Managing Medications in Cancer Programs: A New Best Practice Model

In this guest blog post from 2018 ACCC Innovator Award winner Legacy Cancer Institute in Portland, Oregon, Oncology Pharmacy Navigator Kelly Rice, PharmD, shares how her position has evolved and the benefits its bringing for patients and her cancer program.

At the Legacy Cancer Institute in Portland, Oregon, the position of Oncology Pharmacy Navigator has become an integral part of our program.  During a recent accreditation visit, American College of Surgeons Commission on Cancer surveyors specifically cited the Oncology Pharmacy Navigator as a “best practice.”

Launched in 2015 and initially funded at a 50 percent FTE level by a Legacy Foundation grant, in just over three years this new position has delivered multiple benefits to our patients and our program.

Tackling an Ongoing Challenge
Medication lists are often inaccurate, and medication reconciliation (“med rec”) is a top priority for many healthcare facilities. Upwards of 50 percent of patients do not take their medications correctly. Medication discrepancies, adverse events, and non-compliance are all causes of 30-day hospital re-admissions.  Furthermore, research has shown that cancer patients are highly satisfied when given the opportunity to consult with a pharmacist. On average, our cancer outpatients are on 13 medicines (ranging from 3 to 69). During the first year of our medication management program, 98% of patients seen by the Oncology Pharmacy Navigator had an inaccurate medicine list—i.e., medicines needed to be stopped, changed, or added

The Oncology Pharmacy Navigator is a specially trained pharmacist who maintains accurate medicine lists, provides patient-specific medication therapy management, ensures that patients understand their medicines, reduces the risk of drug errors and duplications, provides patient and family education, and solves drug-related problems. The financial burden of a cancer diagnosis is lessened because the Oncology Pharmacy Navigator focuses on cost-effective therapy while decreasing barriers to medication access and financial concerns.

From the start, our cancer program recognized that the Oncology Pharmacy Navigator was a novel model that provided an opportunity for us to pilot a new best practice for managing medications. Over the course of the first year, the Oncology Pharmacy Navigator tracked quality outcomes and interventions, as well as cost savings.

Improving Safety and Quality; Realizing Savings
By the end of that first year, our metrics showed that the Oncology Pharmacy Navigator was directly responsible for more than $237,000 of cost savings. The majority of these savings came from accessing patient support programs, grants, foundations, and free-drug programs through pharmaceutical companies to help offset the high co-pays often incurred by patients. In addition, some savings were realized from formulary changes and revenue was generated from selling nutritional supplements and vitamins in our hospital-based retail pharmacy.

In April 2016, the position was funded full-time by the Legacy Cancer Institute. During the program’s second year, referrals to the Oncology Pharmacy Navigator increased by more than 50 percent. Savings of more than $200,000 continue to be realized annually.

Looking Ahead
The Oncology Pharmacy Navigator has developed additional quality targets, including meeting at least 50 percent of patient referrals in person and conducting accurate “med rec” in at least 50 percent of all referrals seen. Future plans include using the EHR to more effectively track referrals and interventions, performing patient and provider satisfaction surveys, expanding patient education programs through web-based teaching and video libraries, and establishing an oral chemotherapy program.

At the ACCC 35^th National Oncology Conference, October 17-19, in Phoenix, Arizona, Legacy Cancer Institute will be presenting a more in-depth discussion of how we’ve implemented and grown the Oncology Pharmacy Navigator role, a service that has helped distinguish Legacy Cancer Institute from other local, regional, and national cancer care programs and assists in accreditation and maintenance of our Center for Excellence. Most importantly, integrating an Oncology Pharmacy Navigator into our program is truly benefiting the cancer patients we serve.

Access the ACCC 35th National Oncology Conference agenda and registration information.

ACCC member Kelly Rice, PharmD, is oncology pharmacy navigator at Legacy Cancer Institute in Portland, Oregon.