Hello and welcome, everybody. Thank you so much for joining us today for Point of Care Dispensing for Improved Adherence. Just a few housekeeping notes before we get started. All attendees are in listen-only mode. If you've got questions throughout the presentation, drop them into the chat function today and we'll be gathering those questions for our speaker. The webinar is being recorded, so please know that we're going to be sending this to all registrants. We'll be sending the recording PowerPoint slides via email in the next couple of days. So for today, our speaker is Matt Hoff, CEO of AS Medications. Now I'm going to be turning it over to Matt to get us started. Good afternoon, everybody, or morning, depending on where you are. My name is Matt Hoff. I'm CEO of AS Medications Solutions and thank you guys for giving me the opportunity to present today. Just a quick introduction to who I am and who we are, but AS Meds started back in 1988 and the origin story for us is our two founders went on a vacation to Japan with their wives. And while they were there, one of their wives got pretty sick and wound up going to the hospital. And you can imagine the stress of late 80s, you're in Japan, don't speak the language, you're doctors, so that makes it even worse because you sort of know what's going on, but not enough to do anything about it. And luckily, they were able to get the afflicted wife to the hospital. She was able to get treatment and she left with the prescription. And if it's the status quo, or if it was in America at the time, they would then have to go navigate their way to a pharmacy, make sure that they got the medication, just adding all sorts of layers and barriers to treatment, not to mention the navigation of language barrier. Well, to their surprise, the hospital was able to hand them the medication right there. Their doctor, without the use of a pharmacy, handed the medication right to them, making sure that any questions were able to be answered through the interpreter, all of these things to make it just simple and easy for them to get their meds. So throughout this presentation, you're going to see me compare the solution of point of care medication dispensing to what the status quo is. Status quo being a prescriber writes the prescription and it gets sent out to a pharmacy, and then the patient's truly on their own to get the medication. And there's no coordination between the pharmacy and the provider to make sure folks are following the doctor's literal orders. So when you look at what the current state of affairs is, there's a lot of issues that are caused by this. So medication adherence is only about 60% nationwide. That means that only 60% of all prescriptions that are written, and that's regardless of specialty class, that's an aggregate number, are picked up in the first place. So when you look at some of the reasons that come into it, there's some that are financial, some that are understanding, some that are patients who think they can just tough it out. But a lot of them fall down to social determinants of health or simple communications. When surveyed, over 78% of patients said that there's a positive impact from dispensing. But when you look at what the barriers are, poor understanding of medication, that's one is very, very relevant to the orthopedic space. There's dosing schedules, possible side effects, what the exact proper usage of something like a topical would be. All of these things cause confusions between the patient and their prescriber. And what you wind up seeing is the proverbial pop fly that nobody calls, that providers think that the pharmacist is going to do counseling, the pharmacist thinks that the provider did some counseling, and the patient's really just left with the instructions that are printed on the dispensing sheet. And that's really not fair to the patients, but it's also not fair to the prescribers who have to deal with patients who didn't adhere to the doctor's orders and aren't getting better or aren't getting better at the rate that they should be because they're not following proper usage. So dosing schedules, potential side effects, all the understanding pieces that come into it. There's physical limitations, and I think this one really speaks to the orthopedic environment. For the vast majority of patients who come in to visit an orthopod, they're going to have some sort of issue. It's pain, it's mobility, it's, you know, their hip, back knee is hurting. That makes it difficult for them to get around. Adding an additional step of having to go to a pharmacy to pick up their medications doesn't do anything to make it easier for the patient to get well. You know, physician dispensing is something that's existed since the Middle Ages. It's not something that's new or uncommon. It's relatively unknown in the U.S., and it's more popular in ortho than it is in a lot of other specialties, but it's still not as prevalent as it should be because it's a fantastic way to make sure patients are able to get their medications. Medication cost is another huge reason why patients don't get their medications. It's because it's confusing. It's because of all the problems that you see being litigated in Congress right now around drug manufacturers and PBMs. When you're able to dispense a medication on site for a patient, not only are you in most cases able to provide a lower cost medication, but if a patient does have some sort of financial barrier, they're able to voice that to the doctor right then and there, saving themselves, you know, they may be embarrassed to admit it or something along those lines, but it gives the doctor the opportunity to look at alternative measures to be able to get the medication to the patient. And there's a number of ways that this can look. You know, the patient may self-diagnose and decide, oh, I can take this OTC that's relatively inexpensive versus the RX I was supposed to take. They may cut their pills in half or skip doses, and all that does is really hurt the patients and cost more money in the long run. So when you look at the price of non-adherence, you're taking something that's a 