Good medicine Retail Independent Pharmacy | 2018 - Cardinal Health
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Dear reader, Independent pharmacies continue to be the cornerstone of the community—supporting your local teams, doing what’s best for your town and going out of your way to make sure each of your patients is uniquely served. I love hearing the stories of how each of you go above and beyond for your patients, and sharing these stories with fellow readers in good medicine magazine. This edition, we focus on publishing stories that share tangible steps for success. Our solution spotlight section includes examples of how pharmacy owners are creating opportunities by implementing a variety of solutions, ultimately improving patient care. In the innovative ideas section, you’ll read about how independent pharmacies used out-of-the-box thinking to grow their businesses, and in read all about it, we help you stay on top of the latest industry news. For five years, we’ve been publishing good medicine magazine. Our goal is to provide a place to share best practices, offer education on the latest industry trends and foster a sense of community among you and your peers. I hope you enjoy the fifth edition of good medicine magazine. Thank you for reading, Steve Lawrence Senior Vice President, Independent Sales
Innovative Ideas 02 - Patient advocacy: Connecting patients with services 03 - Lose to Win: Weight-loss competition attracts customers table of contents 05 - Blogging outside the box: Connecting online with clients 07 - Quick tips: Enhance your social media presence 08 - Noteworthy: Smoking cessation program finds success 08 - Noteworthy: “Give a shot” program benefits local charity 09 - Integrative health: Finding balance through yoga 11 - Community connection: Embracing a legacy for the future 13 - Technician Product Verification: Focusing on patient care Solution Spotlight 16 - TelePharm: The changing face of pharmacy 19 - Point-of-Care Testing: The new wave of reaching clients 21 - Inventory Manager: More than an out-of-the-box program 23 - Medication adherence: Tools for success - 5 ways to improve adherence - Dispill® Multi-dose Packaging - Know your patient better - Reimbursement services 27 - Pharmacy Transition Services: Keeping pharmacies independent 29 - Securing your pharmacy: What you should be doing 31 - Order Express: Optimize SOURCESM Generic purchasing 33 - Pharmacy Marketing Advantage: Let’s get digital 35 - Conversion conundrum: Who are your consumers? Read All About It 38 - Provider status: Why pharmacists must be providers 39 - Preparing for the worst: The aftermath of Hurricane Maria 41 - Industry predictions: Moving forward in 2018 43 - NCPA updates: News from the legislative front 45 - 340B contract pharmacy: Expanding access to care 47 - Forefront of pharmacy: What women leaders have to say 49 - Closing the gap: Women in Pharmacy emerges in Puerto Rico 50 - Generation Rx Champions: Transforming chronic pain care 51 - Generation Rx: Fighting prescription drug misuse 52 - Opioid Action Program: Combating the opioid epidemic
innovative ideas Sometimes it takes a little out-of-the-box thinking to find success. Check out how pharmacies used innovative ideas to grow their businesses. cardinalhealth.com Patient advocacy: Connecting patients with services Lose to Win: Weight-loss competition attracts customers Blogging outside the box: Connecting online with clients Quick tips: Enhance your social media presence Noteworthy: Smoking cessation program finds success Noteworthy: “Give a shot” program benefits local charity Innovative Ideas Integrative health: Finding balance through yoga Community connection: Embracing a legacy for the future Technician Product Verification: Focusing on patient care 01
Game changer – Community Liaison program improves patient adherence, community outreach Through an innovative approach developed two ramps built due to health diagnoses or finding resources to years ago, Chris Han has seen a change in the meet non-pharmacy needs, such as community programs landscape of patient care. patients would not otherwise be aware of,” Buck said. The CEO of Cannon Pharmacies, a seven-store group in the As a result, patients may no longer have to choose greater Charlotte, N.C., area, hired Amanda Buck, a social between filling their prescriptions and getting other needs worker for 17 years with the Department of Social Services. met. They also may have better health outcomes, reduce rehospitalization, and be better caregivers for loved ones. “There are often more issues going on for patients than meets the eye,” Han said. “The aging population is growing at a rapid pace,” Han said. “In terms of getting connected into that aging population and Buck, who serves as community liaison outreach director, leveraging those relationships, it’s been pretty exciting.” says her experience has trained her to look at the patients, who may be polypharmacy and have medication adherence The exposure this program has brought to Cannon dilemmas, with a different lens and to develop a team to Pharmacies through networking, outreach and word-of- address those dilemmas as they arise. mouth has shown professionals and the community that Cannon is more than just a prescription-filling pharmacy, This community outreach team includes Buck, patient but rather a place that believes in making life easier for advocates who research grants and patient assistance its patients. programs for medications, and a social worker who works with patients to identify the unmet assistance and resource “It has fostered better relationships with our patients and has needs that may have contributed to their medication allowed us to be a trusted source of help for others in the adherence issues. community,” Buck said. “It has been a game changer for us.” “If someone isn’t able to afford medicine, the pharmacists and patient advocacy staff do an amazing job with finding cost-saving alternatives to medicines that include less-expensive generics, grants, coupons and patient assistance programs,” Buck said. The team’s social worker and Buck work toward identifying the underlying needs of the patients, as well as finding resources that help address the needs that can be related to medication adherence issues. “These vary widely and can range from finding ways to get Amanda Buck, Cannon Pharmacy For more information on Cannon Pharmacies’ enhanced services, go to cannonpharmacies.com. good medicine 2018 02
Tennessee pharmacy uses the scale to attract new customers It’s not often the biggest loser is the biggest winner. Joe McKamey knows that firsthand. After all, he has had a lot of “losers” walk through cardinalhealth.com the doors of the pharmacy he manages in Manchester, Tenn. Through a weight-loss competition program he created at Marcrom’s Pharmacy and Wellness Center, McKamey has helped improve the health of more than 2,000 Innovative Ideas residents in the region, many of whom have become regular customers since signing up for the contest. 03
