Flip the Pharmacy: Pharmacy Readiness Self-Assessment
Pharmacy Name
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Pharmacy NPI
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State/Territory Where the Pharmacy is Located
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Zip Code Where the Pharmacy is Located
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Name of the Person Completing this Assessment
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First Name
Last Name
Email of the Person Completing this Assessment
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example@example.com
FtP Pharmacy Champion Mobile Phone Number
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Please enter a valid phone number.
Domain 1: Leveraging the Appointment-Based Model
Does your pharmacy currently offer a medication synchronization program (NOT an auto-refill program)?
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Yes
No
Does your pharmacy actively recruit and enroll patients into your medication synchronization program?
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Yes
No
What percentage of your patients have you enrolled in your medication synchronization program?
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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 verify if the patient is taking the medication as prescribed?
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Yes
No
Does your pharmacy use the Appointment-Based Model to schedule patients a day to pick up their medications so the pharmacist can proactively perform medication reviews?
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Yes
No
Does your pharmacy have a systematic process similar to the Joint Commission of Pharmacy Practitioners (JCPP) “Pharmacists' Patient Care Process" to identify and resolve medication related problems?
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Yes
No
Domain 2: Improving Patient Follow up and Monitoring
Does your pharmacy have a systematic process within workflow (e.g., continuous medication monitoring) to regularly review a patient's medication therapy, 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?
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Yes
No
Does your pharmacy have a process to flag when a pharmacist needs to talk with a patient?
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Yes
No
Does your pharmacy have a system (electronic platform or paper-based) to keep track of patients in need of follow-up?
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Yes
No
Does your pharmacy request or receive labs from other providers/laboratories to appropriately assess patients?
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Yes
No
Does your pharmacy regularly receive physician/other healthcare provider progress notes on mutual patients?
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Yes
No
Does your pharmacy team offer to take blood pressure readings in your pharmacy?
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Yes
No
Does your pharmacy team request A1c levels from the patient or the patient's physician OR measure A1c levels in the pharmacy?
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Yes
No
Domain 3: Developing New Roles for Non-Pharmacist Support Staff
Is the dispensing process in your pharmacy driven by technicians?
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Yes
No
If allowed by your board rules, does the pharmacy use technician product verification?
Yes
No
Not applicable
Do you utilize your technicians to manage (lead) your medication synchronization program?
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Yes
No
Do you utilize your technicians to triage patients prior to the pharmacist seeing them?
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Yes
No
Do your technicians document within the patient record (e.g., eCare plan) for the pharmacist to review and verify?
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Yes
No
Are all members of your pharmacy team appropriately trained to support the delivery of enhanced patient care services?
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Yes
No
Are any staff members trained as Community Health Workers (CHWs)?
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Yes
No
Domain 4: Optimizing the Utilization of Technology and Electronic Care Plans
Does your pharmacy use an electronic platform, exclusively, to synchronize your patients' medications?
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Yes
No
Does your pharmacy have the ability, through the use of technology tools, to identify/flag patients who are candidates for a clinical work-up/intervention/service?
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Yes
No
Do you use automation (e.g., robots, electronic pill counters) in your dispensing process to improve workflow, reduce medication errors, and free-up your pharmacists?
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Yes
No
Do you believe you have adequate technology in your pharmacy to support your patients and your practice (e.g., pharmacy management system, IVR, eCare Plan platform, dispensing technology)?
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Yes
No
Do you document and submit eCare plans?
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Yes
No
What eCare Plan vendor does your pharmacy primarily use to submit care plans?
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AssureCare
AZOVA
BestRx
DocStation
FDS
Liberty
Micro Merchant Systems
OmniSYS (previously called STRAND)
PioneerRx
PrescribeWellness
QS/1
TDS (ComputerRX / Rx30)
Not Listed
How many estimated eCare plans have you submitted in the last month?
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1-10
11-25
26-50
51-100
> 100
Domain 5: Establishing Working Relationships with Other Care Team Members
Does your pharmacy have access to shared electronic health records?
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Yes
No
Do you regularly request and receive patient information from prescribers/other healthcare providers (e.g. patient progress notes, labs/vitals, discharge summaries) in order to assess your patients' medications?
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Yes
No
Do your pharmacists regularly send clinical recommendations to prescribers when medication related problems are identified?
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Yes
No
If yes to the previous question, do your pharmacists regularly receive responses back from prescribers about their clinical recommendations?
Yes
No
Do prescribers/other healthcare providers in the area know about the patient care services your pharmacists provide to mutual patients?
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Yes
No
Do prescribers/other healthcare providers in the area regularly refer patients to your pharmacy for enhanced patient care services?
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Yes
No
Do you have shared protocols/collaborative practice agreements/clinical services agreements (between the community pharmacy and prescribers/providers; not including statewide protocols) to manage mutual patients with chronic conditions?
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Yes
No
Domain 6: Developing the Business Model and Expressing Value
Do you have sufficient space to deliver all aspects of enhanced patient care services?
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Yes
No
Is there adequate privacy for providing enhanced patient care services activities?
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Yes
No
Do you have “slack human resources” (i.e., extra staff pharmacists and technicians) to handle patient needs outside of normal workflow?
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Yes
No
Do you or does someone on your staff routinely check your EQuIPP performance measures to manage patients in order to reduce DIR fees?
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Yes
No
Does your pharmacy participate in a payer program that pays you for services performed outside of product dispensing fees?
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Yes
No
Select the sources of non-dispensing revenue in which your pharmacy is currently participating/offers:
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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
Pharmacogenomics
Point of Care Testing
Transition of Care Program
Other
Describe your commitment to practice transformation and explain how your pharmacy would benefit from participating in Flip the Pharmacy.
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Pharmacy Assessment Score (score required for grant application, provided in submission confirmation email)
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Submit
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