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Pharmacy technicians trained as Community Health Workers (CHWs) are transforming patient care. Anne Eisenbeis, PharmD, MBA, explains how CHWs bridge healthcare and social support, improve outcomes, and generate revenue. Learn how to implement this model, close care gaps, and empower your pharmacy team to redefine healthcare’s role in the community.
This transcript was generated automatically. Its accuracy may vary.
Mike Koelzer: Introduce yourself to our listeners.
Annie Eisenbeis: I am Annie Eisenbeiss. I'm the director of practice development at the Missouri Pharmacy Association, I kind of wear multiple hats. [00:01:00] One is overseeing our public health grants that involve pharmacists and pharmacy teams in innovative solutions to public health needs or crises.
And then my second big hat is as the lead network facilitator for CPESN Missouri.
Mike Koelzer: Annie, I see that you went after pharmacy school, about, five, six years later, you went to get your MBA. What was the impetus for that?
Annie Eisenbeis: So I practiced as a community pharmacist for five years or so after graduating, and then the Missouri Pharmacy Association had an executive fellowship in association management. And so I actually applied and was the first, executive fellow with the Missouri Pharmacy Association.
And that kind of spearheaded the concept of needing to have almost a more, Business acumen, and then also be able to speak the lingo, because most of the people that I was communicating [00:02:00] with were not necessarily pharmacists or even in health care so I really wanted to be able to better understand finances, and then also operations, people management that We all know did not happen in pharmacy school, and then it's kind of a really important role.
Mike Koelzer: Bye.
Annie Eisenbeis: backed up with evidence and best practices.
Mike Koelzer: how much of that was you wanting to get that information versus having those initials behind your name? And trust me, I wouldn't do it if I couldn't get the initials behind my name, so that's not a slam by any means, but how much
Annie Eisenbeis: Yes,
Mike Koelzer: Was it truly to get the information or was it also because you felt you needed the look of the degree where you were and where you were going to go?
Annie Eisenbeis: That is a great question. So probably the first five years of pharmacy, Annie, was probably more about those initials. But after [00:03:00] starting the fellowship, and actually also thinking that I may want to own my own pharmacy a couple of years before that, I realized how much value there was on the job training and experience, and how, you know, Some of the things that I would have learned in school were just really that starting place,
so getting my MBA was probably more of a starting place, versus giving me the necessary credentials or experience. And with that, actually, the reason I got the MBA where I did was because they offered an executive MBA, So everyone in my program was out for at least five years and having practiced in whatever field.
So we had people who retired from the military, we had agriculture, we had two other pharmacists actually, both from completely different schools. Docs, engineering, basically any background. There were about 35 of us, and I can say too, I probably learned more from the other industries and learners in my [00:04:00] program.
Cause it was actually, we all met together even though it was mostly virtual, It was not on your own time. So, I did learn a ton from the other folks in industries. So even in thinking about pharmacy knowledge, like, especially in those grant programs that we look at and manage, thinking about what I can pull from other industries outside of pharmacy that would be helpful.
So here's a problem that I have, right? technician There's a whole lot of pathways I can go down with technician training and solving areas of need or creating different education options, And even just thinking about, okay, but if I layer on all of these things, am I going to cause burnout with technicians?
Because there's also this need for more people. I actually started researching then in my MBA program, looking at the Chick fil A, training model and Starbucks, and how do you get all of these people across the nation to be really happy at 6am serving me coffee with [00:05:00] a really complicated order,
so, yeah, definitely trying to tie all of that together. And I, probably, Also after that did start looking at other programs like, okay, if I didn't just get my MBA, what else would be helpful now to spearhead some of these ideas. But now I have a list of places that instead of getting a degree in that program, I want to be asked to speak there in 10
Mike Koelzer: That's your goal.
Annie Eisenbeis: Yes.
In particular is the master's in healthcare science at Dartmouth. I want to be asked to speak at that, versus get the master's.
Mike Koelzer: Not both. you wanna speak there. versus going there.
Annie Eisenbeis: So the premise behind Mapmasters is that you have to be in a position to make systems wide change.
and so the typical age is like 47 for the average person in that program. Basically, they have this very strong continuation for Alumni, because as soon as you graduate, what you [00:06:00] learned is changing on healthcare delivery science.
So, I want to be asked to speak at one of their Alumni events , because that's my goal, to make systems wide change.
Mike Koelzer: Goals are beautiful, but they're difficult because you're at the whim of somebody else. Asking you to fulfill that goal. Someone else is included in that goal. You can do a lot of it. You can show up and you can market yourself and you can be known as this or that, but it might be on the day of asking or something like that.
Somebody has, you know, decided to go to lunch and the other person was a decision maker that day or something. In my life, I have one thing on purpose. And that is, I love to play the piano, I love to practice sight reading and I don't give a rat's ass if anybody hears me.
In fact, I don't want anybody to hear me. I can, you know, play for a good long time and it's fulfilling. I'm not doing it for anybody. There's nobody in my way. I can't [00:07:00] blame anybody. It's all me. There's not a lot of stuff like that in the professional world, because you're kind of at the whim of people sometimes.
So it's good to have goals. And I've got them too with the podcast and business and the pharmacy. I've got goals too. There's someone else that has to make those goals come true too. And that kind of sucks sometimes because
and all that kind of stuff.
But, I know you're going to hit that goal, Annie. I just want to say the lady who's going to be asking you might be in a bad mood that day or something.
Annie Eisenbeis: And that's a really good point. I would probably use the analogy that my husband has his dream car that he can attain buying this car in his lifetime,
this is probably more of a um, fun, the hat on the gold star, cause it's probably not even the North star. Especially just in thinking, okay, my ultimate motivation while I love patient interaction is to change the system and make it all better for everybody using pharmacists.
And so I think with that saying that I want to be heard and asked to speak. Not even promoting myself to this area, this is not some group that puts out any requests for speakers either, they would come to me. That would mean that I would have surpassed or built a program or a goal or something that was bigger than pharmacy and big enough for healthcare to pull and say, okay, here's something we need to learn from.
I probably don't do this on my own either. So let me caveat that by saying this is not Annie does all [00:09:00] of the steps by herself. So I bet there's also some luck involved or just some chance of meeting the right person at the right time in the right room.