How it works How it happened As part of the “Lose to Win” Implementing a program that has weight- loss competition, participants been responsible for 51,000 pounds come into the pharmacy once a week lost over the past 11 years doesn’t for 10 weeks for a weigh-in. Customers come without smart, strategic participate as individuals, but are planning. also assigned to a team if they do not In addition to using tools like social register with one. media and direct mail marketing, As individuals, they compete for the the pharmacy—owned by highest percentage of weight lost. McKamey’s father-in-law Ray As a team, participants earn points Marcrom—piggybacked onto other for attending weekly educational promotions that already were part of meetings the pharmacy hosts, as well the marketing budget. “ Weserve as completing other activities during the week. For example, Marcrom’s Pharmacy regularly pays for a radio spot. want to “Around the kick-off of the contest, our we just use that time to promote the How it benefits competition, so it’s not new dollars community, being spent,” McKamey said. In addition to emphasizing education, but when you Each participant pays an entry fee to compete, with those funds going motivation and accountability to the participants, McKamey serve without toward paying for T-shirts, meeting space and cash prizes given to the says pharmacy owners and staff expecting beginning a community-based winners at the end of the competition. program like “Lose to Win” must anything in “Even at $100 per person, the pharmacy follow the same pillars to find success does a little better than break even and ultimately draw more customers. return, ultimately on the competition, but ultimately, we end up gaining several more McKamey held himself accountable by embarking upon his own weight good things “ customers each session,” McKamey said. Participants often transfer their loss journey, losing 75 pounds. happen. prescription medications to Marcrom’s “Utilize your story and give people Pharmacy, as well as purchase several hope,” he said. “It then slowly begins — Joe McKamey, of the health products available at the to grow and over time when people Marcrom’s Pharmacy store, including protein bars and mixes. see you’re consistently committed to something, you’ve then proven to “It’s good branding and marketing, but them that you’re trustworthy and you that’s not why we do it ultimately,” aren’t going anywhere.” McKamey said. “We want to serve our community, but when you serve without expecting anything in return, ultimately good things happen.” Follow the “Lose to Win” program on Marcrom’s Pharmacy’s Facebook page. good medicine 2018 04
Blogging outside the box Pharmacist uses wellness blog to connect with customers Though it’s often the writing on a prescription pad that connects Carmina Lolley with her customers, it’s her own written words that have created a unique method of communication with local residents. The staff RN, herbalist and co-owner at Medicine World in Nashua, New Hampshire, publishes a wellness blog, allowing customers to connect with Lolley beyond the pharmacy window. In the blog, called “Carmina’s Corner,” she offers a variety of tools and other advice for better health - from spring cleanses to ways to fight off cold and flu season. She updates her blog about once a month, and promotes it using social media - an addition to her marketing tools that has helped spread word- cardinalhealth.com of-mouth and drive traffic to her pharmacy. Lolley shared her advice for using creativity to reach customers in an evolving world and what it takes to do a little thinking outside the script. Innovative Ideas — Carmina Lolley, Medicine World 05
How has publishing a blog helped drive traffic to your pharmacy? Advertising to keep your name out there is tough. My best advertising dollar was in the yellow pages, but that has now passed. I tried social media and it seemed to give me a little response. Now I mention to my customers to go out and read my blog and guess what they do? Now they actually go looking for at least a monthly post. ” HAVING A BLOG HAS... What advice do you reinforced my belief have for a pharmacist who is thinking of that educating your starting a blog? clients is something Be consistent. This will keep your regulars reading and that they want. ” new eyes will happen—slowly, but surely. I also am working with local magazines now who publish my — Carmina Lolley, RN blog and I advertise with them as well. No matter how you slice it, it is important to keep your name out there and it definitely takes a little creativity today. How much work did it take to start the blog? What challenges did you face? I finally found someone who works with me—after many failed attempts. There are three of us, one who helps with graphics, one who works at keeping the website clean, and myself who writes the content. I am spending a little more than I spent in the yellow pages. I work a little more, as well, because content is updated monthly. However, this has reinforced my belief that educating your clients is something that they want. To check out Carmina’s Corner, go to medicineworldnh.com. good medicine 2018 06
8 1 WAYS you can enhance your social media presence Highlight photos of your customers (with their permission). 2 Communicate sales and events to your followers. 3 Offer contests and drive engagement/excitement through Facebook. 4 Use your cover photo to communicate the various ways patients can refill their prescriptions. 5 Offering something your competitors don’t have? Make sure to promote it! 6 Patients see you as their healthcare expert — share your opinion on current health news/trends. 7 Post photos of your staff and capitalize on events in the area cardinalhealth.com that your patients are excited about. 8 Feature spotlights on your employees so your patients can get to know your staff more. Innovative Ideas 07
Noteworthy Getting the community excited to give back Woodward, Okla., only has a population of around 12,000, yet with six retail Erik Hudson, Western Drug pharmacies, Erik Hudson knew the importance of finding new and innovative ways to promote his store, Western Drug. Though “Get a Shot. Give a Shot.” campaigns had become popular, Hudson decided to localize this concept further and donate a percentage of every vaccination his pharmacy administered to a youth shelter in Woodward. After implementing the program, Hudson approached the city, explaining that his program benefited local youth. Officials liked the idea that donations stayed in their community and allowed Hudson to set up vaccination clinics in the community for city employees. “The idea sells itself and gets your community excited to come to your pharmacy for their vaccines,” Hudson said. “We have seen tremendous growth as local employers, schools, municipalities, and fire and police stations are choosing us over large chain competitors to do on-site flu shot clinics because they love the idea of giving back to local charities.” Noteworthy Snuffing out smoking Marty Hinterlong has a passion for helping Marty Hinterlong, Medicine Shoppe others quit smoking. As owner of the Medicine Shoppe in St. Clair, Mo., Hinterlong started a Facebook group for his community in support of smoking cessation. Other pharmacies became involved, and, so far, nearly two dozen residents have stopped smoking. Hinterlong also began a campaign where he offers nicotine replacement products slightly over his cost in an attempt to increase smoking cessation. This program, along with monthly diabetic classes he offers that focuses on lifestyle changes, help him serve his community while encouraging him and others to stay up-to-date on health initiatives that affect his customers. good medicine 2018 08