60% adherence solution in the status quo and on-site dispensing moves it up to almost 100% adherence. That's helping the patient follow the doctor's orders and knocking down the barriers that otherwise would prevent the patient from getting the care that they need. You know, no part of this program or no part of any on-site dispensing program takes away from what a pharmacy is able to do. Pharmacies will be there. They're always going to be the option. They're always going to be viable. But as you look at what's happening in the pharmaceutical or the pharmacy landscape right now, Rite Aid announced the closure of 150 stores. CVS was 100 stores a year over three years. Walgreens is announcing the closure of, you know, just a tremendous number of stores, including the two that are in my neighborhood. So not only is a system where patients struggle to get access, struggle to get there, already a problem. It's exacerbating and becoming worse. The wait times are going to go up. Hours of availability are going to go down. The inconvenience is just going to go through the roof. Mind you, that's on top of once you get to the pharmacy, there's a 45-minute to an hour wait just to get the prescription filled. That's 45 minutes to an hour where a patient is probably in pain or could be doing something to mitigate their condition, getting started on the antibiotic earlier, doing all sorts of things to better manage what they actually came to the doctor for. Point-of-care dispensing is a really simple solution. It's incredibly popular with patients. It's incredibly flexible to actually fit the needs of the doctor. It's very easy to implement and does not require a large amount of overhead. But the biggest thing is that you can save both the patient and your staff some time. You save the patient time because you're eliminating the trip to the hospital, or to the pharmacy, excuse me. That skip the trip is invaluable for them. But it also saves your staff time. No longer will they have to deal with calls out to pharmacies for missing prescriptions or prior auths or any of those other things. You're taking all of that in-house. And by removing those barriers and stressors, you're again getting to the crux of the matter, which is getting better adherence, which will lead to better results. Some of the biggest things that you're going to see is that it's able to save money, save time, and just make an overall better experience. Our personal experience is that net provider scores go up dramatically when on-site dispensing is added to a program. We see a huge increase in patient satisfaction scores, which means more patients opting into your practice versus a competitor. And overall, we just see better outcomes and healthier patients. And there's really four aspects to what we're doing and what on-site dispensing is able to do that helps orthos. So first is adherence. Driving it from 60% to near 100 means that patients are actually going to be compliant with what the doctor prescribes as their treatment plan. And the fact that you're doing counseling as you hand out the medication in practice means that patients understand very clearly how they're supposed to take their medications, what they're supposed to do with it, and how it fits in the overall treatment plan. How does the medication they're prescribed integrate with their physical therapy or any other program that the orthopedist puts them on? That level of engagement is absolutely crucial to making sure there's no misunderstandings and that the patients follow what they're supposed to be. All that's going to lead to a more efficient practice because you're not dealing with multiple outside sources. You're not dealing with multiple, you know, barriers where patients may not get their medications, questions, patients that are scared to ask their pharmacist because they're standing in line with 10 people behind them so they don't really want to air their personal business. All those things help make a more efficient practice and that yields results. Healthier, better quality results for patients that are able to actually stay on their medications. So just a couple of theoretical questions for you guys to think about as you listen through this, but think about how much time your staff is spending on the phone with pharmacies. One of the groups that we work with estimated that in a given week one of their providers spent upwards of two hours on the phone with the pharmacy. Now I'm sure that's a anomaly, but think about that for your own practice and how much time and efficiency can be gained by taking the two to three minutes to dispense the medication versus scripting it out to the pharmacy and having the provider on hold with one of the chains waiting for a drug to get rewritten. The next question would be think about how many of your patients have openly admitted to not taking their meds and why. And I think the the end why is very important there because you're going to see patients that have a myriad of reasons why they didn't take their medications. Some just weren't able to get to the pharmacy because they had busy lives. Some weren't able to afford the medications. So providing easier lower cost solutions that actually help the patients get their medications are really going to do them a great favor and that's a better way to take care of folks. The third question is how often do your patients ask providers questions about their medications? And those are really the questions that you would assume the pharmacy would be able to answer. But all of us here have stood in line at a pharmacy and you know nine times out of ten if they're going to ask a question you have people standing behind you so it's not really a safe, secure, HIPAA compliant area where you're able to ask your questions directly to a pharmacy a pharmacist. In a lot of cases especially with folks who need prescripts for some sort of orthopedic procedure that patient probably went home and is laying on the couch trying to ignore the pain in their knee or their back while somebody a caregiver is going and getting the prescription for them. So now you're relying on a game of telephone