Probably a lot of that, not just one. I would imagine part of the goal of hitting a goal is to go. past what is needed for that to happen. So they can hardly not invite you, it's the same thing as the player who turns up the stereo real loud, louder than the crowd's going to be in order to surpass different conflicts so that, you know, the actual goal is not going to be that big.
Mike Koelzer: And so just by talking to you, I know that you're going to go way past it. So they have no choice, but to ask you to go to it.
Annie Eisenbeis: That's right. Kind of like, do they say that the overall experts spend at least 10, 000 hours on their craft? So like piano, like you would have had to spend 10, 000 hours.[00:10:00]
and I've not broken that down,
Mike Koelzer: 000 hours. I figured it out. It's been like an hour a day for 30 years.
Annie Eisenbeis: I did not read the book that, that came from a business mind or book, but
Mike Koelzer: the
Annie Eisenbeis: yes.
I do too. So one hour a day for 30 years doesn't sound crazy, but I feel like to your point, it's practice, that is, that you are basically putting all of your effort into making it better.
And I think that's also key actually in business or anything else. Like my goal in developing the next idea or the next program, or even a section of the program or the training or whatever it is, is basically what I did in the past and what can I do to make those better? So if I did something that worked, what can I tweak just a little bit to make it better, versus.
looking at a program that was really successful and saying, check, we're done. We have a vaccine gap closure program that hits [00:11:00] 75, 000 education interventions with pharmacists and CHWs. So if I were to say that was actually surpassing all of my expectations and check, we're done. Versus, okay, next time I'm going to tweak this and this and this to make it better.
And even not so much those metric goals, like, okay, next time I want to hit 76, 000. But to say next time I want at the end, when I ask for feedback, I want to hear different questions, not the same.
Mike Koelzer: Goal setting, that's all we can do really compared to ourselves one day to the next.
Let's back up a little bit. This shows it's the business of pharmacy. So we don't talk about silly things like how drugs work and how we care for patients and things like that.
That's all the boring stuff. We don't talk about that, but let's back up a little bit. So from what I gather, Your goal has been to use your pharmacy [00:12:00] degree to make a lot of change, health change in the world, reach further than pharmacy has into the more mainstream. Is that about right?
Annie Eisenbeis: yes, probably not, probably almost by chance a little bit too, but yes,
some of it not realizing, yeah, that my, that I could use this pharmacy degree and in a space where I might be the only pharmacy voice be able to say, No, that's not going to work. We should do this and it'll be 10 times better.
Mike Koelzer: So you were in community pharmacy for about five years
Annie Eisenbeis: Mm hmm.
Mike Koelzer: And were you in a retail setting, a community setting?
Annie Eisenbeis: Yes, so I worked at a grocery store chain in St. Louis, an urban area, and then moved, and worked for an independent pharmacy in rural Missouri.
Mike Koelzer: Annie, that time, was that something you [00:13:00] said? I want to expand the great things I've seen here, or is it, I'm not seeing anything happening here. And I've got to make a change.
Annie Eisenbeis: Ooh, that's a good question. Yes, probably a mixture of both. Not necessarily saying that there wasn't anything happening in the pharmacies, but more I could see what barriers were there and what walls needed to come down. Either in the chain setting or in the independent it was almost more What barriers are walls right outside of our own That needed to come down to be able to do more And then also like kind of comparing pharmacy to other health care spaces if this is what we want to do Why aren't we doing it at all like other health care providers?
So how we utilize our pharmacy technicians and where is the value of pharmacy even so I remember [00:14:00] Like in school and in those first five years saying, if you would ask me, what, what is the value that pharmacists bring to the healthcare system and why should we pay pharmacists to do anything more than check medications?
I would have said, Oh, well, yeah, we're the medication experts. to anyone outside of pharmacy that doesn't bring value. To the health care team. I mean, yes, you can like to break it down into bits and pieces, but the big value that I saw that we could be providing this angle in was in the follow up and monitoring.
So, I would see patients once a week or every month or I'd see them come through the drive thru and I get to meet their pets and that we have delivery drivers that go to their homes. On Christmas Eve, I remember our delivery driver was gone. And so I delivered medication to a patient and got to see where they live, how they live, the fact that the insulin is on the fridge, not in the fridge, that is not happening elsewhere. So when you [00:15:00] go to your primary care's office, if they called me three months later, I wouldn't answer the phone. But I can tell you that the patients on MedSync, if I didn't call them, or they missed my call, it was a not happy patient saying, Hey. Where was my call? I didn't get a call this month,
so, they're answering the phone. We have touch points every month and reasons that the patients are coming in. So, I may miss a doctor's appointment for other life priorities. I have two kids. I have two dogs. Things come up, but I would make it a point to go to the pharmacy every month and get our medication.
So there's also this tie to a product, while we don't necessarily always like that, that's a reason that the patient's coming in regardless of whether they want healthcare, advice, or education, and an area to target that advice and education.
Mike Koelzer: All right, Annie, now I'm going to play devil's advocate to this, just to get
Annie Eisenbeis: Yes.
Mike Koelzer: We need to get down to it. From a business standpoint, I like many [00:16:00] touch points. But what precludes that is the payment. So where does that come together? It's kind of the chicken and the egg, I know forever, you know, to add arguably one of the ways in America we define value. Is it going to be paid for?
It's not just, do people like it? Do they like it? And are they going to pay for it? So let's talk about that.
Annie Eisenbeis: Yes. Oh, I love this question. Okay, so this also ties in with all of our grant work to be able to build a sustainable and scalable path as well. so I'm going to focus a little bit on community pharmacy here. I think if you're trying to provide a billable or payable service in a community pharmacy, there's a couple lines that you can't cross right away because you would need funding to invest.
So you really shouldn't have to buy a whole lot of different software that everybody has to have special logins for and look [00:17:00] at separately from your current software. You may need to do that down the line. Initially, no, you shouldn't have to have separate space. Again, could be an expansion. down the line scaling up, but initially, no.
And then you also shouldn't need to hire additional staff. Now, hiring doesn't mean training or educating current staff. That just means hiring somebody else. Also right now, I think pharmacists are not utilizing their support staff to the fullest. So we're super type A personalities. I am the same. So when I work at the pharmacy and you're trying to implement something new, you are going to figure it out yourself.