How a pharmacist is changing lives through yoga A return to wholeness Chemistry is intriguing for all pharmacists, especially the interactions among drugs, herbs and even foods. One chemical reaction that a pharmacist from New “The question is, can therapeutic yoga help us manage the Hampshire witnessed, however, changed the course of his escalation of polypharmacy?” Gupta said. “I believe so.” career – the interaction between yoga and the body. As director of pharmacy and integrative health for a large Jay Gupta, a registered pharmacist, certified immunizer and federally-qualified health center, Gupta has worked with the MTM specialist, teaches yoga and meditation at his Harbor homeless population, where he has seen many suffer from Care Health and Wellness Center as a way to step outside the serious mental health diagnoses and substance use disorders. traditional role pharmacists play in the healthcare field. He has a space dedicated for meetings, yoga and meditation in front of the pharmacy to help this sector of the population, “Pharmacists are experts in the use of molecules that can as well as others. enhance physical, mental and emotional health,” he said. “Research is expanding these options beyond prescription “Offering seated therapeutic yoga classes enhances my medications.” patient interaction beyond dispensing and counseling,” he said. “I’m not just telling them to go and make a lifestyle The National Institutes of Health lists the various components change. It’s an opportunity for me to come out of my box of yoga as the top integrative health modality, Gupta says, and hold my patients’ hands in their journeys toward health.” and published data indicates yoga may help more than 100 physical and mental health conditions. “As community pharmacists, we are called upon to know and educate our patients about everything that has a potential to change the body’s chemistry, so why not yoga?” he said. “It What is “polypharmacy?” behooves us as pharmacists to be educated about yoga and other integrative health options that can potentially interact with the drugs—not just to avoid the risks, but also Polypharmacy is the to enhance health.” simultaneous use of cardinalhealth.com Gupta says as the population continues to age, pharmacists are witnessing a growing problem called “polypharmacy.” Most pharmacists, he says, feel helpless when they notice a multiple drugs by a patient’s expanding medication list without corresponding positive clinical outcomes. single patient for one or more conditions. Innovative Ideas For more information, visit harborhomes.org. 09
Pharmacist Jay Gupta (pictured front-row center) says incorporating yoga classes can be a great opportunity for a community pharmacy. Here are four components to consider, in his own words: 1 The first is education. What 2 Then, how can each 3 Then, how can we bring 4 Finally, how can we use is therapeutic yoga? What is pharmacist enhance their this to our patients? We can all of this information to integrative health? What is own health? In teaching begin by establishing a set develop some best practices person-centered care? nationally, I speak with of recommendations that in deprescription to reduce Hint: It is beyond integrated many colleagues who are strengthen our relationship polypharmacy and enhance care models! hoping to reduce their own with our customers/patients. quality of life? polypharmacy. This is an opportunity for us to use integrative health methods to reverse toxic stress and care for our own aching bodies, insomnia, depression, anxiety, etc. good medicine 2018 10
Community Connection Foster Drug Company embraces a legacy in looking to the future To Bill Foster, pharmacy meant more than filling prescriptions. Six years after his death, that loyalty and willingness to take It also meant caring about customers and devoting oneself a chance are still embraced by those who have continued to meeting their needs in the most innovative and effective serving the community through Foster Drug. ways possible. “Bill always wanted to make sure you didn’t have to come in here and wait if you had a sick child,” says Dianne Smith, who has worked at the store since 1974. “He wanted to have enough employees here to take care of you and get you on “carry We’re doing our best to on and do things the your way, which is why we probably have more employees than any retail pharmacy around.” way he would have wanted To further enhance customer service and convenience, Foster things to be done, and one cardinalhealth.com Drug Company became the first pharmacy in Mocksville, N.C., to have a computer and a drive-thru window. of those ways is to provide Foster also implemented programs at his pharmacy that have helped save lives, from a drug take-back initiative to a the highest level of customer “ program that helps first responders identify a patient’s health service available. conditions upon arrival at a medical emergency. The “Vial of Life Project” provides kits that allow patients to write Innovative Ideas — Dianne Smith, down their medications, health conditions and other critical Foster Drug Company information, and place it on the refrigerator. A decal on the front door alerts first responders to the kit. 11
It can be a tall order for those following homemade soap, pottery and products “We want to do something nice to in his footsteps, including grand- made by local artisans. The store also welcome a new baby and its family into daughter Karlyn Armsworthy, who says performs outreach in the community, the community and to our pharmacy,” adopting Foster’s innovative spirit and including operating a mobile flu clinic, Armsworthy said. passion for customer service has helped hosting fundraisers for residents in them implement a variety of fresh ideas need and participating in health expos These ideas, along with the desire to that not only help the community to educate the public about pertinent continuously evolve as a business, are but draw new customers to their store health and wellness information. a tribute to the pharmacy Foster built. as well. Most recently, the pharmacy is planning “Bill was always really good at thinking For example, Foster Drug added a to implement a program that provides outside the box,” Armsworthy said. “He section within the pharmacy called bags with necessities for new parents was never afraid, and the whole reason “Community Connection” in which when they fill a baby’s prescription why we’re still here trying to do this is local residents are invited to share for the first time, including diaper rash that we want Bill’s legacy to live on.” handcrafted goods. Items lining the cream, baby wipes and other store’s shelves include local honey, must-have items. Foster Drug added a section within the pharmacy called “Community Connection” in which local residents share handcrafted goods. For more information, visit Foster Drug Company’s Facebook page. good medicine 2018 12
