Much has changed over the last two years, but even more has changed over the last 10 years. As we celebrate the 10th anniversary of Independently Healthy, we revisited some of the customer stories featured in our 2012 edition, then known as Best Practices.
For a decade, Independently Healthy has celebrated forward-thinking pharmacies, highlighting how independent store owners maintain success and good health in their communities.
Here, we catch up with three pharmacies on where they’ve been and where they are now.
In late 2010, Western Maryland Health System (now known as UPMC Western Maryland) began seeing readmission rates increase to more than 20% due to lack of medication adherence following discharge. The hospital system approached The PharmaCare Network to help with a discharge plan. Together, they reviewed Boston University Medical Center’s discharge model called Project RED (Re-Engineered Discharge), which includes in-depth medication plan reviews with patients and specific directions for post-discharge follow-up. Given their findings, the health system decided to repurpose this plan for its patients’ purposes. The plan was known as MedStart.
Keith Pirolozzi, director of Outpatient Pharmacy Services, answers a few questions about how The PharmaCare Network and MedStart have evolved in the last 10+ years.
Do you still use MedStart today? If so, how has it evolved?
When we started MedStart in 2011, we used a hybrid model where the hospital would partner with a decentralized pharmacist. We came in and provided the medication directly to the patient, answered questions they had and walked them through their medication dosages, noting how often —and when — they needed to take them. Over time, we saw that readmission rates were decreasing.
We designed MedStart to do new medications based on a patient’s discharge. If new meds were not needed, the patient’s doctor would manage that on their end; we weren’t involved.
Today, it’s evolved to filling all medications for the patient — it’s not just about new meds. It’s come to a point where hospitalists and pharmacists are doing the medication reconciliation with the patient, and the doctors and nurses, and our pharmacy, are working together to address the patient’s medication maintenance.
What’s the benefit for the patient today?
The benefit is that the patient doesn’t have to pay for the medication at discharge; where they would be responsible for their copays at their home pharmacy. The hospitals now ask patients not to bring their wallets for their procedures. Instead, we send an invoice, and the patient has 30 days from the invoice date to pay it. If the medication is expensive, they can pay in installments.
Back then, the volume of medication distribution wasn’t as much for us because we focused on giving patients their new medications at discharge. Now, we can give up to five to six different medications, offering them all of their medications at once.
Also, the other part of this evolution from back then to today is that we’re providing 30 days of medication at discharge. On day 31, the patient can look at what medication has or has not been taken and talk to us about next steps. In fact, there are many times the patient will call us and say, “I’m out of meds but can’t afford more.”
Over time, we realized we needed to help. We began working with local charities, namely Associated Charities, and the hospital on how we could collectively take care of the continuity of medication needs after those 30 days. We also work with the local hospitals’ care coordination staff to identify patients for whom we used free trial cards or had large deductibles or copays. Cost is a huge factor in this process, as some patients’ deductibles are over $400.
We work with the hospital by having them create a report for all current patients receiving high-dollar medications. We review these reports daily and load the information into our systems. We get an idea of their copays and send the data back to the care coordination staff. This gives them a heads up on what the patient will owe ahead of time. From there, we work together to help find more affordable drug or use the resources we have in place — like the financial assistance with Associated Charities and the hospital — to help them get their medications, especially on day 31 and beyond.
What additional transformations have your pharmacy undergone?
I’d say that our increased communication with hospital staff, specifically the care coordination staff, has chiefly taught us that teamwork is best. We all work together to try to discharge patients out of the hospital with minimal charges and more affordable medications.
We’re all focused on genuine and authentic service for our patients. And that’s what keeps them coming back to us: service.
What’s your perspective on the future of independent pharmacies and pharmacies being a true healthcare destination in the communities you serve?
Retail pharmacy will be a healthcare destination in the near future, so we’re pivoting toward that model. We now have a nurse practitioner on site and have taken our durable medical equipment and supplies to some locations. We also have blood draw stations and have partnered with a local lab to run lab reviews.