to make sure patients get proper instruction on the use of their pain patch or cream or you know oral medication. That's not a great solution. Having it done right in office makes sure that the provider the doctor can tell the patient exactly what to do how to use it in a safe environment and if the patient has any questions they're talking directly with the person that they've been working with for you know the entire length of their problem. Another question is what barriers do you commonly see for patients returning to work? Why don't patients get back on the job as fast as you would anticipate them? And a lot of times it's because they weren't adherent and that adherence goes beyond medication to things like physical therapy but medication adherence is also a huge part of that. And I think the last question that I'd like everyone to ponder is how many pharmacies in your area have recently closed down? Is it harder now for your patients to get access to medications? Have hours been restricted? If you live in Kansas City did the pharmacy chains just have a walkout? All these things are incredibly relevant to patient care and without physician dispensing are outside of the control of the practice. So where does this really fit into ortho? What are the most common use cases for this? We see this a lot with pre and post-op. So patients are able to get their medications right before they go into surgery or right after. And if you think about one of the main reasons why surgeries are delayed it's because the patients weren't able to pick up their pre-op medications. So getting those dispensed on site will do a lot to improve the efficiency of the practice by making sure you're not having to constantly reschedule operations. But it also just makes it a more seamless process for the patient and takes something that's scary and eliminates one more barrier to make it better. Acute treatment is another one. A lot of orthos have walk-in centers to deal with relatively minor things and that's a great place for the ability to do on-site dispensing to save patients who are in some pain and discomfort a trip to a pharmacy and extra wait time. Chronic treatment is another area that we see it. You see everything from a 24-hour supply to 90-day supply being dispensed out of orthopedic practices. Workers' compensation is probably the most common use case for orthopedic dispensers. Probably one of the biggest drivers and most attractive parts of on-site medication dispensing in the orthopedic space. It's depending on the state that you're in it could be very lucrative but that's something we'd be happy to talk about offline. And then formulary control. You know if you look at one of the biggest things that everybody's looking at right now it's PMP reporting, controlled substance profiles. What are your doctors actually dispensing? By being able to bring non-schedule 2 medications, non-schedule 3 medications on-site you give much more control. You give an easy button to make sure that the safest medications and a well-thought-out step therapy program are inherently part of what your practice does. You know pain is one of those things that we all know is you got to get ahead of it to stay ahead of it. So being able to give where appropriate like something like a lidocaine patch can save a patient from having to go to a pain specialist down the line because they were mitigating the pain from day one. So that's another great area where this gives you more control of the patient, more control of the practice to make sure everything is being done in line with best practices. So at this point we'd like to open it up for questions but feel free to scan the QR code if you'd like to connect with my team and myself or email Victoria who's part of my team if you have specific questions but love to hear questions from the group. You can feel free to drop your questions into the chat just make sure that the two box shows everyone that way we can see what your question says. I haven't seen anything come through yet, but definitely do drop it in. Oh, here we go. We've got one here. I may have missed this, but how do you handle Schedule 2 medications? So my company in particular does not sell Schedule 2 medications for on-site dispensing. We do believe there's an appropriate time and place for a pharmacy. For administered medications, that's one story. For medications patients will take home with them, we choose to stay away from them. And a lot of that comes down to, you know, not that it's a question of are they being used appropriately or misappropriated. A lot of that comes down to is the juice worth the squeeze for the practice? So the amount of scrutiny, security, reporting, by the time you go through all those hoops, there really isn't the benefit there that you would have. And it's just better off being handled by a pharmacy because those guys have a much more rigid process or more educated on it. And then we dispense for all three. So we do a commercial program, workers' comp, Medicare, and a cash carry. So the cash carry looks more like urgent care where patients don't run it through their insurance. But depending on the situation, we can, you know, figure out what the best fits are. And I say fits because there could be multiple for one practice. All right. Those are great questions. As Matt said, there is contact information. You can scan the QR code or contact Victoria at her email listed there. If there's nothing else that's going to come through the chat. Just want to say thank you to everybody for attending today. This was a great session. Again, this recording will be made available on the AOE Learning Center. After this session ends, you should be receiving an email as soon as that recording is ready to go. And if you have further questions, again, please reach out. Appreciate everyone's time today. And thank you so much to Matt and his team for putting together such a great presentation. Thank you all. I really appreciate the time and the attention.

point-of-care medication dispensing

patient adherence

AS Medications

prescription system challenges

medication instructions

on-site dispensing