Technician Product Verification frees pharmacists to FOCUS on patient care How does the new What did you see happen Technician Product with error rates? Verification practice As the healthcare model improve the As part of this practice model, there was also a research study involved landscape continues workflow at a pharmacy? where we tracked safety/error rates and also pharmacist time. What we to evolve, the need for Technician Product Verification completely changes the found was that the error rate either stayed the same or improved a bit, providers to take a more workflow. We implemented a Drug Utilization Review (DUR) print and pharmacist time spent in active role in their queue so that all prescriptions (new, dispensing greatly decreased— down to 30 percent in one of our refill, with and without DUR), go patients’ medication into a verification queue prior to a locations and 11 percent in the other location. The pharmacists’ use has become label printing. Only a pharmacist may approve a prescription from time spent in patient care activities greatly increased— up to 60 per- increasingly apparent. this queue and print the label. During this phase, the pharmacist cent in one location and 84 percent performs the DUR, looks at in the other location. Essentially, we adherence and appropriateness, found that technicians using For Cheri Schmit, improving patient care and and makes notes for questions or technology to perform product developing a path to transition from a traditional information to gather from the verification was just as safe as a pharmacy to one that better meets the needs patient. I think that our pharmacists pharmacist doing a final check, and of customers is essential. Schmit, the 2017 are doing a much more complete it allowed the pharmacist to shift International Clinical Innovation Award winner and thorough DUR because it is their time from dispensing activities for Medicine Shoppe and Medicap Pharmacy not happening in conjunction with to direct patient care activities. franchisees, implemented a new practice model product verification. This allows that completely changed the workflow for her for a stand-alone task of DUR and pharmacy and ultimately improved accuracy. cardinalhealth.com I think changes the pharmacist’s However, the director of clinical pharmacy at GRX thought process. They can move Holdings, LLC, in West Des Moines, Iowa, also found beyond “is this the correct drug that that the new system allowed technicians to achieve is prescribed” to “is this drug the same amount of accuracy - allowing pharma- appropriate for this patient, does it cists to shift their time from dispensing activities to meet guidelines for therapy, is the direct patient care activities. patient adherent, is it safe and effective, are there gaps in Innovative Ideas Good Medicine spoke with Schmit about what this therapy, and do they need new model means for the future of pharmacy. immunizations/labs?” 13
What must pharmacies do to find success with How can embracing available technologies this practice model? become easier? They must have well-trained and motivated technicians. The To provide enhanced services, you must have efficient technicians will likely need to take the lead in managing the technology tools to help identify, screen, document, verify, dispensing workflow. They also need additional training and etc. And the technologies and vendor platforms are becoming certification and there must be good communication and very valuable. We have been able to significantly decrease our trust among the pharmacy team. Technicians, especially Direct and Indirect Renumeration (DIR) fees and improve our certified-checking, may need to shift and delegate some performance metrics by utilization of technology tools and tasks to non-checking technicians or even support staff when resources. I think when pharmacies see the impact this can appropriate. Workflow will need to change, and I think have both on their practice and on their patient outcomes, the technology is a must. We utilize bar code technology with “why use available technologies” becomes very apparent. both our pharmacy management system and our dispensing Embracing technology is always difficult and no one likes software. We had to physically rearrange our pharmacy to change. My advice would be to pick a platform that integrates make for a more efficient workflow and add an additional with your dispensing software and with as many other computer station. We also added Chromebooks to our platforms that you use as possible. If you can access one counseling rooms to improve education and documentation platform for multiple tasks, then it is certainly much easier. You abilities while meeting with patients. have one place to go for everything, so you get familiar with A pharmacist’s thought process has to change. Pharmacists, the platform and you tend to have it open and available all the by habit, have developed a thought process where we are time since you are using it for everything. concerned with verification of product and rightfully so. The other thing is start small and build. If you are going to Now pharmacists have to switch their thought processes to use technology to identify patients for pneumonia vaccine enhanced care and services. A documentation system also is a or set up a sync-fill program, start with a few patients. Get must. Many technology vendors are racing to help fill this gap/ familiar with the software and process and then gradually need and there are several available, but you must have a way build as you become more adept and work out your policies to document patient interaction and encounters as well as and procedures. collaboration with other healthcare providers. Cheri Schmit, GRX Holdings, LLC For more information, check out pharmacy.iowa.gov. good medicine 2018 14
solution spotlight Pharmacy owners share how Cardinal Health solutions are creating opportunities and improving patient care. TelePharm: The changing face of pharmacy cardinalhealth.com Point-of-Care Testing: The new wave of reaching clients Inventory Manager: More than an out-of-the-box program Medication adherence: Tools for success Pharmacy Transition Services: Keeping pharmacies independent Securing your pharmacy: What you should be doing Solution Spotlight Order Express: Optimize SOURCESM Generic purchasing Pharmacy Marketing Advantage: Let’s get digital Conversion conundrum: Who are your consumers? 15
The changing face of pharmacy How telepharmacies improve patient adherence and bottom line Nearly 68 percent of physician visits involve drug therapy, and according to the Centers for Disease Control, 72 percent of hospital outpatient visits result in a prescription. Yet, ensuring patients fill and adhere to those prescriptions is a widespread concern in the medical community. To meet the needs of underserved populations and address adherence concerns, pharmacy owners across the country are using TelePharm’s cloud-based software to open new telepharmacies that operate like traditional pharmacies, except the pharmacist reviews prescriptions and counsels patients from a remote location. From the urban landscape of Chicago to the rural countryside dotted with small towns, three Illinois pharmacists share their stories of how telepharmacies have benefitted both their communities and their own business models. good medicine 2018 16
