-term care patients are among the frailest and are almost always dependent on medication,” said Halbert. “This makes them vulnerable to the limitations set forth by Medicare Part D, which dictates limited hours of operation for authorizations and overrides, sometimes resulting in medication not being available.”

Partners Pharmacy created a Medicare Task Force program consisting of 13 professionals working to solve the problems created by Medicare Part D. “We are on all the coalitions involved in Medicare Part D reform, as well as the state Medicaid program,” said Halbert. “We are proactively involved in addressing this
challenge, which has no direct solution.”

Part of the solution lies in technology. When physicians can enter a prescription order for a patient into their PDA and get an immediate response as to whether that medication will be covered, they can adapt to better serve their patients, said Halbert.

Electronic medical records will also help improve overall patient care through more consistency and better safety oversight. “We receive a paper chart from the hospital, but do we really know the last time a patient got a dose of their pain meds? With EMR, we will be able to close some of the gap and have a better continuum of care,” Halbert said.

To facilitate the transition to electronic records, Partners has adopted Health Level 7 (HL7) standards for electronic interchange of clinical, financial, and administrative information among healthcare oriented computer systems. “We are actively looking at several different systems, some standalone and some much more
integrated,” Halbert said.

Partners assigns an account manager to each facility that comes on board to act as a technical liaison. The representatives visit regularly (every day at first) and return phone calls within two hours of receiving them.

“In nursing homes, next to payroll, pharmacy is probably the largest cost for them,” Halbert said. “It’s a big part of who they are and what they do.” When things do not go smoothly, Partners is committed to resolving the problem quickly. It’s an approach that Halbert believes will serve Partners’ clients as they face healthcare’s increasing challenges and serve his company as it expands into new markets.

“We’re progressive, we’re growing, we’re looking at technology, and we’re looking at reimbursement. We are synonymous with pharmacy in New Jersey,” said Halbert. “Our clients are not just a number—each customer receives service at its best 24 hours a day, 365 days a year.”