Weigh the pros and cons of onsite lab and pharmacy

Few behavioral health centers have onsite labs or pharmacies, but many are considering the idea. According to experts, facility leaders, at the very least, must review:

1.       Whether an onsite lab/pharmacy fits with your overall mission and vision;

2.       Available square footage to host the services onsite;

3.       The critical mass of individuals or services needed to sustain your own lab/pharmacy or a contract with a partner provider;

4.       Your ability to integrate and access lab/pharmacy data on your own or with a partner;

5.       Your patient population’s barriers to access, including cost and transportation;

6.       Start up costs for your own lab or pharmacy, including cost of medication inventory;

7.       Your ability to manage medication inventory and pharmacy IT platforms;

8.       Your ability to comply with state pharmacy laws;

9.       Margins you would need to own the lab/pharmacy versus the price breaks you might receive from a partner; and

10.   The local competitive landscape.

A recent presentation from the SAMHSA-HRSA Center for Integrated Health Solutions weighed the pros and cons of adding such services. In an instant poll of more than 100 seminar attendees, 79% reported that they do not have an onsite lab. And 43% those without onsite labs reported they have difficulty accessing lab information for clients. By comparison, only 16% of the facilities that do have onsite lab services reported they have difficulty accessing information, suggesting that onsite services provide integration benefits.

Onsite pharmacy is another growing trend. Among more than 100 seminar attendees, 63% do not have onsite pharmacy, while 25% said they have a contracted pharmacy within their facilities. Only 12% indicated they own and operate an onsite pharmacy.

Contracted services

Presenters shared their experiences with onsite arrangements. For example, Becky Hudzik, MA, director of wellness and recovery services for WellSpring Resources, a community behavioral healthcare center in Alton, Ill., said that her organization opted to contract with Genoa Healthcare for onsite pharmacy.

“Starting our own pharmacy was beyond our resources,” Hudzik said. But access to medication was an urgent need for WellSpring clients, so leaders opted to seek out the contract arrangement so they could offer patients pharmacy fills more conveniently within their care facility.

The center qualified for the contract because it had the necessary critical mass of clients and scripts, with its five residential group homes and more than 6,000 individuals served per year. Hudzik says the onsite pharmacy occupies 144 square feet of space and is open Monday through Friday from 8:30 am to 4 p.m., staffed by a pharmacy technician with pharmacist oversight. Other services offered include single-dose packaging of medication and delivery to residential sites. Assistance plans provided by the contract also help low-income consumers afford their medications.

Similarly, WellSpring contracted for its lab services. LapCorp provides tests, blood draws and other lab work, three days a week, in two rooms onsite, with strategic pricing. Hudzik said because the agency is collecting rent from the space used by its pharmacy and lab onsite partners, WellSpring is making some money. She believes the financial proposition of contracting for pharmacy and lab onsite makes sense.

“If we are willing to be a guarantor, we can get lab work at a discount price,” Hudzik said. “Consumers pay us, and we pay LabCorp.”

In addition, the onsite convenience is translating to better client adherence to care plans and higher medication possession ratios. Hudzik recommends that agencies shop around for pricing and service when considering onsite partners.

Owning your pharmacy

Sandra Stephenson, MSW, MA, director of Integrated Healthcare, Southeast, Inc., in Columbus, Ohio, said operating a closed-door onsite pharmacy was the right choice when the opportunity presented itself. Staffed by three pharmacists, one clinical pharmacist and three technicians, Integrated Healthcare’s onsite pharmacy filled 75,000 scripts in 2013.

“This is not for faint of heart,” Stephenson said. “It’s been very challenging but a good experience.”

Integrated Healthcare was able to purchase an existing pharmacy on its campus for nothing more than the cost of the goods on the shelves when the previous management company decided to pull out.

“Suddenly overnight, we were in the pharmacy business,” she said.

The biggest challenges were mastering the technology interface required to operate a pharmacy and inventory management, which has a direct effect on the sustainability of the business. For example, medications can expire on the shelves, so keeping extra supply can lead to wasted products and wasted money. It was a strategy Stephenson said Integrated Healthcare leaders learned to improve with time and experience. But owning the pharmacy has been well worth the effort.

“It’s convenient for the patient having the pharmacy right in the building where they get their other services,” she said.

Beyond just convenience of a seamless service for patients, the real-time intervention of pharmacists and the ability to share patient information have led to better care. For example, clinical pharmacists can offer immediate consultation with the prescribers as well as the patients. They can also offer assistance with prior authorization processes.

“We were happy when we were able to hire a clinical pharmacist,” Stephenson said. “They’re very well trained in terms of dealing with medical prescribers and talking through dosing and less expensive options.”

Integrated Healthcare has also contracted with LabCorp for its embedded lab services with some additional off-site capacity.

“People who can’t pay don’t get labs, and that is not okay in an integrated setting,” she said. “We used $85,000 last year of own funds to pay for labs.”

Stephenson said she would never rule out owning a lab in addition to the pharmacy that Integrated Healthcare currently owns, but the main concern thus far is maintenance and space constraints because labs do require a significant amount of equipment for specialty services.