The changing face of pharmacy, cont. An evolving field “We are now looking at a couple other locations that are in rural areas to see if it makes sense for us Age is no barrier for pharmacist to go into those areas,” Colee said. who embraces change Although Colee wondered how difficult it would be to learn the technology associated with operating a A pharmacist for nearly 45 years, Dale Colee has telepharmacy, he says the system is very easy. seen the field of pharmacy evolve. “Telepharmacy is cutting edge,” he said. “It’s added At 68 years old, his advice for his counterparts is to to our identity in the community.” embrace change, especially in the area of technology. After a 340B community health improvement center approached Colee about opening a Even in urban areas, pharmacy inside its new Decatur, Ill., clinic to telepharmacy is popular help encourage more adherence among patients, he began researching telepharmacy. It may be just minutes from the heart of Chicago, but the need for a telepharmacy is undeniable in As owner of Dale’s Southlake Pharmacy in Decatur, the Bellwood neighborhood. Ill., and Colee’s Corner Drugs in neighboring Though located in the middle of an urban sector, a Forsyth, Colee knew the location was perfect, but telepharmacy has the potential to serve a portion he wanted opening a new pharmacy to make of the community who may live close by, but still financial sense as well. It has, he says. face challenges in filling their prescriptions. To address this need, Tushar Mehta, who owns “ The wave of the future is, no doubt, technology. I’ve seen a lot of different two independent pharmacies nearby, opened a telepharmacy inside a local health clinic to provide convenient dispensing at the point of care. things over the years, but embracing “In the Chicago area, parking can be an issue for technology is how you keep up residents, so not everyone has access to a car,” he said. “Time is a very big concern for patients, especially for with it. If you want to survive as a parents during the winter months when Chicago sees greater amounts of snow and rain. These conditions pharmacy in today’s environment, “ make it very difficult for patients to go to the clinic you have to do this. and then go elsewhere for their medications.” Because most patients served at the telepharmacy are children, Mehta knows the importance of “The fact that we have a telepharmacy has allowed providing convenience for families. us to cost effectively increase the number of Serving about 40 patients a day from the clinic prescriptions we are doing with very low overhead and an additional 50 to 60 who refill their and with no additional pharmacist needed on the prescriptions, the telepharmacy is staffed by a payroll,” he said. certified technician. Though it reduces payroll and —Dale Colee The neighboring clinic, which sees about 18,000 allows someone to own a pharmacy without high cardinalhealth.com patients a year, serves both adults and children overhead costs, Mehta says it took some time for and includes OB-GYN and radiology services. customers to acclimate to a new style of service. “They asked us to put one onsite as a resource “It was a different way of accepting there is a for the community to reduce barriers for people pharmacy without an in-person pharmacist,” he trying to get their medications,” Colee said. “If said. “People came up and would ask if it was even they walk right by the pharmacy, they have a legal. Now after three years of being open, people greater potential to fill their prescriptions.” don’t ask that question. People are amazed with Solution Spotlight Since opening Colee’s Community Pharmacy, the the fact that you can go to a cubicle and talk with family-owned group of pharmacies has increased a pharmacist on screen.” its business by about 30 percent. 17
“ Patients go to the doctor, but they technology in a new way wasn’t always easy. Several customers assumed they would have to drop off may not make a second trip to get their prescriptions and come back in 24 hours so that the prescriptions could be filled elsewhere and their medications. With telepharmacy, transferred back to the Atwood location. this service discourages the patient Working with the clinic next door, Falk began an education campaign that included direct from doing this sort of thing. They mailings, as well as encouraging clinic staff to get the care they need and go home “ clear up any misperceptions. He also advises those thinking of opening a with the whole package. telepharmacy to get the community behind them first. Rural telepharmacies fill void, “Get yourself in front of a city council or town hall meeting, and before you open or shortly after you lead to growth open, hold an open house so people can come in and learn how a telepharmacy operates,” he said. After noticing the increasing number of deliveries “Most people who have been taking prescriptions David Falk and his team at Sav Mor Pharmacies for a long time don’t want any hiccups.” —Tushar Mehta were making to the small community of Atwood, Ill., Falk recognized potential. Once Falk did that, he began seeing an uptick in business. “We saw a market that was like a desert that wasn’t “We were kind of fearful that the older population being fulfilled,” he said. would be a big stumble point because of the Up until his telepharmacy opened, the rural technology, but it really wasn’t,” he said. “We have community of 1,200 people hadn’t seen a a private consultation room where the monitor is. pharmacy in town for more than 15 years. Most of them knew the pharmacist from the host “People were driving 10 miles each way to get store, so they were already a familiar face and it put a prescription filled,” Falk said. “By adding a them at ease.” telepharmacy there, we knew we would probably pull some business out of the pharmacy closest to Atwood, but we also knew there was a lot of business in Atwood that we could tap into.” With a health clinic operated by Kirby Medical Center already located in the village, it seemed like the perfect fit to open a telepharmacy next door. “The village of Atwood really stepped up to the plate and made a building available to us and pushed through permits,” Falk said. “Not only has it helped us as a pharmacy, but it has helped the community and the clinic next door.” That forged relationship then led Falk to open an additional telepharmacy inside another Kirby clinic in the region. Falk now operates five telepharmacies, all in rural areas. “It’s been a snowball effect,” he said. Though about 1,100 prescriptions are filled per month at Falk’s first telepharmacy location in For more information, visit Atwood, changing customers’ perceptions of using cardinalhealth.com/telepharm. good medicine 2018 18
Health and wellness destinations Point-of-Care Testing allows pharmacies to diagnose flu, strep on the spot It’s a pattern pharmacist Sally Salib The process is easy, Salib says. Using treatment protocols that outline patient screening eligibility, sees every year — ill patients coming testing and medication initiation, she swabs a to the pharmacy looking for relief customer if that person is displaying classic influenza from severe symptoms. or strep symptoms. If the test comes back positive, she contacts the customer’s physician immediately. Without definitive proof, Salib could not know with The physician then sends a prescription back to the certainty what ailment was causing their suffering. pharmacy for the appropriate treatment, such as That’s why the owner of Briargrove Pharmacy in Tamiflu or an antibiotic. Houston, Texas, implemented the Cardinal Health “The doctor’s office usually gets back to us right Point-of-Care-Testing Program, which provides away, normally within 30 minutes while the tools and resources that allow retail pharmacies cardinalhealth.com customer is still at the pharmacy,” Salib said. to offer flu and strep testing to their customers on the spot. This rapid diagnostics practice ensures Briargrove Pharmacy fills the prescription. The program positions pharmacies to go beyond interpreting, dispensing and counseling “By adding this service in our pharmacy, we have on medication, to become true patient care attracted new customers,” Salib said. “Our customers destinations — ultimately promoting business know we are here as a community pharmacy, and sustainability and providing increased access to we can help them more than any other pharmacy.” Solution Spotlight healthcare in their communities. In fact, Salib said she didn’t face any real challenges to get Point-of-Care Testing up and running in her pharmacy. 19
