This article is sponsored by BetterRX. In this Voices interview, Hospice News sits down with Ben Clarke, CEO, BetterRX, to learn about the current pharmacy challenges facing hospice providers, and the steps they can take to overcome them. He explains how hospices can balance pharmacy costs while providing excellent patient care, and he also provides an outlook for the future of hospice pharmacy in the years ahead.
Hospice News: What career experiences do you most draw from in your role today?
Ben Clarke: Going back to the early days of my career with KPMG, I learned the importance of the continual improvement of processes. From there, I went on to work for Amazon, where I absorbed the importance of moving quickly and digging in to solve very complex problems, surrounding myself with the smartest people to accomplish that.
About 10 years ago, I joined BetterRX, which owned and operated its own pharmacies at the time, and I think that was the most profound experience in my professional growth. I was able to build upon the previous skills I had while getting hands-on experience in hospice pharmacy. That is where I learned how to navigate the challenges that both pharmacies and hospices face, and I draw on those experiences every day.
How did BetterRX get started?
Our roots are in hospice pharmacy. The first pharmacy that BetterRX launched — under the old brand — was created to help solve a need that our founder, Jared Stong, discovered through a very unfortunate life-changing experience. He had a loved one close to him, who suffered at end of life and passed in pain.
That is an unrecoverable experience — a life-changing moment that you won’t ever get back. There is only one shot to get that right, and unfortunately, in this case, the last moments of this loved one’s life were horrible. It could have been avoided, and Jared set out on a journey to solve the problems and complexities that resulted in his loved one passing in pain. The first phase of that journey was to start a pharmacy.
Jared is a PharmD by trade, and he started a closed-door, hospice-specific pharmacy. Other than being specialized, which was very important, this pharmacy’s key differentiator was offering delivery. This was back before delivery was common, and he found that by offering delivery, he was able to save nurses a lot of time while getting medications to patients faster. The pharmacy grew quite quickly.
Eventually, there were three locations, then over time, I joined Jared to help figure out how we could scale this business to help as many patients pass as peacefully as possible. We learned by being a pharmacy, and by trying to solve some of the very complex problems through technology, that we could develop technology solutions to solve problems that no one else was focused on. We used technology to develop solutions both for the pharmacy and for the hospices themselves.
Through iteration and innovation, we eventually converted from a chain of pharmacies to a technology company that provides hospice pharmacy services to hospices of all sizes with a cloud-based or SaaS technology solution, designed to solve those very complex problems. At its core, the solution is connecting the pharmacy technology with provider technology to deliver a single technology platform that breaks the status quo, in terms of how hospice pharmacies operate.
What are the industry challenges hospices currently face with pharmacy?
If we look at a hospice in its purest and most simplistic form, its purpose is to ensure a peaceful passing for all patients. That can only be done by providing hospices with the best tools to get medications to patients when they need them so that their symptoms can be controlled, and they can pass peacefully.
Unfortunately today, hospice pharmacy is often seen first as a line item on the P&L that needs to be controlled. While it is important to control medication costs, we believe that the most important role of hospice pharmacy is to help nurses ensure the peaceful passing of all patients.
In a recent survey that we did, 96% of hospice nurses indicated they’ve had to watch patients suffer at end of life because they can’t get medications to them timely. That is the opposite of the hospice mission. There are four reasons why we believe that number is so staggeringly high and that led us to the conclusion that hospice pharmacy itself is broken.
The first is that mail order is often too slow and unreliable for hospice patients. This can sometimes result in non-crisis situations turning into crisis situations because of unforeseeable delays. Uncontrollable events such as weather, lost packages, deliveries to the wrong house, labor shortages — mail order is the wrong solution for hospice.
The second reason why we believe hospice pharmacy is broken is that the solution PBMs rely on to get medications to patients in crisis is through local pharmacies. Yet, most local pharmacies don’t like working with PBMs. They are highly frustrated working with PBMs because PBMs make it very difficult for local pharmacies to fill for hospice profitably. Low reimbursement, low volume because of mail order, all the phone calls and billing rejections, it’s a mess.
