Louisville, Ky.-based Baptist Health nearly doubled the share of discharged patients leaving with prescriptions in hand. Then it made enrollment automatic.
The system flipped its Meds to Beds program from opt-in to opt-out in Epic this year after pushing capture rates from between 30% and 40% up to 70% across its eight hospitals. Now every eligible patient is enrolled unless they decline, with the system aiming for about 90%.
The program was already running across the system when former system director of community pharmacy Shweta Desai, PharmD, joined Baptist Health in March 2020. The problem was participation. Under the opt-in model, someone outside the community pharmacy had to enroll each patient, explain the program and confirm there were no extra copays or obligations.
“We all know how busy nurses are, how busy our inpatient clinical pharmacy teams, med rec teams, everyone is,” Dr. Desai said. “The reason for changing to opt-out was to pull that additional workload off of these other teams and make it entirely community pharmacy owned.”
Dr. Desai raised that hospital’s capture rate from 32% to 48% by engaging nursing leaders. That gain came without changes to the Epic build, and she saw that the existing workflow and technology would limit further progress.
Standardizing the workflow
When she moved into a systemwide role, Dr. Desai met one-on-one with pharmacy managers at each hospital to learn how they ran Meds to Beds. A new system pharmacy managers meeting gave the group a place to weigh the pros and cons of each approach. From those discussions, Dr. Desai built a workflow diagram that combined the best parts of each site’s process, then used site visits to align every hospital to it.
“Every facility, of course, is different. Their leadership is different. Their patient population is different,” she said. “But basically we were able to align the bones of the workflow across all of the eight facilities.”
One practice adopted systemwide came from the two busiest hospitals. Pharmacy teams there called patients before filling their prescriptions. They ran the benefits investigation first, applied discount cards and told patients what their copays would be. They also offered counseling. Calling first meant teams did not have to reverse a completed fill when a patient chose an outside pharmacy.
Dr. Desai and the system’s IT and data teams also improved reporting accuracy and added new Epic functionality. That work led to Rover devices for medication delivery and a Rapid Discharge Program that speeds discharge medication access for emergency department patients.
Building to 70% before flipping the switch
The next step was buy-in from system leadership, chief nursing officers at each hospital and nursing leaders on individual units. Jumping straight to nearly 90% was not realistic without first testing whether staffing and workflows could absorb the added volume, Dr. Desai said. So the system set an interim goal of 70% under opt-in.
“Do we need additional pharmacy team members? Is this appropriate for nursing? Does this get in their way? What kinks can we work out before we flip the switch?” she said.
Behind the scenes, Dr. Desai worked with IT to build the opt-out workflow and create tip sheets for nursing, case management, transitions of care and pharmacy teams. She also partnered with legal and compliance on patient-facing brochures and signage. Baptist Health hit the 70% milestone this spring, then began a phased transition to opt-out that is now complete.
What other systems should know
Payment collection remains the rate-limiting step, Dr. Desai said. Pharmacy teams can fill prescriptions and call patients in advance, but payment must be collected before delivery. The system has discussed options such as adding the charges to the hospital bill. Dr. Desai said Epic is developing a solution.
Dr. Desai credited success to constant communication across pharmacy, nursing, providers and case management. The clinical IT team visited every unit to educate nurses on the change and how it took work off their plates.
Dr. Desai said Epic told her about 50 health systems have moved Meds to Beds to opt-out. By her account, Baptist Health ranks among the top five of those systems by volume, and the others in that group are larger. Many systems that have switched are live on only a few units. Baptist Health is live on every unit at every hospital.
For Dr. Desai, the case for the program comes down to what happens after discharge. A retail pharmacy does not know a patient just left the hospital, she said. It will not prioritize the prescription, look for an alternative when a drug is out of stock or chase a prior authorization.
“We make sure that before they leave, they have everything they need, and then when they need a refill on their follow-up, that they don’t run into any barriers that cause them to be readmitted,” she said. “Meds to Beds has been known to increase adherence and decrease readmission rates, and that’s a huge win.”