“ benefits As an independent pharmacy, this is really adding strong for our patients because it is increasing access to “ healthcare and helping keep our community healthy. — Sally Salib, Briargrove Pharmacy Prior to implementing the service, Salib did some discovered this first-hand, when after advertising of her own research to gauge physicians’ reactions, the program on Facebook, patients began coming by contacting a few physicians from whom she fills in on their own, inquiring about the tests. prescriptions. The feedback was positive. Although Salib must call or fax physicians to report “They’re happy because they’re able to help more positive test results in order to receive and fill a patients,” she said. “Some doctors don’t even do prescription, she says it’s part of the job. the flu test. This is a good thing because the doctors “As pharmacists, we work with physicians all day who aren’t doing the tests are sending patients to us.” long as part of the service,” she said. “It’s worth In just two months during the most recent flu and doing that for someone who has the flu.” cold season, pharmacists at Briargrove performed She advises those considering Point-of-Care 70 tests. Continuing education courses and training Testing services to “just be brave and do it.” videos through the Point-of-Care Testing Program provided the knowledge and tools necessary to “As an independent pharmacy, this is really adding integrate the service into the pharmacy’s normal strong benefits for our patients because it is daily operations. increasing access to healthcare and helping keep our community healthy,” Salib said. “It’s easy to get started, “This seemed intimidating at first, but it’s very easy and many primary care practitioners are supportive.” to learn,” Salib said. At a time when consumer-driven healthcare is at the forefront, this program helps meet the demand For more information, visit for increased access for convenient healthcare cardinalhealth.com/poctesting. services in the retail pharmacy setting. Salib good medicine 2018 20
BETTER inventory management Cardinal Health™ Inventory Manager creates balance, helps pharmacies navigate 340B orders For independent pharmacist The program also has the ability to map 340B orders — a key benefit for Kevin Duane, better managing Duane because his pharmacy dispenses his inventory is essential in 340B-eligible prescriptions. 340B is a improving business metrics. government-regulated program that requires drug manufacturers to provide That’s why he turned to Cardinal Health™ outpatient drugs to certain covered Inventory Manager (CIM) to help create entities, such as hospitals, at a reduced a more balanced inventory at Panama price. The program provides low-cost Pharmacy in Jacksonville, Fla.—a move medication for safety net providers who that has helped him increase cash flow, use it to further their mission to serve improve patient service levels and vulnerable patient populations. Kevin Duane reduce outdated products. As a contract pharmacy, Panama Panama Pharmacy CIM is a web-based program that Pharmacy dispenses the eligible helps pharmacies manage prescription prescriptions from its retail inventory inventory. The program combines and receives replacement inventory “just in time” replenishment, driven once a full bottle of a specific item is by automated order points and gone. Contract pharmacies typically sophisticated reporting capabilities, do not know when the replacement with dedicated inventory consultation inventory is coming, often leading to and support. inventory swell. 5 FACTS You didn’t know about CIM 2 You have a support team — including our IT team which is part of Fuse, the Cardinal Health commerical technologies and innovation center. How is it that we can customize settings to meet your inventory Cardinal Health Inventory™ Manager (CIM) is built management goals? We have a CIM-specific team here to cardinalhealth.com to help manage your prescription inventory, but help! In addition to your sales rep and pharmacy operations consultant (POC) in the field, you have a corporate-based team did you know that it’s much more than an “out-of- of inventory experts here for you. the-box” program? Here are five surprising things about CIM that make it a far more robust solution for your pharmacy. 3 The audit list isn’t just comprised of random items — it has logic behind it and has helped to identify theft. Solution Spotlight One of the keys to maintaining a clean inventory is to 1 We can customize settings such as days-inventory- complete ongoing audit (cycle) counts. Each day, CIM provides on-hand (DIOH). a list of items that should be counted. The goal is to facilitate CIM’s standard settings help you manage your inventory more counting through your entire inventory several times per year effectively; but, we can also tailor the system to your specific and to help point out items that continually seem to be “off.” needs. Want to increase on-hands of popular generics while decreasing seldom-used brands? We can do that! 21
Duane has helped prevent this swell because CIM maps Q What are key features you rely on most heavily? 340B orders to the pharmacy’s account. 340B items that A: We use the ordering function daily. It gathers pricing data have been put on order for shipment by the covered from our buying group and we can use the “analyze cart entity get taken into account as CIM builds the daily function” to make sure we are buying in the most efficient demand-based order. way in regards to our buying group matrix. It also takes into Good Medicine spoke with Duane, who has incorporated CIM account rebates on generics, so we are able to compare net into his pharmacy’s day-to-day operations for four years, about to net with our buying group in real time. We manage the how it has benefitted his business and helped mitigate his excess inventory report weekly and I see a direct reflection 340B inventory concerns, as well as what key features he relies of that in our decreased wholesaler bills and increased cash on daily. on hand. Q What made you decide to use CIM in your pharmacy? Q What impact has your 340B affiliation had on What features and benefits of CIM made it impossible your business? to pass up? A: 340B has allowed us to serve a wider scope of patients than we would have been able to before. We are able to A: When I purchased the store it had CIM in place, but I work closely with the 340B physicians to discover creative looked heavily at alternatives to ensure we were dealing solutions to better cater to that specific patient group. with the best solution. CIM’s ability to manage multiple wholesalers and its ability to quickly display excess Q How has CIM helped mitigate your 340B inventory for return made it an indispensable part of inventory concerns? the pharmacy. A: Since CIM receives data from our traditional account, our Q How has CIM helped your business? buying group account and our 340B account, we can use it as a true “dashboard” and see how each piece fits together A: It has helped improve cash flow by letting us manage in a real-time basis. 