The third problem is that the ordering processes of the traditional hospice pharmacy providers are poorly designed because they allow unfillable scripts to be sent to pharmacies — orders that are incomplete, unsigned or unapproved. Whenever those types of orders are sent to the pharmacy, the pharmacy can’t fill them, and a flurry of events happens. Now the hospice and the pharmacy have to chase down approvals and signatures, and try to get the rest of the information they need from an incomplete order that may have been left in a voicemail, for example. Nurses are spending a ton of time chasing down these medications, which is very stressful because they often get blamed for medication delays that result.
And medication tracking is not offered by traditional hospice pharmacy providers, and because the status quo is a disconnected care team that regularly lacks visibility, the result is often in medication delays and needless suffering at end of life.
The fourth problem with the status quo is that hospice pharmacy providers aren’t giving hospices the technology and data that helps them control their costs in a way that also helps support their patients with the right medications. We see this when hospices use comfort kits that cannot be customized and formularies that limit patients’ options. This makes it hard to quickly adjust to patient needs while keeping costs under control.
What can hospices do to address the four industry challenges that you just mentioned?
First, we need to stop filling medications through mail order. Instead, scripts should be filled by the community pharmacies that are closest to the patients. Whenever you fill scripts several states away, you risk a patient not getting prescriptions when they need them, which can result in needless suffering at end of life.
The second thing that hospices should do is make sure that community pharmacies are rewarded properly for filling those medications. This will incentivize them to provide the level of service that the hospice needs in order to take appropriate care of these hospice patients at end of life.
The way this is accomplished is by ensuring the pharmacies are properly reimbursed. Then you’ve got to eliminate all the phone calls and all billing rejections that take so much time from these pharmacies so they can get the scripts out the door faster and reduce their labor cost per script filled, plus reimburse them fairly.
The third thing we need to do is improve the medication ordering process. We should ensure that only fillable scripts are sent to pharmacies — those that are signed, completed and approved, which will make it much easier on the pharmacies, as well as the nurses. We also need to provide medication tracking throughout the medication ordering process, so that the entire care team knows where medications are at throughout the process.
Additionally, we need to give tools to hospices that help them get the right medications to their patients, no more and no less. This is important both from a bottom-line perspective for the hospice, but more importantly, it’s critical that the patients are receiving the right medications to properly control their symptoms and help them pass comfortably.
A couple of examples of what we should see much more of are customizable comfort kits, so that hospices can customize them to the needs of their patients, and customizable formularies, so that hospices and their staff can order the medications that their patients need. Hospices should also have the choice to either call a pharmacist for a consult or get the same recommendations without a phone call, through software on their smartphone. And we need to get rid of the long hold times that waste valuable nurse time.
How can hospices balance pharmacy costs while providing excellent patient care?
Too often hospices make cost the most important criteria for their hospice pharmacy which can jeopardize their ability to provide great patient care. We need to give hospices the right tools and real-time data which can help them prioritize patient care while controlling their pharmacy costs. For example, real-time data and pharmacist recommendations help nurses order the right medications at the right cost, no more, no less. This way hospices can ensure they have a great reputation in their community and they can grow very quickly if they want. We have seen this time and time again with our clients.
What is your perspective on the future of hospice pharmacy?
We believe that the status quo in hospice pharmacy is no longer acceptable. Disconnected care teams, poorly designed ordering processes, pharmacies that are not properly rewarded to provide the care that is required of hospice patients at end of life — these things need to change. We are in the middle of the silver tsunami, where 10,000 Americans turn 65 every day. More and more patients are going on to hospice, and we have to fix traditional hospice pharmacy to help ensure that every patient has a peaceful passing.
The reason this matters so much is that it is a problem everyone will have to face. All human beings are headed toward the end of life. To understand how important it is to get this right for every patient, everyone needs to think about the one person they care about more than anyone else on planet Earth. Then, imagine that one person writhing in pain at end of life and you can’t do anything about it because you don’t know where the medications are, and you can’t get them fast enough. This is a very personal problem for every one of us, and it has to be solved.
Finish this sentence: “In the hospice industry, 2023 will be the year of…”
…changing the status quo.
Editor’s note: This interview has been edited for length and clarity.
BetterRX is providing a free 30-minute consultation to see how the hospice pharmacy status quo is causing problems for your hospice, along with expert advice on how to implement solutions to help ensure all your patients pass peacefully: BetterRX.com/FreeConsult.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected].