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1/31/2018
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Yes You Can!How Community Pharmacies Have Profitably
Implemented Enhanced Care Service
Bruce Kneeland ‐Michigan Pharmacist Association ‐Annual Meeting, Feb. 25, 2018
Introduction
Who Is This GuyWhy Should I Care
Real pharmacies doing things that really work
Disclosure
Bruce Kneeland reports he does not have actual or potential conflicts of interest associated with this presentation
Bruce Kneeland receives compensation as a:Consultant to PrescribeWellness, LLCWriter and sales representative to ComputerTalk magazineSpeaker’s bureau member
The presentation to follow has been reviewed to insure it is free of commercial content or bias
Bruce Kneeland has indicated that off‐label use of medications will not be discussed during this presentation
Learning Objectives
1. Describe Enhanced Care Services in a community pharmacy
2. Recognize patients and caregivers will pay out-of-pocket for them
3. List services commonly considered as Enhanced Care
4. Identify how to implement patient care services
What Are Enhanced Care Services?
• Enhanced Delivery• Adherence Program• Medication Synchronization• Immunizations• Meditation Therapy Management• Disease State Management• Point of Care Testing• Medicare Plan Selection• Drug Nutrient Depletion• Weight Loss• Documentation• Network Affiliation
1. Professional DeliveryTrained delivery personnelScheduled (not Domino’s)4 Zones/6 drivers/5 cars100 deliveries per day250 – 400 prescriptionsMany medsync’dMany adherence packagedMicrosoft Streets to organizeMobile signature captureMarket it to allied professionals
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Professional Delivery
Attitude
Professional Delivery
Things To Ponder…..
Dress CodeMobile TabletRouting ServiceDelivery AreaAd on SalesGather Info Share InfoDelivery Car:
signage or notScheduled or On‐DemandEnrolled in ProgramFree or Modest ChargeEtc. Etc.
Hometown Pharmacy, Fitchburg, WI
2. Adherence Program
John Gans, R.Ph.Former Executive DirectorThe American Pharmacist AssociationThe Concept Pharmacy Project1996 – 1998“Drugs don’t work if people don’t take them”
“The biggest expense is people missing work”
Adherence Programs
Refill Reminders
Phone calls
Text Messages
Increased sales
Return trips
Less Return to Stock
Not just sales ‐ CRM
Adherence Programs
Compliance Packaging
Optional but helpfulFree or for a Fee???
A variety of commercial options
Your ChoiceOne or More
Kodiak Drug, Joliet, IL
Adherence Program
Companies with Grants to:
Provide free iPhones
Do in home visits
Provide Rides
Schedule Appointments
Transdisciplinary Teams
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Adherence Programs
Social DeterminantsBarriers to Better Health Social Emotional; Mental Economic Physical
Adherence
What About Flavoring
Fee or Free?KidsPetsFull course of therapyPush away and spillSpit out
America’s Pharmacist Article, Good Taste, June 2017
Whaley’s Pharmacy, Jefferson City, MO
3. Medication Synchronization
Get Started
Paper works
Share with Prescribers
Market Selectively
Goal:
Get to 100
Then go for more
Towncrest Pharmacy, Iowa City, IA
Medication Synchronization
William Shelver, PharmD
Started Auto fill – too many return to stockPaper based MedSync – grew to 100PMS based system – grew to 300Upgraded Technology – now 731Simplifies workflow after 200 patientsImproves adherenceCuts costs on deliveries
Palace Drug, Canyon City, CO
MedSync
Point of Purchase SignageBrochureFlyerDemonstrationTargeted ApproachRemember Family Caregivers
Family Caregivers
40 Million people
65% female
Spend average $6,954
25% for Medical
14% for personal care items
All cash
Source: AARP
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4. Have An Immunization Program
Collaborative Practice AgreementWell PromotedThe “Right” set‐upYear RoundMultiple ProductsIn StoreAt Work SitesOn DemandBy AppointmentRoster BillingRegistry
Have An Immunization Program
This Photo by Unknown Author is licensed under CC BY‐SA
Info from NicoleTypes of vaccineDollars availableMarketing support
Have An Immunization Program
Year RoundVariety of VaccinesSource for products and suppliesTechnician Takes ChargePromotional toolsIdentifies and invites patientsFills out formsIn storeWork Site programBilling toolRegistry Reporting1900 flu shots 2017 ‐ 2018
Woodstock Pharmacy, Woodstock, GA
Have An Immunization Program
Travel VaccinesYellow Fever permit State Health Department
Valu‐Med Pharmacy, Midwest City, OK
Think Outside The Box
What else could you do that others post signs and say they won’t do?