340B replenishment shipments can our inventory on a “just in time” basis. Our turns are be tracked and compared to dispenses, which ensures our higher than ever, so we have more predictable cash flow. 340B inventory is reconciled. Without CIM, we would have Excess inventory is definitely reduced using its reporting to do this manually by hand and it would take quite some functions, and we have fewer drugs expiring because we time. It is a real time saver in that regard. can stay on top of slow/no moving items. For more information, visit cardinalhealth.com/CIM. 4 We can add a 340B account to reduce inventory swell. One of the pains often felt as a 340B pharmacy is the inventory swell that comes from receiving the replacement bottles without warning. CIM has the ability to map 340B orders to your account, taking the ordered 340B items into consideration as it builds your daily demand-based order, thus limiting inventory swell. 5 You can manage inventory from secondary suppliers, too. We get it. There are just some products that you have to buy from sources other than Cardinal Health. You may not buy all of your products here but you can track them here. CIM enables you to manage prescription inventory from all of your suppliers in one place. good medicine 2018 22
medication adherence 5 ways to improve medication adherence Understand why your patients aren’t taking 1 their medications. Adherence is a multidimensional phenomenon, in which multiple cultural and practical factors affect a patient’s behavior and capacity to adhere to treatment. 2 Educate your patients on their medications. Show patients how their medications can improve their quality of life. 3 Tailor a solution. Depending on each patient’s needs, you may need to tailor a solution to address specific adherence obstacles. Provide workflow solutions that address all of your patients’ needs. Not all of your patients will face the same adherence obstacles, but workflow solutions can help in various ways. 4 cardinalhealth.com Market your pharmacy as a healthcare destination. Help more patients improve Solution Spotlight 5 adherence by promoting your pharmacy and the services you provide to your community. 23
medication adherence Dispill® delivers a dose of independence After Gabriel Guijarro began offering Dispill® compliance packaging at his Lufkin, Texas, pharmacy in 2015, he immediately saw just how valuable the service was to patients. Hearing from nurses at home health agencies who routinely packaging worked. They also found the most came in contact with patients with disorganized or missing success in targeting home health agencies. medications, Guijarro realized he could help. “Oftentimes, a nurse would visit a patient’s house He now has more than 200 patients using Dispill in their own and find out that several of the prescriptions needed homes, helping customers with what they want most—to to be refilled, and the patient would have to rely on remain independent. a family member to pick up the missing drugs and then revisit that patient later,” Guijarro said. “So, the administrators at our local home health agencies How it works immediately recognized the value that Dispill could Providing a safer way to take medicine, Dispill offer in eliminating the amount of time nurses spend packaging provides prescribed medication in an sorting out medications and re-visiting customers.” all-inclusive blister pack—eliminating the need for pillboxes and single-dose bingo cards. This, in turn, decreases the risk of patients mixing How to expand up medication or forgetting the time of day they Looking to the future, Hargroue says the next step have to take them. is to target assisted living facilities. “Dispill packs are easy to fill once you have a “There is an owner who is building a new 50-room system in place,” Guijarro said. “The pack is easy facility in our community and he is a proponent to read, organized, includes the pharmacy contact of compliance packaging,” he said. “So there information and I can display my logo.” is a potential to bring in 50 new patients to our pharmacy on Dispill!” Other ideas for expansion include reaching out How to market to adult daycare centers, partnering with county As owner and pharmacist at The Medicine Shoppe, agencies that focus on keeping seniors independent Guijarro knew he had a great service members of his and marketing Dispill to family members and community needed. How to create awareness about caregivers who will have better peace of mind that the service, however, would take some strategy. their loved ones are taking the correct medications. Guijarro hired Johnny Hargroue as the pharmacy’s specialty sales executive, who then targeted For more information, visit local doctor’s offices and demonstrated how the cardinalhealth.com/dispill. good medicine 2018 24
medication adherence Improving patient adherence and the bottom line Simple steps can lead to big outcomes when utilizing Reimbursement Consulting Services Today, 145 million Here’s how: Americans suffer from • When on the RCS dashboard, go into Out of every chronic disease, yet Individual PDC measures. Set to Medicare 100 prescriptions Patients/Rolling Year. written, only*: only one-third take their medications • Review the patients who are 70-79 percent 50-70% on the PDC measures. These are the as prescribed. patients who are most likely just one fill This causes a ripple effect— away from being compliant, Kaempf says. are filled by a pharmacy affecting the entire cost of Using tools like auto refill or medication 48-66% care. When patients adhere to synchronization can easily help improve a prescribed medication; however, patient’s adherence. both clinical and financial • For patients who are at 40 to 60 percent are actually picked up outcomes improve. That includes on their PDC measures, simply reviewing by the patient performance scores that ultimately dispenses for obvious errors can make affect a store’s bottom line and direct and indirect remuneration (DIR) fees. a significant difference. “If a patient is getting a 30-day supply every 60 days, the pharmacist should talk to the patient 25-30% are taken properly Lisa Kaempf with Cardinal Health to confirm how they are taking the Reimbursement Consulting Services, says pharmacists know that it is important to work with • medication,” she said. If the patient is not taking the prescription 15-20% are refilled according to directions, the pharmacist cardinalhealth.com patients to be adherent to their should call the doctor to get a new medications, but struggle with prescription. “By targeting that patient, it’s how to fit that into their daily a quick win,” Kaempf said. “They go from workflow. However, improving a non-compliant patient to a compliant just one patient’s adherence can patient on the list.” make a significant difference in increasing prescription counts and decreasing DIR fees. Solution Spotlight For more information, visit cardinalhealth.com/rcs. *Source: Ruppar, Todd. (2017, February 21). Overcoming Barriers to Medication Adherence for Chronic Diseases. 25 Retrieved from https://www.cdc.gov/grand-rounds/pp/2017/20170221-medication-adherence.html.