It's perfect. And then you will train somebody else. So in other words, you never train somebody else unless they insert themselves. Right. and so that was another way of trying to figure out how to reach pharmacy technicians and delivery drivers and everybody else involved in the pharmacy and empower them in the same way we're empowering the pharmacist to provide [00:18:00] additional services.
Cause also the ROI will never be there if it's the pharmacist checking somebody in. Doing the initial data collection gathering anything like blood pressure, etc. And then also calling and following up and billing, because in other healthcare spaces, they don't do that. That is not your MD coming in and connecting with you,
for the hour or even reminding you to come in, so that was where tying in this role of a community health worker, pharmacy technician was brilliant. This was not my idea. I'm just kind of the dot connector that connected the people who thought of it, the people who could create it, and the people who could scale and sustain and basically bring all of the smarter minds together and the funding.
I did bring the funding source together.
Mike Koelzer: that
That position is a community health technician.
Annie Eisenbeis: so training a pharmacy technician to become a community health worker. I think of if your pharmacist is your clinical and primary care extension out in the community setting, then your technician, who does not [00:19:00] necessarily have extensive clinical or strong education background, but does have a strong sense of purpose, community can be that social work, environmental, and basically connecting all of those social resources together to address health disparities and access to anything even in addition to health care.
So if it's a patient that just needs help with transportation, right, or needs help with paying for something else, electricity, whatever it is, they pull all of those resources together. And so if you think of your pharmacist as your health care hub, because we're getting prescriptions and we're connecting with all of the providers, not just primary care, not just, the ER.
And then you have your community health worker trained pharmacy technician who can also be that social extension as well. And because of the number of touch points in follow up and monitoring, the two married together is, Brilliant. Also, it's kind of a forced, team environment now [00:20:00] because now you're not saying you have a pharmacist and you have a technician and the education or clinical gap is so wide because now you really have different expertise and technicians are already trained extensively because of Board of Pharmacy rules to refer to that pharmacist already for clinical things.
So you're not even having to Tell them where that line is.
Mike Koelzer: All right. So, this is the team that is going to get more touch points because people like them, but nowhere does the payment come in?
Annie Eisenbeis: Yes, great question. So basically now your payment is in the health equity space as well as those per member per month value based care arrangements. And now you're not trying to do it with one single pharmacist at a single location because you can train pharmacy technicians to become community health workers and have an entire team dedicated to this.
So when Medicaid MCOs don't get patients to answer the [00:21:00] phone and can't keep track of patients and their care, guess who can, and guess who they will pay to do that. There's also specific CPT codes and billing codes specifically for community health workers, while there aren't necessarily yet specifically for pharmacists.
I think too that the two together actually
Mike Koelzer: I'm
Annie Eisenbeis: or
Mike Koelzer: to
Annie Eisenbeis: need to pay pharmacists as well, because community health workers not tied to a health care setting are not a sustainable role in other spaces.
Have that tie into health care. So not only are you bringing all of these social resources and referrals, now you have a tech who's always six feet away from a pharmacist who can then tie into all of the healthcare space as well.
So it's really right now the only bridge between social and health care outside of a social worker in a healthcare space that somebody may not go to every month like they do a pharmacy.
Mike Koelzer: technician, is that a new [00:22:00] position? And is it licensed? , the state get their nose in it
Annie Eisenbeis: yes. So in Missouri, for example, we had to have our curriculum specifically for pharmacy technicians, approved by the state and the Department of Health, And then we did have to work with our board of pharmacy to say what can a CHW do that's maybe different or in addition to what a pharmacy technician can do.
Because if you say a pharmacy tech is not allowed to refer, that's fine in a clinical sense, but not in a social sense. They do need to be able to refer to some of these other programs. And so just working closely with our board of pharmacy, who's been excellent as well. We also realized that that was not specific to Missouri.
So when we started developing this curriculum about three years ago with a pharmacy that had kind of started and spearheaded this pilot, we said, okay, we can either own this and be accredited in all 50 states, or we can work with people whose expertise and their job. So thank you to CE Impact who took this on and is accrediting it in all of the [00:23:00] other states and territories.
and then I will say to you, that was an interesting discussion, like with what our board of pharmacy wanted to do versus our Department of Health, not necessarily, wanting to expand pharmacy technicians becoming CHWs. Did they want to just hire CHWs? So we did look at that.
Building that sustainable model with being able to bill, and being able to provide additional services. We now actually in Missouri have network adequacy, so, our entire network of pharmacies that have community health workers can meet the needs of a large percentage of the population if we were to contract with a specific payer.
Mike Koelzer: Or any, give me a scenario of, What we're talking about here. So, Bob or Sally owns the independent pharmacy and they typically show up. Maybe they are working a shift in the morning and they've got, [00:24:00] a few technicians and a delivery person, whatever that might be a basic pharmacy. How does that look different? a few years from now, once this program is, maybe now, but even in a few years from now, once it's really rolling, what is that going to look like from it to what is envisioned?
Annie Eisenbeis: Okay, so you have the same number of staff in the same building
Mike Koelzer: right.
Annie Eisenbeis: and you have a yeah So you have a program now that your technicians and your delivery driver have a community health worker training
Mike Koelzer: Through CE or something, they've gotten trained.
Annie Eisenbeis: So it depends on the state. They could go to multiple places Pharmacy specific. I know the only one in Missouri is through CE impact, but they could go to colleges so there's others and each state may be a little different
Mike Koelzer: And how long, Andy, does that take , for someone as you're seeing it now, how many hours sitting in front of a computer basically is that going to take somebody?
Annie Eisenbeis: [00:25:00] So it's about 100 to 160 hours. So it's not small, it's not like a weekend or a day to become immunization trained. It's 16 weeks, but actually, or 12 to 16, depending on the state, but actually the golden egg or like the thing that is the most valuable part of the course is the service learning hours.
They spend 60 hours or 30 different meetings, which could be virtual or could be phone or in person, meeting with specific resource leaders in their community. So maybe it's the health department, maybe it's Meals on Wheels, maybe it is funding like, the caring communities in the county, who help with, paying for medications.
And so it's meeting all of the different contacts and leads and how is a patient eligible? Who is eligible? How can I make sure that anyone who needs this resource knows about it? Because now we know about it because the CHW. So they build this binder
[00:26:00] of community resources.
