Sterling Healthcare is a Roswell, GA-based chain of nursing and home rehabilitation facilities, which include nine skilled nursing homes and one assisted living community. Their skilled nursing facilities accommodate both long- and short-stay residents.
Many Sterling facilities offer in-house therapy and pharmacy, as well as around-the-clock registered nursing coverage.
Resident-centered care is paramount, according to Tyler McGee, Sterling’s corporate marketing director.
“Our main objective is to get our residents back out to the community healthy,” McGee says. “Whether that be the next transition of home health or getting them back into their normal happy and healthy lives in the community, that is our overriding mission here.”
Like nearly all providers these days, Sterling is challenged by the rising acuity of its patient population, all in the face of declining reimbursement and lengths of stay. Complicating matters are new and tougher regulations from the Centers for Medicare and Medicaid Services, as well as pressures on value-based purchasing and bundled payments.
And, as so many nursing facilities face today, there are infrastructure and physical plant issues that need to be tended to regularly.
As the intensity of competition increases, Sterling, like others, works diligently to improve quality while doing everything possible to prevent its residents from making a return visit to the hospital.
One of Sterling’s biggest challenges involves its workforce. And like any successful provider, it has learned the value of recruiting carefully and taking care of employees once they come on-board.
A diligent search netted a new leader who clearly had the right stuff.
“Literally overnight, it went from frantic and me not sleeping to not having any more problems,” McGee says. “The individual I found jumped right in, took charge and got things done. We have really good line staff and CNAs at that facility. They were just starved for better leadership. You have to get the right people in the right places in nursing facilities. It’s critical.”
McGee credits part of Sterling’s workforce success is allowing good people to think for themselves when solving problems. “Unlike the bigger chains out there, we’re not constantly browbeating our people,” he adds. “We give the facilities autonomy to make decisions. This streamlines processes and helps free our staff to have more quality time with the residents.”
Another big challenge is the coming wave of baby boomers. Not only are providers like Sterling worried about their capacity to care for them, but how the whole payment system will react to the stresses.
“We have a lot of baby boomers retiring and getting to that age, which is good,” he says. “I don’t know how funding is going to work for them going forward.”
A third key challenge for Sterling, and most every other SNF provider, is remaining competitive to attract private pay residents and referral sources. That means high Five-Star ratings, demonstrated and increasing quality performance and outcomes, and minimal adverse events and rehospitalizations. Meanwhile, the growth of assisted living communities cropping up everywhere only heightens competitive and wage pressures.
Since becoming a PharMerica client only recently for the second time (more on that in a moment), Sterling is finding a great deal of success with many of its pharmacy solutions.
One of them is ViewMasteRx®, PharMerica’s on-line, pharmacy management system that is secure and easy to use while providing access to comprehensive pharmacy information and services. Users can access medication orders and billing information, manage reports, schedule refills and see cost saving options.
“We use ViewMaster quite a bit,” says McGee. “It provides powerful information to us right from the beginning when we get an authorization or are looking at a potential referral. It helps us make important decisions beforehand like the type of care, costs, a price model we look at to see if we are able to accept these residents, and helps us look at whether we’ll use a more economical prescription.”
In 2017 alone, Sterling realized substantial financial benefits using PharMerica solutions.
“Our main objective is to get our residents back out to the community healthy,”
Under PharMerica’s preferred drug program, which targets clinically appropriate cost effective medications at all phases of the resident stay, Sterling realized nearly $730,000 in cost avoidance savings in 2017. More than 80% of its savings came from the top 10 drug classes PharMerica identified.
By following up on denied Part D drug claims on Sterling’s behalf, PharMerica saved Sterling nearly $149,000 in 2017.
McGee says Sterling anticipates fully implementing PharMerica’s EZ-MAR™, a web based application that combines e-ordering and an e-MAR system designed specifically for nursing facilities. “It’s very beneficial.” he says.
“What’s great about EZ-MAR is its electronic features. You’re able to capture the resident data in real time. It also makes charting more meaningful. It’s a very cost-effective solution, which helps us allocate the money saved to annual budgeted items. Being margins can be thin, we look to find creative ways to boost our bottom line, EZ-MAR is one of those creative outlets.”