medication adherence New Action Center within RCS prioritizes the patient, workflow Reimbursement Consulting Services (RCS) will In addition to providing patient-level opportunity information through the Action Center, RCS also offers now include the new Action Center, which will dedicated pharmacy advisors who help locate the most incorporate a prioritized patient and workflow optimal opportunities that are important to an individual that will make it much easier for pharmacies business at that point in time. to identify revenue opportunities and communicate with patients. “We have significantly enhanced RCS to allow customers to quickly focus on clinical opportunities and communicate effectively with patients,” said Mike Zabonik, senior manager for Product and Solutions Marketing. This patient work queue will provide adherence workflow improvements, as well as provide other opportunities such as customer trends, identification of patients with immunization needs and improved direct and indirect remuneration (DIR) estimation tools. The goal is to improve overall store performance and make it easier and more efficient for pharmacists to use this tool. How to improve a patient’s adherence Every patient’s needs are different, and each patient may respond better to one solution over another. Here are a variety of services that help improve patient adherence so that you can best meet each patient’s individual needs. Auto refill and refill reminders: Compliance packaging: Prescription assistance Remind patients they need to Deliver prescribed medication programs: refill their prescriptions or that to individuals in an all-inclusive Offer free or discounted medicine their prescriptions have been auto blister pack. utilizing a drug company refilled — via telephone, web, Medication Therapy program or a discount program. app, text, email or social media. Management (MTM): Home/worksite delivery: Medication synchronization: Provide MTM services to help Offer same-day delivery services, Consolidate and coordinate a patients get the best benefits for eligible prescriptions, to patient’s prescriptions so they from their medications by actively patients’ homes or places can all be refilled on the same managing drug therapy and of work. day each month. by identifying, preventing and resolving medication-related problems. good medicine 2018 26
Pharmacy Transition Services Keeping pharmacies INDEPENDENT cardinalhealth.com “ We really consider Cardinal Health our strategic partner. It really is top-to-bottom help. “ Solution Spotlight — Kevin Faris, independent pharmacist 27
How one team takes on the challenges of buying and selling Life is full of transition, even with the From start to finish, Pharmacy Transition Services team members work with buyers and sellers to provide ownership of your pharmacy. consultation to ensure each transition is completed “To our estimation, just over 1,000 independent successfully. They specialize in analyzing pharmacy pharmacies transition each year by selling to a valuations, on the buy side and sell side, to ensure chain, closing their doors or transitioning to another fair market value. Team members also provide independent owner,” says Judd Wilstead, director of consultation, align buyers and sellers, offer financing pharmacy acquisition on the Pharmacy Transition options and purchasing structures, arrange legal Services team for Cardinal Health. “Over the last 10 years, counsel when necessary and develop succession our Pharmacy Transition Services team has focused on planning and exit strategies. helping independent pharmacies remain independent. Most recently, Faris worked with this team to purchase We have completed nearly 2,000 pharmacy valuations seven locations in San Diego. Logistically, selling or and over 700 transitions. We can help you form a game purchasing one store can be complex. Seven stores plan to ensure a successful transition.” compounds that complexity. While some independent pharmacy owners have a “This was a very large purchase,” Faris said. “Financial desire to acquire other pharmacies or sell theirs to help, cost of goods help and everything that Cardinal fellow independent owners, navigating what can be a Health does, we needed. We had to dot our i’s and cross complicated process is difficult for someone without our t’s because this was such a large transaction.” acquisition experience. Prior to the San Diego acquisition, Faris also worked with “Most pharmacy owners went to pharmacy school to learn Wilstead and his team on transactions in Nevada, Hawaii, how to be great pharmacists. They weren’t necessarily Idaho and Alaska. educated on how to buy and sell businesses,” Wilstead “We really consider Cardinal Health our strategic partner,” said. “We are here to help every step of the way.” Faris said. “When we look at a store or stores, without When Kevin Faris, an independent pharmacist on the their help, we wouldn’t be able to transition some of West Coast, began to expand the number of pharmacies these, and it’s not just financing or valuation. It really is he operated so his team could better compete in his top-to-bottom help, even when you get to the actual ever-evolving local market, he realized he needed help acquisition and it’s passed to the local sales team. It’s to ensure the acquisitions went smoothly. getting accounts set up and getting everything ready “We want to grow, but grow responsibly, because at the for the new owners to take over.” same time, it can get overwhelming,” Faris said. “If you aren’t taking the right steps, it can come back and bite you.” The Pharmacy Transition Services program is focused on helping those who are thinking about succession planning, retiring or buying another pharmacy. For more information, visit cardinalhealth.com/pharmacytransitionservices. good medicine 2018 28
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