​​There is light at the tunnel’s end. Long term care facility census is slowly rebounding, and while COVID is still of concern, facilities are managing it with far fewer illnesses, hospitalizations, and deaths. However, profit margins continue to be razor thin,  and staffing shortages linger. More than ever, providers and their teams need cost containment that does more than just streamline expenses. 

These efforts must help impact other challenges—such as staffing and census—in a constructive way. 

Embracing this holistic approach to customer service is second nature to PharMerica. “We know that while the future is looking brighter, providers are still struggling with challenges that could slow or restrict their post-pandemic recovery, and we are working to turn these struggles into successes,” says Stephen Creasy, PharMerica director of clinical services. Tina Carrasco, vice president of strategic accounts, adds, “Staffing is tied to cost containment. If you don’t have consistent staff, it breaks down efforts related to compliance, communication, costs, and—ultimately—growth and success.”

​​TI Ties to Team Harmony

“Our Therapeutic Interchange [TI] programs save medication costs,” Creasy says. “But once they’re implemented, they’re also automated, so they not only continue to manage costs over time but they also take the administrative burden off of nursing staff so they can focus on what they love—patient care. At a time when there are historic levels of staffing shortages and turnover, this prevents issues from falling through the cracks due to lack of staff time, experience, or knowledge.”

Facilities and their teams can trust these TI programs: They are designed by physicians and pharmacists who specialize in geriatrics and long term care to assure clinically appropriate and cost-effective pharmaceutical care for nursing home residents. “Not only are these programs designed by experienced practitioners, but they are reviewed by our Pharmacy & Therapeutics Committee,” Creasy says. “We don’t just look at costs but we make sure that each medication is clinically sound and appropriate for this patient population. This involves a deep-dive literature review and assessment before it even gets to P&T for approval or denial. It’s a very structured process and unique to PharMerica,” he says.

“This gives prescribers and other practitioners peace of mind knowing that all recommendations are backed by the best and most current clinical evidence.”

At the same time, Creasy says, “Our programs continually evolve. We are always looking for new opportunities to go from higher-cost to lower-cost medications that have demonstrated clinical efficacy and comparable effect. And if new evidence says that a medication is no longer cost-effective or efficacious, we will replace it with a more appropriate drug.”

​Don’t Stop, Won’t Stop Cost Containment

The company’s efforts to contain costs while maximizing outcomes and quality don’t stop there. PharMerica’s Standard Quantity Level Limits program lowers clients’ costs by setting dispensing limits based on quantity or days supply. 

This program delivers two distinct advantages to customers. The first is limiting financial exposure on high-cost medications that may not be used, thus reducing waste. The second advantage is that it helps improve nursing facility staff productivity by reducing the time spent on medication returns. 

The categories for inclusion of medications in the standard program focus on themes that are particularly prone to waste and/or returns. These include short-stay residents, hospital carry-over therapies, package-size opportunities, medications covered by alternative payers, and high-cost drug exposure.

​Collaboration for the ​Continuum

On admission to the facility, when new orders are started, PharMerica’s cost containment programs go into effect and continue throughout the person’s stay. For instance, through the Global Authorization program, prescribers can pre-approve interchanges to lower-cost preferred medications for future medication orders, and prescriber-approved forms stay on file at the applicable PharMerica pharmacy for future reference. 

But it doesn’t stop there. The consultant pharmacists conduct interim reviews when a resident transfers between settings, such as from assisted living or memory care to the nursing home or from the nursing facility to home. And at discharge, PharMerica implements DischargeRx.

“This is a seamless integration process designed to keep each individual safe and on track with their progress. It also helps prevent them from having adverse events that send them back to the ER or hospital,” says Creasy. 

​Happy Staff, Healthy Census

All of these programs and efforts have at their heart not just cost containment but, most importantly, quality care. And this is linked to both staff stability and census. 

“When staff have the time, tools, and skills to focus on quality care and the best possible outcomes for residents, they are more likely to take great pride in their work and feel a loyalty to their teams,” says Carrasco. 

One source of staff stress is lack of training, and PharMerica’s programs cover this. “Our teams go in and constantly educate staff to help ensure there are no gaps in knowledge with turnover. We educate them on pharmacy issues, and we have great tools to support them. We take these efforts off the facility, so it’s also one less burden on managers and team leaders,” she says. 

At the same time, customers can always come to their PharMerica team and request any specific education, training, or tools they need. “We’re always there as their partner, not just for pharmacy services but for overall quality care and quality,” Carrasco says.

As for occupancy, this is driven by several factors, including staffing, Five-Star rating, and readmission rates. “Our consultant pharmacists get involved from day one, reviewing records on admission, ensuring there are appropriate diagnoses—essential for the Patient-Driven Payment Model (PDPM), identifying and addressing any issues or concerns, and working with the team on care planning,” says Carrasco.

“Our efforts help ensure that census builds in a cost-effective way that also ensures and enables the best possible care and outcomes for each resident,” she says.

“Facilities are looking at opportunities from vendors to lower costs,” Creasy says. “There are lots of moving parts when it comes to medications and lots of variations and options, often within the same drug class. Our clients appreciate that we take the time and effort to ensure quality while giving them the lowest costs possible,” he says. 

“At the end of the day, if what we do improves outcomes and enables our customers to be successful, we have accomplished what we set out to do.” ​​