Mike Koelzer: part of the training
Annie Eisenbeis: Yes.
Mike Koelzer: That's beautiful what you said about, don't need to invest in more computers, more space, more people,
Annie Eisenbeis: Right.
Yes.
Mike Koelzer: So many, I want to bring up stuff as they come up because my wife says I'm skeptical and she's probably right. this 60 hours that these three people have to get the technicians, is that going to be on the, while they're working? Because you said we don't need more people, but if you take 180 hours over three people, that's time away from the customers when is that? Part done.
Annie Eisenbeis: Yes, so it depends on the business and what makes sense for you. So I know for pharmacies in Missouri, there are some that did pay their technicians during that time, for example. And so the course is usually, like the live portion, is usually on Tuesday evenings to try to accommodate [00:27:00] Community pharmacy hours, at least, which our other courses, offered by our state community colleges were always during the day, so we could rarely get technicians away from 12 to 2, to be able to attend those live.
We actually are now able to accredit or approve an on demand option for Missouri. Not all states allow that, but we've kind of proven our sustainability case to the state, so they're allowing us to do that. And then we have a conglomerate of CHW technicians now to share best practices and questions. I will say too, back to your like what does this look like in three or five years when it's kind of fully cooked.
I would ask that owner or pharmacist who is overseeing any of the clinical services or really honestly any of the business line items. How many of your technicians or delivery drivers, unless they are co owners, [00:28:00] are asking you, how do I bill what's next for any line item of the business? So if you have any technician coming to you and saying, okay, I love MedSync, how do I bill for this?
I love dispensing a specific line of medications. How do I bill for this? Because I can, at least in my experience, I never had one. I never had a technician or delivery driver empowered to ask me or the owner about a service even if they enjoyed or were like that was their purpose in the pharmacy.
incredible success, and we're able to just move into the next phase.
So our very first post, we used Basecamp to connect with all of our pharmacy teams because it wasn't just the owners. We had 500 plus providers, in technicians, CHWs. So when I posted this was shutting down at the end of the day, the very [00:29:00] first questions: What's next, and how do I bill, and it came from pharmacy technician C.
but I thought that was interesting.
Mike Koelzer: I don't want to get away from this though, because I, trust you when you say no new people and no new space and so on, but you've got three technicians and so and so only wants to work 20 hours a week and someone's at 40 and someone who wants to work 30 hours a week now over 16 weeks and it's an average of a hundred to 160 hours.
Let's say that. Eight hours a week. Where do these people come up with the extra eight hours? Is it biting the bullet? Because you can't take them away from the pharmacy for 24 hours and maybe they they to go to that kind of training, maybe they would have, maybe they would already be a dental assistant or someone that required this kind
Annie Eisenbeis: Right.
Mike Koelzer: So where does that time come from?
Annie Eisenbeis: Yeah, so that's another great question. I would probably call that done. Time and money, if you can hire even a [00:30:00] part time person it's back to the money. So in Missouri, that's where I looked at our grantors and said, pharmacy could be huge in this space. Like we're already embedded in the community.
Our patients answer the phone for other reasons, like we're not having to find them to be able to connect and share. what's needed, what screening, et cetera,
and we can connect all of the dots for them. So, not only are there scholarships available in a multitude of places, for the course itself, but we have worked with our grant partners as well to start tying in. If this is a new program, especially in public health or population health, then we need to be paying for the training time.
That's just as valuable, if not more valuable, than the end result or the implementation. So even a CHW who's already fully trained and certified as a Community Health [00:31:00] Worker Technician, if I'm wanting them to do a CW, specific service and substance use disorder that requires another six to eight hours of training.
And I want them to actually do something with that training, Then that means that that time is valuable to me as the program manager, but I should be including funding for that time if it's valuable.
that's where, too, I think as public health or as grant writers or as Grant managers, we need to be implementing that into the program or for payers as well to say, okay, if this is a part of a pilot for a payer or an innovation center, that you need to be layering in the training time and payment for it, either a stipend or whatever it is, because that's just as valuable as the implementation and the end result.
Mike Koelzer: Okay, Annie. So thank you for that. Now let's back up again. All right. So now this owner with these, let's say three technicians. All right. So now they're trained 16, 20 weeks have gone by and these three have the [00:32:00] CHW and there's maybe a delivery driver and maybe some other person in the store.
you got this set up. So the pharmacist and three CHWs and a couple others. Now what?
Annie Eisenbeis: So I would probably back up a little bit to say, if you have one pharmacy Who's the only one anywhere doing this, then you probably have a little bit more of an uphill battle because you're likely not going to carry the same weight as a state of pharmacies or a network of pharmacies with CHW technicians.
Mike Koelzer: So let's say that we're in a place.
Annie Eisenbeis: Missouri.
Mike Koelzer: Let's say that we're in Missouri. All right. now your pharmacy has committed to this and
Annie Eisenbeis: Yes.
Mike Koelzer: Now you're at week 20. Now what?
Annie Eisenbeis: Okay, so now we layer in programs, that the social determinants of health assessments and those payers that want the data around the SDOH outcomes. [00:33:00] So to know, how many of my patients are having issues because of all of these other factors. And then two, that's where the CHW can come in.
And then the pharmacy technician now who's trained as a CHW is a little bit more empowered to be a part of these. clinical or education programs from that data collection, assessment, screening, so we have started layering this type of work into what I defined as the value of pharmacy,
in the follow up and monitoring that happens in a process that already exists, at least in most independent pharmacies. Maybe it's not super strong, But it exists in the software and the workflow, and that's medication synchronization. So we have this opportunity that we can run reports for patients who are on our MedSync, we can follow up, we can assign technicians to all the different spaces, and then we also have the schedule, the timing of our deliveries, etc.
So, Why are we not also using that process for [00:34:00] building all of these other valuable, billing opportunities, for lack of a better term, like education and screening?
Mike Koelzer: if you're in Missouri and you've got a sync program and that's not rock for us, it was rocket science. I tried sync three times, Annie. I'm talking about failure. I'm a three time failure.
Annie Eisenbeis: But you also don't need to have a patient who's on chronic medication to add them to your MedSync workflow.
