Flip the Pharmacy: Pharmacy Readiness Self-Assessment (Cohort 3)

Pharmacy Name* This field is required.

Pharmacy NPI* This field is required.

Pharmacy NCPDP* This field is required.

Choose the State/Territory where the Pharmacy is located.

Your Name* This field is required.

First Name

Last Name

FtP Pharmacy Champion Email* This field is required.The individual who will be ensuring the FtP workflow innovations are implemented

example@example.com

FtP Pharmacy Champion Mobile Phone NumberThis will only be shared with your FtP Team Lead and your FtP Pharmacy Coach

Area Code

Phone Number

I attest that I have watched the Flip the Pharmacy and Appointment-Based Model Orientation Video* This field is required.If you have not watched the recording, please exit the survey and watch the video prior to completing the survey. Once watched, please complete the survey.

YESNO

Review the minimum requirements within the CPESN Med Sync Service Set Standard. The next question will ask if you meet the standard.

Does your current medication synchronization process follow the CPESN® USA Medication Synchronization Service Set Standard?* This field is required.

YESNO

Does your pharmacy currently offer and recruit patients into medication synchronization (NOT an auto-refill program)? * This field is required.

YESNO

What percentage of your patients have you have enrolled in your medication synchronization program?* This field is required.

None

1-10%

11-30%

31-50%

51-100%

Does your pharmacy contact the patient prior to their synchronization date to confirm each medication to be refilled AND if the patient is taking the medication as prescribed?* This field is required.

YESNO

Does your pharmacy use the Appointment-Based Model to schedule patients to perform clinical medication reviews? (e.g., contact the patient prior to medications filled and give the patients a day to come pick up their medications or schedule delivery)* This field is required.

YESNO

Does your pharmacy have a systematic process similar to the “Pharmacists Work-up of Medication Related Problems” to identify and resolve medication related problems?* This field is required.

YESNO

Does your pharmacy have a systematic process within workflow (e.g., continuous medication monitoring) to regularly review patients, at the point of care, to assess if: a) They have reached a therapeutic outcome; b)Their medications are safe; c) Their medications are effective* This field is required.

YESNO

Does your pharmacy have a process to flag when a pharmacist needs to talk with a patient?* This field is required.

YESNO

Does the staff have a system (electronic platform or paper-based) to keep track of patients in need of follow-up?* This field is required.

YESNO

Does the pharmacy request or receive labs from other providers/laboratories to appropriately assess patients?* This field is required.

YESNO

Does your pharmacy regularly receive physician/other provider progress notes on your mutual patients?* This field is required.

YESNO

Does your pharmacy team offer to take blood pressure readings in your pharmacy?* This field is required.

YESNO

Does the pharmacy team request OR measure A1c readings from prescribers or patients?* This field is required.

YESNO

Is your staff trained to appropriately deliver enhanced patient care services?* This field is required.

YESNO

Is the dispensing process driven by technicians?* This field is required.

YESNO

If allowed by your board rules, does the pharmacy use technician product verification?

Yes

Not applicable

Do you utilize your technicians to manage (lead) medication synchronization?* This field is required.

YESNO

Do you utilize your technicians to triage patients prior to the pharmacist seeing them?* This field is required.

YESNO

Do your technicians document within the patient record (OutcomesMTM, eCare plan) for the pharmacist to review and edit?* This field is required.

YESNO

Are any staff members trained as Community Health Workers (CHWs)? * This field is required.CHWs are trusted members of the community and have a great understanding of the community that they serve. This trusting relationship enables CHWs to serve as a link between health and social services and the community to help improve access to services. Having at least one CHW on staff at your pharmacy can help set yourself apart and become extremely attractive to payers and partners.

YESNO

Does your pharmacy use an electronic platform, exclusively, to synchronize your patients' medications?* This field is required.meaning not using paper

YESNO

Does the pharmacy have the ability, through the use of technology tools, to identify/flag patients who are candidates for a clinical work-up/intervention?* This field is required.

YESNO

Do you use automation (robots/electronic pill counters/etc) in your dispensing process to improve workflow, reduce medication errors, and free-up your pharmacists.* This field is required.

YESNO

Do you believe you have adequate technology in your pharmacy to support your patients and your practice (pharmacy management system, IVR, eCare Plan platform, dispensing technology, etc.)* This field is required.

YESNO

Do you document and submit eCare plans?* This field is required.

YESNO

How many estimated eCare plans have you submitted in the last 3 months?* This field is required.

1-10

11-25

26-50

51-100

> 100

What eCare Plan vendor does your pharmacy primarily use to submit care plans?* This field is required.If you use a different system than one listed below, the system is currently not an eCare Plan documentation system with the ability to send eCare plans to CPESN USA

AssureCare

AZOVA

BestRx

DocStation

FDS

Liberty

Micro Merchant Systems

OmniSYS (previously called STRAND)

PioneerRx

PrescribeWellness

QS/1

TDS (ComputerRx / Rx30)

Not listed

Does your pharmacy have access to shared electronic health records? * This field is required.

YESNO

Do you regularly request and receive patient information from prescribers/other providers (e.g. patient progress notes, labs/vitals, discharge summaries, etc.) in order to assess your patients’ medications?* This field is required.

YESNO

Does the pharmacy regularly send clinical recommendations to prescribers when medication related problems are identified?* This field is required.

YESNO

Do you regularly receive responses back from prescribers about your clinical recommendations? * This field is required.

YESNO

Do prescribers in the area know about services your pharmacists provide to mutual patients?* This field is required.

YESNO

Do prescribers in the area regularly refer patients to your pharmacy for enhanced services?* This field is required.

YESNO

Do you have shared protocols/collaborative practice agreements/clinical services agreements (between the community pharmacy and prescribers; not including statewide protocols) to manage mutual patients with chronic conditions?* This field is required.

YESNO

Do you have sufficient space to deliver all aspects of enhanced patient care services?* This field is required.

YESNO

Is there adequate privacy for providing enhanced patient care services activities?* This field is required.

YESNO

Do you have “slack human resources” (extra staff pharmacists and technicians) to handle patient needs outside of normal workflow?* This field is required.

YESNO

Do you or does someone on your staff routinely check your EQuIPP performance measures to manage patients in order to reduce DIR fees? * This field is required.

YESNO

Does your pharmacy participate in medication therapy management (MTM) services through OutcomesMTM and complete at least 90% of your eligible patients?* This field is required.

YESNO

Does your pharmacy participate in a payer program that pays you for services performed outside of product dispensing fees?* This field is required.

YESNO

List the other sources of non-dispensing revenue or projects in which your pharmacy is currently participating/offers:* This field is required.

None: Our Pharmacy does not have any current non-dispensing revenue

Annual Wellness Visits

CPESN Payer Program

CPC+ contract

Chronic Care Management (CCM) - Medicare Service

Transitional Care Management (TCM) - Medicare Service

Remote Patient Monitoring (RPM) - Medicare Service

Clinic/Community Partnership

Diabetes Prevention Program and/or DSME

HIV-related services

Medroxyprogesterone injections

Long-Acting Injectable Administration

Pharmacogenomcis

Point of Care Testing

Transition of Care Program

Other

Describe your commitment to innovation and why your pharmacy is interested in Flip the Pharmacy.* This field is required.

Your Pharmacy's Score* This field is required.Please do not edit. This score was calculated based on your responses.