Sterling also is beginning to dip its toe into leveraging PharMerica’s Nurse Consulting Services. “When we have a specific pressing need, nurse consulting makes sense,” he says. “A PharMerica RN comes in with a specific set of knowledge that goes right to the problem at hand. It’s widely beneficial for the facility.”
McGee is nearly giddy when talking about a new tool PharMerica offers. Developed by Pro-GeneX, the solution delivers evidence-based, fully reimbursed pharmacogenetic testing for high-risk residents. Using a resident’s DNA obtained by saliva, pharmacogenetics allows a facility to ensure high-risk residents do not have any genetic markers that would prohibit medications from working on their specific conditions.
PharMerica says the proper combination of targeted pharmacogenetic testing and cutting-edge data systems provide real-time context to providers and greater safety for patients. It also improves a facility’s bottom line by reducing readmissions through state-of-the-art gene sequencing to personalize patient’s medications prior to discharge.
For a provider as passionately focused on resident-centered care as Sterling is, pharmacogenetics is a powerfully compelling tool.
“To us, pharmacogenetics is a beautiful intersection of technology, science and healthcare all coming together,” says McGee, reflecting on one resident who was taking 10 different medications. “She was mostly in a general state of unhappiness – depressed, angry, irritable and aggressive. We had Pro-GeneX administer the cheek and in turn, we were able to prescribe better prescriptions to work with her DNA, less prescriptions and lower doses. Now the resident is all smiles, she has progressed immensely.”
“If this program were to have this kind of effect on just one resident per facility, it’s worth the extra work,” McGee adds. “Her quality of life improved in every way. When we find something like this that vastly improves the lives of our residents, there’s a huge trickle-down effect of fewer medications, cost savings, better surveys, better quality of life and better outcomes. We have a lot of baby boomers coming on board in the coming years, so this technology is should be broadcast to all providers.”
McGee believes programs like pharmacogenetics can provide a much needed edge for providers when it comes to referrals. They can provide the kind of market differentiation needed to attract new residents and keep existing ones.
“Five-Star ratings are an important way we differentiate ourselves,” McGee says, noting several of Sterling facilities that have reached this milestone. “Everyone is going after these. If you have really great surveys, that’s part of it. Another criteria is staffing, giving the facility proper staffing can only help stream line the productivity of your facility. Another thing is our quality measures. We’re really starting to hit our stride with QM’s and exceed those.”
This isn’t the first time Sterling enjoyed a great relationship with PharMerica. The provider was one of PharMerica’s earliest clients a few decades ago.
“It was just like going back to the family,” says McGee, who obviously wasn’t around during the first turn. “There’s a lot to be said about familiarity and having a comfort level with a company you trust,” McGee says. There’s a lot of people and vendor turnover in this industry. But there are some key people at PharMerica who were there the first time. It’s like we picked up where we left off, and the transition was great. The transition was very fluid. Sure, it involved a lot of work. It just seemed like a well-oiled machine.
PharMerica made it easy for us. The fluidity of it was so simple. That’s what makes it best. When everyone is on the same page, it’s so much easier.”
Providers will judge vendors on any number of criteria – both subjective and objective. But common themes that keep both together are trust, transparency, fluidity and responsiveness.
“It goes back to what I said about trickle down benefits,” he says. PharMerica’s responsiveness is probably their best attribute with us – whether it’s responding to a resident’s need at 7 pm on a Friday night or catching minor issues before they become big ones with our pharmacy. If you’re working with a vendor and it’s all about their bottom line and you’re just the little fish in the big pond, you probably should re-evaluate that relationship.
“The pharmacy companies and other service providers who we’ve left stopped thinking about the residents, and that is the number 1 reason why I got into this business in the first place, The Residents. We have many residents in our facilities who don’t have families looking in on them. I have ‘buddies’ in every one of our facilities. I take time to talk to as many residents as I can when I visit. I treat our residents like I want to be treated and how they should be treated, like Family.”