Mike Koelzer: Let's just say you're not a failure like I am in that category. You've got the pharmacy, you've got the med sync set up, you've got the CHWs. And so, yes, that sounds like a real natural fit that they piggyback then onto those phone calls that are already happening.
Annie Eisenbeis: It is basically building a conversation about a specific thing. So you could build a conversation about vaccines.
So we, you know, saying, did you realize that, you know, my pharmacist did an eligibility check. It looks like you're due for your [00:35:00] shingle shot.
the patient says, no. Okay. So next month I'm still going to ask, cause I'm already calling you about your medications potentially, you're used to me calling every month. So you're still going to answer and be cordial.
say, Hey, I still care about you. So I am going to bug you.
Don't forget, you still need that shingle shot. We have it at the pharmacy. And basically changing that. No way, Jose, I'm never going to get a vaccine for my shingle shot too. If I have a question about my shingle shot, I know who I'm going to ask.
Mike Koelzer: All right, so we're building this scenario in my head. So now they're calling already, they're talking about this. Then typically when they're talking about that, the person might just say, yeah, I'm going to get it. Or they might bring up an issue of why they're not getting it or some other concern.
So far, we haven't really used the value of the CHW in this phone call, because anybody could ask about the shingles shot.
Annie Eisenbeis: Correct.
Mike Koelzer: This next part of it is where Some of [00:36:00] that CHW shines in some of the responses they get from this.
Annie Eisenbeis: I think not only that, there's actually another layer of services that could be specifically making that CHW shine. I think the CHW role empowers your technician to shine a little bit more in this space. Maybe being more comfortable with having this continuous conversation. But then also in the documentation.
So if you didn't document, you didn't do it. So if you had a five minute conversation about the shingle shot or, or whatever it is, it could be a screening too. It could be that you're due for a cancer screening. And so if you had this five minute conversation now as a CHW, you're a little bit more, empowered or trained to also document appropriately.
And then two, you can layer in social determinants of health screening. So if a patient says something about not affording or not at, you know, not having time or whatever, having other issues. It's basically this ding, ding, ding, [00:37:00] red flag, I know what to do to overcome these barriers. But then again, documenting and collecting that data is just as valuable to everybody else than just getting it done.
Annie Eisenbeis: So then on top of that, though, there's this whole untapped area of care coordination that I don't think pharmacists could tap into as easily or as well without a pharmacy tech CHW.
Annie Eisenbeis: So it's kind of funny. If you had asked me five years ago, I would have had a totally different answer than today.
I think The turning point or the key to pharmacy transformation and pharmacists being able to focus on and bill for services, is actually going to be on the shoulders of our pharmacy technicians becoming more trained, empowered, and kind of having their own expertise. Not necessarily again, clinical, and maybe it's not CHW specific.
Maybe it's other spaces. Maybe it's business, marketing, whatever it is, operations. but empowering our staff that are not [00:38:00] clinical to have other knowledge and expertise So, with the care coordination piece, our CHWs can support coordinating a patient's care. So, if we think about a vaccine, for example, but also in the face of a future, potentially, pandemic,
to say, what is the key to getting patients, whether it's testing or treatment or a vaccine, it's probably going to be someone in the community being a resource and a hub. And so that coordinator could easily be a pharmacy technician, especially thinking about the last pandemic, who were the heroes without capes,
The frontline people were all in those pharmacies, whether it was the pharmacist or the pharmacy technician and the delivery drivers. They're all still there when everybody else is at home. So, I think that if you looked at that, whether it's an emergency response or just in general, to address all of the health disparities that were always there but are coming to light post pandemic, and [00:39:00] wanting to look at health equity and being able to reach everybody, especially the vulnerable and underserved areas, the key to that is going to be your CHWs Partnered with a pharmacist.
Mike Koelzer: Okay, Annie, so let's go back to that phone call. if they have a shingle shot or not, but now the CHW puts their thinking cap on. The person gives a response. There's value in that response.
Annie Eisenbeis: Mm hmm.
Mike Koelzer: What is the value in that I'm going to go out on a limb here and say, someone's going to pay me to collect that data.
They are going to pay me. Is that what you mean by value? Or it's just like, well, we have more to work with because they said they're not getting this shot or something. Tell me about
Annie Eisenbeis: We live in America, so value is money. It's dollar signs, so, the dollar sign behind a five to fifteen minute education encounter about vaccines, especially if the patient does not receive the vaccine that day. So, thinking about a medicine call and telling you you're due, [00:40:00] so when you come get your meds on Thursday, that's okay.
Come get your shingle shot is about 25 at least on the average position fee schedule for that CPT code specifically. There are others associated with other education on chronic disease,
Mike Koelzer: even giving the shot, just the education about it.
Annie Eisenbeis: actually specifically without getting the shot. So if you did not get a vaccine today and I offer you vaccine education, come not necessarily in a pharmacy because pharmacists have provider status issues, but this was where, too, we tied it specifically to that CPT code to then take to our Medicaid, et cetera, and say why they should turn this on,
Missouri is one. We have provider status in our state with our Medicaid program. So, yeah, looking at the average reimbursement rate,
Mike Koelzer: does.
Annie Eisenbeis: no, the pharmacist.
Mike Koelzer: Pharmacist does.
Annie Eisenbeis: in Missouri. Sorry. Yeah, we were going to share both to say the pharmacist and a pharmacy tech under a pharmacist supervision
Should also be able to bill for that.
So it's about 25 for a 5 to 15 minute [00:41:00] encounter.
Mike Koelzer: Through that kind of conversation, then the person doesn't want the shot. Gotcha. They've been told they don't
Annie Eisenbeis: Mm hmm
Mike Koelzer: I'm thinking the next step then is the key to getting some of the other community providers involved with questions or at least information that the patient is asking. Came up with just by jabbing about, you know, stuff. So then what is that next step? Where is the, well, you said it, the value in America is the dollar. So where is the next step they've documented? I'm not going to get a shot. Where does the next help come in and how is that paid for?
Annie Eisenbeis: Yes, so I would say that it's not a single 5 15 minute encounter. So it's 25 unlimited. So maybe they say no, or maybe they say, Yeah, that's not on my priority list today. But I know for [00:42:00] me, at least, I'm in health care, and I left my PCP's office and immediately forgot, unless it was my priority to remember, what his recommendations were.
