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Medscope, 2013

Implementing a MedsCheck Service



 Must be in place before service can be provided
   a) A Medicare MMR service provider number for the MedsCheck service
References: Becoming a MedsCheck service provider   MMR Service provider application form
   b) A private room (or screened area) where the review can be conducted without the being overheard by others
   c) A system for documenting the review outcomes (Action Plan, Meds list), the patient consent and the claiming paperwork.
 Recommended The following need to be considered for the efficiency of the MedsCheck service
   a) A computerised managed system such as MedsCK. A computerised system is not only required to record the mandatory documentation, but is also required to handle scheduling, claiming and follow up management. If processed manually, the overhead costs will make MedsChecks unprofitable. MedsCK FREE can be used for small volume MedsChecks with no cost to the pharmacy.
   b) A resource management plan. A MedsCheck must be conducted uninterupted and so you will need to allocate and manage staff carefully.
   c) An implementation plan that addresses the various stages of the process; Identification, promotion and scheduling, schedule management, MedsCheck review and documentation.
   d) A business development plan that sets and tracks your MedsChecks targets.
   e) Staff training. Pharmacists should be clear on the objectives of a MedsCheck and front of shop staff need to know how to promote MedsChecks to consumers.
A MedsCheck review must be conducted uninterrupted. The pharmacist is not permitted to take a quick break to answer a question or dispense a script during the consultation with the consumer. To successfully implement a MedsCheck service, therefore, the pharmacy needs to allocate a block of time where a dedicated pharmacist is reserved specifically for conducting MedsCheck reviews.
 1. Plan when (days / times) the pharmacy will accept MedsCheck appointments.
The success of the program will be governed by how well your front-of-shop staff is able to book appointments. Identifying eligible candidates will never be a problem, ensuring the reserved MedsCheck block is economically occupied will be.
 2. Identify the times in the day that the front-of-shop staff are to promote the program. Talking to customers about the benefits of the program takes time. Do not attempt to promote MedsChecks during peak time when staff are under pressure to service customers.
 3. Train staff on how to promote MedsChecks and provide consumer information brochures that staff can talk to.
 4. Provide clear KPIs and incentives to ensure the allocated MedsCheck blocks are economically occupied.
Economic sustainability is just possible at one review an hour ($50/hr). With a good implementation plan a minimum of 2 X 20 minutes reviews per hour ($100/hr) can be consistently achieved.
 5. Book appointments far enough in advance to allow you to react to forecast quiet days to enable you to manage your resources economically.

Identification

The MedsCheck eligibility criteria are reasonably broad. Pharmacies will not have any trouble identifying sufficient consumers to fill their appointment book. The challenge will be in achieving the target conversion rates; identification to consent.

There are two basic identification methods available. Pharmacy's preference of one over the other will depend upon the skill base of their staff, particularly their front-of-shop staff.

By the dispensing pharmacist



In this model the dispensing pharmacist (using consumer's dispensing history) notifies the sales staff of an eligible candidate. The onus is then placed on the sales staff to promote the value of the program and gain consumer consent. If adopting this method we suggest the following are considered:
  • Don't attempt to schedule MedsChecks during peak times. Promoting MedsChecks to consumers while being under pressure to service customers will yield poor results and cause negativity amongst staff toward the program.
  • Train sales staff appropriately as the success of the program will be solely dependent on their skills. Consider providing performance incentives.
  • Provide consumer information brochures to help staff promote the program
  • Regularly review the appointment rates for the allocated MedsChecks blocks and discuss with your sales staff.
The MedsCK software can be setup to automatically email the MedsCheck appointment KPI data to the MedsCheck coordinator for the pharmacy on a daily basis.

By invitation via a mail-out



The dispensing database can be mined for patient lists that match the MedsCheck eligibility criteria. Most dispensing systems have the ability to export patient lists in a format that can be used to mail-merge a MedsCheck promotional template to generate personalised letters to your customers. Even though the response rate will be lower than that option 1 above, the advantage is that consumers responding to the letter are more likely to book and show for the appointment.

The MedsCK software has an inbuilt mail merge facility for generating promotional letters to your customers. In MedsCK you can:
  • Upload your eligible customer list from the dispensing system into the MedsCK contacts.
  • Generate personalized letters using the default MedsCK promotional template to selected consumers.
  • Customise the MedsCK promotional template to suit your own needs.

