At the start of the pandemic in 2020, Air Force Col. Markus Gmehlin faced a massive and urgent task: adapting the TRICARE Pharmacy system to ensure that everyone could get access to their medications – but to also avoid packing people into pharmacy waiting rooms and potentially further spreading the virus.
Gmehlin, the chief of TRICARE Pharmacy for the Defense Health Agency, said the top priority was safety.
"We wanted to have some good standard guidance to maintain staff and patient safety. That was first and foremost," he recalled.
The next challenge to address was how to continue providing the medication that beneficiaries need.
"We wanted to maintain access to care for all of our patients, especially for maintenance medications, like high cholesterol meds, heart medications — things that people need on an ongoing basis."
"We looked at the various military Medical Treatment Facilities to figure out who had the leading practices," he said.
Early in the pandemic, many of the military hospitals and clinics began offering drive-up and curbside pharmacy service. Beneficiaries called pharmacy personnel from outside the pharmacy, then the pharmacy personnel carried the medication out to the patient and offered curbside counseling.
That worked, in the sense that patients would never have to physically enter the pharmacy.
But Gmehlin said it was not a sustainable plan, due to safety concerns, temperature extremes, and weather conditions.
So Gmehlin and his team initiated a set of new pharmacy programs that have transformed the pharmacy system, including the "Q–Anywhere" and "ScriptCenters" programs. Those changes have proven to be highly successful and will likely remain permeant components of the pharmacy system.
Gmehlin is finishing a 30-year military medical career, with an official retirement date of June 1. In his final role, he led the delivery of a $10 billion annual pharmacy program across the Military Health System. And he worked with the Pentagon's Health Affairs team and DHA leadership, and often interacted with industry groups.
In a recent interview, he reflected on his time with DHA.
"If I have done anything, it's that we got the right team built to keep the program moving forward," he said.
"We've got some great folks," he said. "They understand that we just cannot maintain the status quo and that we need to constantly reevaluate our program to figure out how do we do it smarter, more efficiently, and how do we align with civilian or commercial best practices."
Q–Anywhere
"What we implemented was a remote pharmacy check-in capability," Gmehlin said. The process started in the fall of 2020, and is currently deployed at 50 military hospitals and clinics.
With Q-Anywhere, beneficiaries scan a QR code to activate processing of new prescriptions. The phone-based app prompts them to "get in line," by entering their Defense Department identification number, which activates their prescriptions. The beneficiary receives a confirmation text message. When the prescription is ready for pickup, another text message is sent. When beneficiaries arrive for pick up, they show pharmacy personnel the code on their phone.
"Huge reduction in people waiting around and it has been tremendous for customer satisfaction. Folks are thrilled," he said.
ScriptCenters
Also implemented during that timeframe in 2020 were the "ScriptCenters."
Gmehlin described this option as an "Amazon-type locker." Patients can choose this option, which allows them to scan their ID at the designated ScriptsCenter, wait for the assigned locker door to pop open, and then retrieve their medication out of the locker. There are 90 units at 76 different locations. Some locations have ScriptsCenters at the base or post exchange, or at another location inside the hospital.
Both Q-Anywhere and the Scripts Center required planning with the pharmacy operations division, which has four branches. One branch is the Informatics Integration Branch, which works all the information technology projects. When new COVID support funding became available, the team strategized on the tools and products that would be most useful.
"Then we worked with the service leadership and each of the MTFs to determine if they were interested or not interested," Gmehlin said.
Gmehlin hopes the long-term impact of his job is that people understand the good things that come out of the pharmacy program, what people are working on, and how they try to create a sustainable benefit, while at the same time increasing access to various medications.
"The neat thing is when the DHA journey started, there were three separate health systems: Army, Navy and Air Force. And everybody had a different way to do things, -- different outcomes, different everything. The exciting thing is working with the services to now unify three separate systems, or cultures into one, and incorporating the best that everybody brings. It has been great to see a single system that comes together to provide the best care."
"At the end of the day, it is about how do we provide best outcomes and health for our amazing beneficiaries."