So just even having that month to month, that this is something you need to do is helpful. And so again, 25 every month is pretty good, but at least per patient.
And then I would say, let's say that patient says yes. Okay, so actually I'm going to change this a little bit to make it more complicated.
This is actually a patient that now has to change pharmacies, so they're not using your pharmacy for whatever reason. So how do we still say that the pharmacy is the one closing that gap in care?
on steroids, to say, this is the care coordination now, that CHW can coordinate them going to the health department or them going to the VA office or another pharmacy down the street.
And basically following up. to say, did they get it? They can check the immunization registry or the provider. [00:43:00] So basically that care coordination of getting the patient from, yes, I want it to where they need to go, even if it's not at that pharmacy and saying the pharmacy team is the reason that that gap was closed, that gap in care was closed, not here, but because of us,
So even to say, okay, I'm going to help you make an appointment at the health department, because we all know trying to make appointments somewhere where you're not used to it and then getting there and checking in is kind of overwhelming. I just tried to make an appointment for physical therapy.
It's a whole ordeal, now I'm calling my insurance and trying to figure things out. So in comes the CHW. I wish I had my own person. CHW at times, so basically I am now the CHW calling the health department, getting you an appointment, making sure that the transportation you needed shows up and gets you there, and then following up if it didn't to get basically also close that gap too.
And so part of that, even if it's not a vaccine, let's say it's something that can't happen at the pharmacy, like, [00:44:00]
We are closing that gap using a CHW still, even if it's not even able to happen at the pharmacy. Because we have, again, the touch points and the patient answering the phone.
We have the relationship, so then eventually, too, that patient, when they have a question about it, even if they've been a no for 12 or 14 months, now, oh, my friend just died of shingles, I'm going to give you a call. Maybe not shingles, that was a bad example, but I'm going to give you a call and now I have questions and you're the only person who's listening.
Like, routinely talk to me about it. And you're most accessible, so I don't have to make an appointment to talk to you.
Mike Koelzer: Do you get paid for that? That's what I'm looking for. I'm looking for those
Annie Eisenbeis: Sorry, Yes,
Mike Koelzer: for that. Just like you got paid for a unsuccessful jab at that point, but you get
Annie Eisenbeis: yes,
Mike Koelzer: stuff too.
Annie Eisenbeis: yes, and it depends on where and who you're partnering with on how you get paid. So it could be a per member per month, type of value based arrangement, or there are [00:45:00] also, CPT codes around care coordination. And I want to say those range from like 50 to 80, depending on what's done and then who's involved.
The payer ultimately gets to kind of say what that looks like and the contracting, but yeah, there's money there, without GIR fees ever hopefully associated with them, that involves using your team in a different expertise that is not solely the clinical person.
Mike Koelzer: I'm preaching to the choir here to pharmacists, but pharmacists do all this stuff for free and how they get paid for it. The person then decides to get their medicine filled at their pharmacy, and then they lose 200 on that prescription.
That's what pharmacists have been up against. so now this flips everything. So now they're getting paid for services. They're not losing any money on the prescription. Hopefully they're going to gain it sometime. Who, [00:46:00] who's paying for this stuff?
my guess is it's grants and maybe some government stuff. And then hopefully corporations are smart enough to say, Hey, this doesn't have to be 80 years olds. We're doing this with, how about we pay pharmacists for. All of our employees, because the CHWs are keeping our staff healthy.
Annie Eisenbeis: Mm hmm.
Mike Koelzer: just like a company might have daycare for children. the CHWs are not helping that way. They're helping them with coordination and things like that. paying for it, Annie.
Annie Eisenbeis: yes, yes. So, okay, who's paying for it initially? I would say our grant opportunities or partnerships. So when I say initially, I'm talking about the scholarships and the training for that pharmacy team to basically take that
Grants could pay for a new service or pilot to basically develop the steps needed,
A grant is the infrastructure that is needed [00:47:00] to keep it efficient and effective and share all of the best practices. But a grant's not the long term solution, it's the starting place. So then you now have all of this data from the grant opportunity.
So, we have several in Missouri now that have focused on the vaccine gap, but that we can tailor to diabetes, hypertension, CKD, also even in specific spaces, depending on that partnership. So, maybe it's the vaccine gap in nursing homes specifically, looking at not just the residents, but the staff and family who come to visit as well.
So, we used this model now, this framework and said copy, paste, copy vaccine hesitancy education into diabetes gap closure, into any gap closure, into cancer gap closure screenings. And so now, now you have a much wider range of potential players. So it could be your employer groups. It could be Medicaid.
Mike Koelzer: It could be, [00:48:00] commercial plans. Basically it's where is their gap? Here's the question. Is there right now, not counting the administration, which some of these grants cover, getting this stuff going, is there, and who is paying right now for the CHW to talk about the vaccine or to get them to a doctor appointment, something or other, who's paying for that?
Is there anybody paying for that right now?
Annie Eisenbeis: In Missouri, we have some regional, payers specifically, and then we have discussions in the work, too, for a statewide payer, but I don't feel like I can get into the details yet, but ask me again in six months, and my answer will be yes, we have 20 people.
Mike Koelzer: but there's a group
Annie Eisenbeis: I'm going to go ahead and going to go ahead and run this, and I'm going
Mike Koelzer: But there's a group now that is paying for some of those numbers, however they define it. To close some of these gaps, not the administration of it, but actually these [00:49:00] phone calls and the doctor visit and so on.
Annie Eisenbeis: Yes, I tried to exclude like we have a lot of grant opportunities and partners, but I'm trying to kind of keep that separate. So outside of even grant partnerships saying we want to focus on a specific subset of the population and close gaps, because that's a huge area, especially in other states that don't necessarily have pharmacies involved in public health grants, yet they should.
so we do have opportunities and contracts either currently or in the works. Mostly right now they are pilots, so they're smaller, but they've started small in the last six months, I want to say, and have started expanding already, which to me at least is Good, because I'm impatient.
Mike Koelzer: You might show. Success with these kinds of things, but it's hard to prove it. You're not sewing someone's leg
Annie Eisenbeis: Yes.