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Special Orders 5. Medication Therapy Management
Improves refills
Provides positive reason to contact prescribers
Provides reason for customer referrals Boosts STAR ratings
Takes time
B & B Pharmacy, Spring Hill, TN
Medication Therapy Management
46% 1 Pharmacy35% 2 Pharmacies20% 3 or more
55% have scripts filled elsewhere
Source: Boehringer Ingelheim 2016 Pharmacy Satisfaction Report32,669 people
Medication Therapy Management
STAR Ratings
Brown Bags Days
Start With Paper
Backbone of MedSncy
Professional Relations
Fax; Yes or No
Towncrest Pharmacy, Iowa City, IA
Medication Related Adverse Events
100,000 deaths per year
4th leading cause of death
Millions suffer other negative effects
Medication Therapy Management 6. Patient Centric Care
1.Run an exceptional pharmacy
2.Find a service you are passionate about
3.You need to have/get bedside manner
4.The place needs to look right
5.Don’t be afraid to charge
Niesenholtz Pharmacy, Philadelphia, PA
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Patient Centric Care
You Can Fill Prescriptions and Be A Healthcare ProviderAdjust Your Workflow To Make This Possible
Metropolis Drug, Metropolis, ILRed Cross Pharmacy, Le Grande, OR
The Patient Centric Care
Exposed Ponder ResearchPreparationImplementationAdjustmentSuccessRepeat
7. Disease State Management
Central Drug, Portland, OR
Scheduled ProgramsClass Room in PharmacyFormal BrochureDoctor DetailingDrug Reps co‐promoteDrug Reps provide refreshments
Disease State Management
Flower Mound Pharmacy, Flower Mound, TX
Diabetes ClassesGrocery Store TourGrocery Store Gift CardCLIA Testing Lease Space to Health FoodStore Owner
8. Pay Out‐Of‐Pocket
Gym MembershipMassageYoga ClassesDiet/Weight Loss Programs
People Pay Out‐Of‐Pocket
91 cents worth of coins can sell for $20 ‐ $75
If …
packaged and presented right
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9. Point of Care Testing
Hot Topic Summer Trade Shows
Strep ThroatFlu
Must Be MarketedPatientsSchoolsDay Care CentersEmployersPrescribers
Magnolia Pharmacy, Magnolia, TX
Point of Care Testing
Pay out‐of‐pocket
Comparable to Doctor’s office co‐pay
No appointment
Collaborative agreement
Fill prescription
Iuka Drug, Iuka, Mississippi
Point of Care Testing
Point of Purchase Signage
Brochures and Flyers
Market to referral sources
Elevator Speech
Confidence
Point of Care Testing
Todd Troxell
Cash Only ‐ $399Problems with insurance
privacylower
Consult before and afterMinimize side effectsSelect more appropriate medAdjust dosage4 Types of metabolizers
Pharmacogenetic Testing
Trox Pharmacy, Jacksonville, FL
Success TipHave Or Hire Bedside Manner A Team
Aubrey Pharmacy, Aubrey, TX
10. Medicare Part D Plan Selection
Top Line Numbers
41 Million People On a Part D plan60% Part D 40% AdvantageAverage cost Part D $39.21 per monthAvg. enroll has choice of 26 PDP Or 16 Advantage Plans
Source Kaiser Foundation KFF.org Sept. 16, 2016
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Medicare Part D Plan Selection
Staff Member Assigned10 – 20 Minutes Win‐Win‐WinPatient Gets Good PlanPharmacy Avoids Loosing PatientPick up scripts at other pharmacyPatients recommend pharmacyOpen EnrollmentAbout to turn 65Medicare.govCommercial ProgramsSystem calls eligible patients
Medicine Park Pharmacy, Sanford, NC
Success Tip You and Your Team Must Look And Act The Part
Redline Pharmacy, Hastings, NE Lombard Pharmacy, Lombard, IL
11. Nutritional Support
Birdsboro Pharmacy, Birdsboro, PA
PassionatePersonal RecommendationLarge AssortmentAttractively DisplayedWell SignedTechnology SupportPOS/PMS AlertsAdvance Promotion
Physical Location
Diet Counseling
Technological Support
Monitoring & Encouragement
Nutritional Foods and Supplements
Monthly fee for service
Weight Loss Program
Nutritional Support
Jim Martin, Dripping Springs Pharmacy, Dripping Springs, TX
Weight Loss
Formal ProgramMeasure labsCustom for each patient$120 enrollment fee1 Hour15 Minute weekly follow‐upBio‐Impedance Body CompositionShakes and supplementsCash payment
Nutritional Support
Drug Nutrient Interaction
Better HealthBetter ProfitsClinical DocumentationLettersPoint of PurchaseInformational ApproachTime to thinkLine Not At ChainsNatural Products Expo
Ron’s Apothecary, Juneau, AK
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Nutritional Support
Jim and Dorinda Martin
3 Years125 patientsPrivate RoomProfessional MarketingIn Store MarketingReferral ProgramProfessional FeeProduct sales
Success Tip
One of Most Powerful Words In Advertising
Be Careful
You can always give it away but at least set a value on it so they know what they are getting
12. Documentation
Care PlanCollaborationBillingFollow UpCounselingTo Do ListDrug Nutrient Depletion
Documentation
Customer Relationship ManagementMass CustomizationCustomer Service Hair SaloonF.O.R.D
FamilyOccupationRecreationDreams
Hair Saloon vs. Community Pharmacy
Documentation
Member Community Care of North Carolina
Captures info in softwareCreates Care PlanPerforms MTM
In store Over the phone
Hospital Transition of CareBills Medicaid Electronic Health RecordsMedicine Man Pharmacy, Sanford, NC
13. Network Affiliation
Benjamin Franklin; “We must, indeed, all hang together or, most assuredly, we shall all hang separately.”
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Network Affiliation
Think Outside Your Pharmacy
AIDS AllianceMental HealthChamber of CommerceSenior Residence FacilityGirls Scout Cookies Drive
Martin‐Tipton Pharmacy, Amarillo, TX
Network Affiliation
CCNCCPESNState AssociationsBuying GroupsPharmacy System VendorOther VendorMSO’sLocal CollaborationEtc.
How useful was the first and only fax machine?
Marketing
The process of identifying what customers want or need and then getting them to know about, have an interest in and purchase it while generating a profit.
Marketing
People don’t know to ask for…..
MTMMedSyncAdherence PackagingStrep TestFlu TestPharmacogenetic TestSaliva TestDrug Nutrient Depletion
Words and Services Need to be explained!!!!
In Closing
Copy Flavoring ArticleList of CPESN Utah Enhanced servicesCopy Customer Satisfaction Survey
Email [email protected]
The End