Hospice is all about maintaining patients’ quality of life, and pharmacological care is a big part of that promise. When patients experience new or worsened symptoms, time is of the essence. Hospice nurses need quick, convenient and consistent access to medication to ensure the patient’s discomfort may be addressed.
Local pharmacies provide a convenient option for urgently-needed medications, making life easier for patient caregivers and hospice nurses. Enclara Pharmacia provides hospices with access to over 65,000 pharmacies nationwide, but not every corner pharmacy stocks the medications frequently used in hospice care. That’s where Enclara Pharmacia’s Neighborhood ConnectionsTM program comes in.
Through Neighborhood Connections, Enclara has built a special network subset of over 7,000 retail pharmacies nationwide which commit to stocking hospice medications and also understand the different regulations that apply to dispensing for terminally ill patients. The Enclara Neighborhood Connections team handles contracting and billing for ancillary services such as delivery, so that hospices can focus less on logistics and more on care. It’s a step beyond what other hospice pharmacy benefit managers (PBMs) provide.
“The whole concept behind Neighborhood Connections is to provide a hospice client with access to medication anytime, day or night,” Enclara VP of Pharmacy Networks Jerry Kilkelly said. “A patient might be discharged from the hospital late in the day and admitted to hospice later in the evening needing medications right away to manage symptoms. We have to be able to point nurses to pharmacies near the patient with the drugs they need in stock.”
Enclara’s hospice partners usually cultivate relationships with a handful of Neighborhood Connections pharmacies in their service area. If they need to find an alternative to their usual pharmacies for any reason, selecting another Neighborhood Connections participant provides added confidence.
Local Access is Central to the Enclara PBM Value Proposition
Unique in the marketplace, the Neighborhood Connections program has also been crucial for Enclara Pharmacia’s continued growth. Enclara used to be known primarily as a mail order pharmacy, dispensing medication for delivery to hospice patients’ homes. Local pharmacies were used primarily for emergency needs. Although direct delivery remains important, Enclara’s pharmacy benefit management (PBM) service has become increasingly popular. That’s thanks in part to Neighborhood Connections making regular use of local pharmacies a more viable option for hospices.
The Neighborhood Connections team is responsible for expanding, maintaining and monitoring the network. They also play a major role in selecting pharmacies for new hospice clients and hospices expanding into new areas. In some cases, a hospice is already happy with its local pharmacy partners and will continue to use them while benefiting from Enclara’s PBM services, powerful technology and clinical support. Those pharmacies will often join Neighborhood Connections, further growing the network. Additionally, the Neighborhood Connections Plus program leverages Enclara’s corporate relationships to provide access to additional clinic-based pharmacies in several states, which offers even more opportunities for integration.
When a hospice needs to build up its local pharmacy relationships, the Neighborhood Connections team works to develop a custom network proposal using existing pharmacies in the program, based on proximity, after-hours availability, delivery services and other factors. If there are gaps in coverage, the team reaches out to pharmacies in the area to find out which ones might be a good fit.
“The goal is to always use the same pharmacies in that network area,” Kilkelly said. “That is important because it builds volume at the pharmacy level, so they get to know us, our hospices, and our patients’ needs better. The more scripts that they see coming in, the more familiar they get with hospice. It helps them to financially justify stocking drugs that may only be used in hospice. For instance, a local pharmacy will probably never see a prescription for highly concentrated morphine unless it’s for a hospice patient.”
Building a Custom PBM Network for Each Hospice Location
Building a custom local pharmacy network for a hospice takes research, in part because of the variation between markets. For instance, proximity means different things in different areas. Traveling 10 miles to a pharmacy in a dense city would be unthinkable, but in a rural area even 30 miles might be considered totally normal. A lack of 24/7 pharmacies is a growing challenge, particularly in rural areas. If no 24/7 pharmacies are available, the Neighborhood Connections team will negotiate with other pharmacies to provide after-hours access, meaning they will keep a pharmacist on-call to come into the pharmacy, dispense the medication and arrange to have it delivered or picked up. They may also work with the pharmacies on offering courier delivery and other ancillary services.
Sometimes, selecting the right pharmacy comes down to more than just location, hours and stock. Attitude and commitment matter more. “At the end of the day, we’re looking for people who are engaged and supportive of hospice,” Kilkelly said. “The real clincher is when you talk to somebody at the pharmacy, and they say, ‘yeah, I’ve got a family member who’s gone through hospice, I know what it’s about, and I understand the value.’ Those are the types of pharmacies, pharmacists and staff that really make a difference.”