Mike Koelzer: kind of stuff. So I know a lot of it's the [00:50:00] documentation and proof. And then to tell someone it's like someone being the conglomerate of corporations or the government, it's like, seriously, these people would have died if we didn't do this.
It's not just like, maybe. So it seems the big thing then is proving what you did. Yeah.
Annie Eisenbeis: Yes. So I would say two things to that. The first, but I'm going to talk about the data to show the vaccine gap closure rates. But first, I will also say the turning point to those insurers saying yes, we should do this is going to be when one large one says let's use pharmacy tech CHWs and pharmacist teams because they're all of a sudden going to have a totally different outcome than the rest, especially too, because you can't do this in a call center.
You can't just set people down and make these phone calls because nobody answers the phone. I don't answer the phone, like I know when it's my pharmacy calling to talk to me about MedSync stuff, and [00:51:00] that's it, I actually have them saved. But other than that, you better leave a voicemail or I'm not calling you back.
So we're in that era, so you can't use a call center. So that's the other. This only exists in the community pharmacy setting. So then backtracking though, so then to say, okay, we know that vaccines not only, have kind of this political side to, to like hesitancy, but I would say that, We are looking at January to May of our data and saying this was not during a peak campaign of get your flu shot, get your COVID shot,
so from January to May, we had about a 10 percent gap closure rate with just doing the 5 to 15 minute education calls. And we had about 30, 000 in that period. So that's a pretty good rate of people who just got tested. talking in a five to 15 minute monthly conversation and went and got a gap closed.
Not flu, not COVID. [00:52:00] Those weren't available. So the focus was primarily Tdap, RSV a little bit. There was pneumonia and then shingles. And we had pharmacies that saw a 400 percent increase in the number of shingle shots that they gave from the prior year in that month, just because patients didn't realize they knew that flu and COVID is available at the pharmacy.
I didn't realize I was eligible and I didn't realize you guys had this. And so that was also part of it. to say, how many people were talking to you and then how many got the vaccine. So we collected that data in those follow up calls. Now we're looking at 75, 000 education interventions and we're still processing some of that data.
But to say we anticipate that that gap closure rate is significantly higher because now we're entered flu and COVID as well. And then we also added some of that care coordination for the CHWs at the end of July. And so when we look at these outcomes to say, okay, we have a reference that says it's about four, [00:53:00] a little over 4, 000 that saved annual healthcare spend.
If a patient gets a vaccine, if an adult gets a vaccine, which we only did adults. There's a whole opportunity there for kids too, but I'm not going to get into that. And so when we looked at the number of vaccines provided. and gaps closed in September alone. There were over 40 million saved to the healthcare system, at least in Missouri.
So that's a pretty good rate. And then again, that's not, that's like initial, you know, taking the totals and crunching them versus diving into all of the other details, because we collected an extensive amount of demographic data, social determinants of health assessments. And then like, like all the chronic conditions as well.
So I think even to like the patient's zip code of residence versus where the vaccine was gotten, cause that's interesting as well. So hopefully we'll have data to support not only that the gaps were closed because of these pharmacies, even for, you know, this whole [00:54:00] entire patient population but all of these subsets of reasons where and why you could pay a pharmacy team to do this and where they could close gaps.
Mike Koelzer: I think the key to a lot of these numbers, like when you show people numbers is all right. if you don't pay us, screw it, we're not going to do it anymore. See, I think what pharmacy has done is we said, you know, pay us for this, pay us to teach someone an inhaler or whatever, then they don't pay and the person's coming in there and they're going to die because they're having an asthma attack and they pick up an inhaler.
Guess what? The pharmacist is going to tell them how to do that. That's an example of whether it's paid or not, the pharmacist is going to do it. And those are hard numbers then to parse because, if I'm an insurance, people are like, I'm not going to pay them. They're going to do it anyway.
Why should I pay them? But if you get something like this where it's like, we helped. Mrs. Smith, she didn't want to, but we helped her get her [00:55:00] colonoscopy. And because she came into the pharmacy, no one was going to call her. She wasn't going to pick up the phone from some call center, you know, from across the world or the country. She came into the store. We talked to her. Then she called us a week later. We set this colonoscopy up for her and it, found cancer and it her life, but guess what insurers, we ain't doing that. If you don't pay us, that took some effort. And this just doesn't happen by Mike being up there and talking about, you know, the weather I sure as hell ain't going to talk to Mrs.
Smith about her colonoscopy or my techs. So it's like, screw it. We ain't going to do it. You're not going to see the value. She's going to die from it. Now these numbers make sense because it's not something that pharmacists are just naturally going to do. And everybody gets a free ride from it.
Annie Eisenbeis: So to top that, we actually have a pilot that we did with the National Kidney Foundation [00:56:00] looking at patients who were at high risk for CKD, so patients with diabetes and hypertension, and then recommending that they go and get their kidney function testing done. We had a pharmacy specifically use a community health worker to meet them at the health clinic.
Department and then walk them through the process. So of the, I'm just going to use closer numbers that are easier, but it was about this. So of the 200 patients that they recruited that were eligible to get this testing done, they had 50 percent of them complete the testing, which again, this was not at the pharmacy.
They had to go to the health department and get this, these blood tests done. And then I think of a urinalysis as well. So then come back, they also had to get that data. So. They had 50 percent of the patients get the blood tests done and the urinalysis with the CHW support. They also said that the patients that didn't go, they had the CHW call from the health department and say, Hey, it's funny.
I'm here. So it was [00:57:00] like this accountability, the second time most patients didn't miss. And so they found one in three of those patients had underlying kidney disease. So. Also take that to an insurance company and say, okay, we can address this now before they're on dialysis, or you can wait and we can address it, you know, start education then,
but that's a lot more money.
Mike Koelzer: That's right. That's a perfect example. We're on the same page that was not going to get done without this program. It's not like they were going to come anyway, and we were going to tell them how to use something because we're getting screwed by them. Insurance, but you know, we love Smith and we're going to tell her anyway about that. No, there's, there's no way we're going to talk about kidney function or help her get there or things like that. And so that's a perfect example of this ain't happening without this program. No,
Annie Eisenbeis: yeah, this pharmacy did not have a phlebotomist on site. They had to partner with
Mike Koelzer: [00:58:00] I mean, they care about her, but not to the point of setting all this stuff up.