Schedule Management

Schedule management involves taking appropriate measures to control no-shows. The economic viability of the MedsCheck program can be severely compromised if the pharmacy experiences a high level of no-shows.

MedsCK provides some tools to assist in schedule management:
  • Consumer appointment slip. When a MedsCheck is scheduled in the appointment book, MedsCK automatically prints out a take home slip with the appointment details, minimising the risk that the consumer will forget.
  • SMS reminders. MedsCK will automatically SMS the consumer (provided mobile details are recorded) the day before the scheduled appointment.
  • Daily running sheets. MedsCK will automatically email the day's scheduled appointments to a nominated staff member who, if required, can call consumers to confirm their appointment.

MedsCheck Review

The MedsCheck review is a 20 minute (30 minutes for diabetes MedsChecks) face-to-face consultation with the consumer that focuses on improving medication use through education, self-management and medication adherence strategies with the goal of improved health outcomes [PSA Guidelines V1.0]. The review must be conducted by a registered pharmacist (uninterrupted) in a private area where the conversation cannot be overheard by others.

Prior to the commencement of the consultation, the pharmacist must:
  • Check consumer eligibility 'formally' using the approved screening tool.
  • Print out a copy of the consumers medication list from the dispensing system
  • Confirm consent (which would have been recorded when the appointment was booked)
During the consultation, the pharmacist is expected to:
  • Check with the consumer if other medication (including non-prescription and complementary meds), not listed in the dispense medication list, is being taken.
  • Assess medication adherence and formulate strategies to address issues
  • Assess the consumer's understanding of their medication, and provide educational material where required.
  • Assess consumer's understanding on the correct use of any monitoring devices and provide education where required.
  • Identify and discuss management of chronic conditions including lifestyle factors related to medication use and adherence.
  • Attempt to resolve any medication related issues that are identified during the consultancy.
Mandatory At the end of the consultation, the pharmacist is required to:
  • Provide the consumer with written plan detailing agreed goals and actions and agreed follow-up with the consumer's relevant careers.
  • Provide the consumer with an printed updated medication list.
  • Arrange agreed follow-up actions, which may include, contacting and/or providing copies of the Action Plan and meds list to the consumer's GP or other healthcare provider.
As outlined above the focus of the MedsCheck is education and adherence. This is well within the skill level of all registered pharmacists and so no special training is required.

If a pharmacist is presented with a case where more complex issues are identified, the consumer should be recommended for a home medicines reviews (HMR) where an accredited pharmacist, having the consumer's complete medical profile, can conduct a full review.

MedsCK review management system facilitates the MedsCheck review process by:
  • Providing a simple workflow that allows the pharmacist to document the MedsCheck review.
  • Incorporating a consumer information library whereby the pharmacist can access and print relevant educational material for the consumer.
  • Having a smart Action Plan template to record the review's outcomes. The Action Plan is one of the mandatory outputs of the MedsCheck.
  • Being able to print the updated medication list for the consumer - a mandatory output of the MedsCheck.
  • Documenting the entire MedsCheck process with the ability to generate a complete audit report.

Follow-up Managemnt

As part of the Action Plan developed during the review, pharmacists are required to follow through on tasks they have agreed to follow-up on. The most common follow-up tasks will include sending a copy of the Action Plan and meds list to the consumer's GP and/or carers. A system is required to remind pharmacists of due tasks.

MedsCK has follow-up management features that support pharmacists in follow-up management:
  • The MedsCheck review summary page includes a Send To GP button that will automatically fax/email the Action Plan and Meds list to the GP on the consumer's consent - the most common follow-up task.
  • MedsCheck will automatically send email follow-up reminders to the pharmacist before the task due date.

Claiming

Claiming is a two part process:
  • The consumer is required to sign a completed Payment Application form at the end of the MedsCheck review that proves the service was provided.
  • At the end of the month, the pharmacy claims by lodging the individual Payment Application forms (of each MedsCheck performed in the month) along with a claim coversheet.
The completed forms then need to be posted to:

Community Pharmacy Agreement Officer
Pharmaceutical Benefits Branch
Department of Human Services
PO Box 9826
ADELAIDE SA 5001

Or faxed to 08 8274 9373


MedsCK includes the Payment Application form generator that automatically pre-populates and prints the form for the consumer to sign. In addition, MedsCheck provides a mechanism for pre-populating and printing the end of moth claim cover sheet.