It's not like Christmas Eve delivery where it's going to happen anyways. It's like, this ain't happening.
Without
Annie Eisenbeis: Right. Right.
Mike Koelzer: All right, Annie. We haven't talked a moment about involving the pharmacist somehow. The guess is that this program kind of backs you and says, we've got this in the pharmacy when someone doesn't use some injection or some steroid thing or something.
When someone doesn't do that correctly, or they don't put this in the refrigerator or this doesn't happen, or they don't get a follow up, this isn't something the CHW can do. It's not in their skillset. This is the pharmacist's skillset. And guess what? They're not going to do it if they don't get paid for it, because it's something beyond what the average pharmacist thinks they're responsible for, or it takes more follow up than the average pharmacist would do, but I'm guessing this back doors into that to then [00:59:00] get this value for pharmacists too.
Annie Eisenbeis: Yes. And I think that's where you've hit the nail on the head. Like this is basically our toe in the door to say, okay, we can address issues that no one else can using our pharmacy tech teams. But now, We actually can say what the value is of adding that medication expert, so we have this follow up and monitoring, now add the medication expert.
So thinking about those patients with underlying CKD, they probably have a lengthy med list that we now need to go through with their provider and say, what needs to change, what does, et cetera, cause now maybe half of these meds are needing a half a dose, or a removal because they're not being properly functioned by their kidneys.
So I think having a medication optimization but also from the context of like thinking about right now, we get paid for CMRs potentially, and once a year we can meet with a patient and do a comprehensive medication review. But do you think that's [01:00:00] as helpful? If their medications may change throughout the year or as when something happens then do this medication review or optimization.
I actually like the word optimization to say we're going to look at this a little bit more holistically to say this patient can't afford this one. Take that off their list, like basically almost a med rec on steroids. And then, so that is also an area for using the pharmacist expertise once there is this event or a diagnosis, etc.
I will also say that, like, adding that 5 to 15 minute encounter on a MedSync call incorporates that technician, but there's going to be clinical referrals and questions for that pharmacist. So I think, thinking that 25 a month five to 15 minutes is always and only the tech CHW is probably not the case.
yes, but they may pull a question for that pharmacist specifically, especially when you get outside [01:01:00] of preventive care or primary care. Maybe you're speaking specifically for patients with diabetes and then, you know, they have some different individual clinical questions. I also think that's an area for Documenting referrals, so you have your referrals to the social space, but then that pharmacist ties in the referrals to the rest of the healthcare system.
And so having them be a part of that team as well, that opens a can of worms for the need for people. Better health information technology, and basically having these exchanges and being able to access data bi directionally. That's actually an area too for CHWs, so not just pharmacy specific, but to have these referral loops.
So, to say I'm referring to this social resource, I need to make sure that that got closed and that the patient got taken care of. Or it may be kind of this continuous, the patient needs this every month and I [01:02:00] need to make sure that that happens. I think the same goes for the healthcare system because we're a little bit all in different spaces, different expertise, and different silos.
So when a patient leaves the ER or leaves the hospital and they go to their primary and they come to the pharmacy, who can help coordinate the healthcare side? That's your pharmacist.
Mike Koelzer: Years ago, I wasn't in the pharmacy a whole lot. I was Pissed off at the insurance and all that stuff. And I could afford, I didn't even, I didn't like my employees either. I didn't like a lot of my employees. They're gone now. I just didn't like being around them.
I'm sure it was me, not them. I just didn't like being around them. Partially because I was them and we were losing money and all that kind of stuff. And I was kind of in a pity party, like, nobody appreciates us. The PBMs don't appreciate us. Nobody appreciates us.
We're not needed. Then about three or four years ago, I went back. I go back around the time of COVID, not because of COVID, but just because of different well, frankly, I got rid of a [01:03:00] lot of the employees. And it hit me like a ton of bricks that we're not getting paid for it, but we are needed. I haven't felt so valuable, not in the American sense, but I haven't felt so valuable for years realizing it's like, what the hell? If I wasn't here, do you really think someone would take care of Mr. Jones the way we solve something? He'd be dead in his living room in a couple of days if we didn't do this.
Here's the problem, Annie, you see with these pharmacy deserts now, is that when I came back and, and this hit me, like how needed we were. I gave the same care. If I was getting paid or not getting paid, but guess what? When the time comes around for me to get out of there, I'm going to get out of there a hell of a lot quicker because I'm not getting paid more than I would if we were getting paid and I could sustain it. And knows that day when it comes, but when it comes, it could just be, I [01:04:00] hope, I not.
I hope to do better than this, but it could just be locking the door, you it's a cliff, no one knew it was coming and now you're going to have people across the city lying dead on their shag carpet because our pharmacy wasn't there and we filled that hole. That's coming with all of these pharmacy closures, but people don't realize it because pharmacists are committed people who give and give and give without getting paid until the It drops off a cliff. So people have to wake up, I think, to the value of community pharmacy, the CHWs, pharmacists, and so on.
So Annie, the things that you're doing the people you're representing today, we gotta throw some names in there. I know we've got the CPESN. I know them. I know that we've got the pharmacists association, who Should get a shout out now. Who's getting in the dirt with this?
Annie Eisenbeis: So our Missouri [01:05:00] Department of Health and Senior Services has been phenomenal with being a partner, especially in those grant opportunities, and then CE Impact took our Missouri curriculum and ran with it. So it's in 40, 49 other states now, and I think four territories.
Mike Koelzer: all of them to all the people that are doing this and helping pharmacies not fall off the cliff and lying dead at home because pharmacists are not there, shout out to everybody any, what's the best way to, get in touch with you to say, Hey, I heard the show, I'm behind you and I have this question for you.
Annie Eisenbeis: Yes, so they can either, probably the easiest way, actually, is just email because my MPA email is easy because it doesn't include my last name, so it's just annie at morx. com.
Mike Koelzer: A N N I E at M O R X dot com.
Annie Eisenbeis: Yes,
Mike Koelzer: Annie, golly, I know you're busy with all this stuff you got going on. So I appreciate you spending [01:06:00] time with us. listeners appreciate it. And I look forward to following you and seeing all the great things that you're going to do.
Annie Eisenbeis: thank you so much, this was fun.
Mike Koelzer: All right, Annie, wishes. And we'll talk again.
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