It’s less about looking at our geographical locations (we have seven in total) and more about utilizing our current sites to expand our services. We’re always asking ourselves, “What else can we be doing to offer comprehensive services to our patients?”
That’s what we’re focused on now and in the future.
In 2012, quick-response (QR) codes provided easy access and efficient connectivity to this pharmacy. The matrix-type barcodes host four standardized kinds of data: alphanumeric, byte/binary, numeric and Kanji.
David Burke, co-owner of Burke’s Main Street Pharmacy in Hilton Head, South Carolina, quickly recognized the benefit of using QR codes. When we interviewed him in 2012, he said, “You have to keep up with technology, or you’re dead in the water.”
Here, David tells us why technology is still important to him — and to his family and staff.
Do you still use QR codes in 2022?
We do, but not like we did. We have a QR code at the register that automatically goes to our website, but it’s not as popular as it was 10 years ago.
The pandemic quickly shifted our focus from QR codes to Cardinal Health’s scheduling platform, MyScheduling for Outcomes™ Connect, to track and administer vaccines. The whole platform was monumental for us — and by “us,” I mean my brother Tim and sister Cate, who work here with me.
It was an anxious time as people were not only trying to navigate uncertain waters, but businesses were, too. So we had to focus on effective, user-friendly and practical technology. We still use QR codes, but now it’s all about using the platform for our future clinical service programs such as flu, A1C, strep, etc.
MyScheduling for Outcomes™ Connect is an easy-to-use scheduler to streamline patient work that allows us to set up multiple appointments, send reminders to patients and view our pharmacy’s calendar.
How did you and your family work together to get through challenging times?
We’re celebrating our 35th anniversary at our store this year. My siblings and I are the second generation to run this store, with our dad being the first. So over time, we’ve learned how to work together. But during the pandemic, we had to remain strong for one another and lean on each other even more to keep the business moving.
Once the COVID-19 vaccines were released and the public started to gain access to them, there was an overload of people calling us, coming in or dropping by to see if they could get a vaccine. Honestly, it was a madhouse! However, we used the scheduling platform to help manage vaccine registrations, and it not only helped us manage the day-to-day operations, but also allowed us to capture emails, names, addresses and demographics. It made life a lot easier for me, my siblings, our working relationship and, most importantly, our customers.
How did you make technology work for your store and your customers?
Over time, we’ve realized that data is king. We wanted to collect as much information as we could on our customers so we could better serve them. During the pandemic, we not only tracked their COVID-19 vaccine history but also took a deeper look into their overall vaccination history. Did our customers have their flu, shingles, booster, hepatitis A, hepatitis B and tetanus shots? As they came in for their COVID-19 vaccine, we brought up their record and — when and where needed — recommended an additional course of vaccine treatment. We talked them through it, outlined the pros and cons, and answered and addressed any questions or concerns they may have had. We still do this today.
Technology has absolutely helped us create a more holistic approach to helping our customers. We’re now looking at the bigger picture, such as their medication and vaccination history, labs, family history and more.
What’s next for Burke’s Main Street Pharmacy?
As I said, we’re celebrating 35 years in business here. My siblings and I are getting older, and we’re looking to younger generations to help us. We want to hire recent pharmacy school interns and graduates because their training is vastly different from ours. We’ve noticed that they’re clinically focused and trained in using a holistic approach — the one we’ve been using for the last few years. It’s incredible what they’re learning today. Everything is so new and fresh to them, so it’s a win-win.
I can remember as a kid being a stock boy in a drug store, and the pharmacy couldn’t grasp the doctor/patient relationship. I look back on that and can’t help but think it was detrimental to a patient’s health not to prioritize the pharmacist. Today, we’re an integral part of the care team, meaning our pharmacy is now “at the table” with the doctor and the patient, and together we’re all working toward an effective and comprehensive care plan.
We’re no longer an option; we’re a necessity — and this is now our future.
In 2012, Marty Bigner, owner of Thrift Drugs, searched for ways to improve his patients’ health, work with the local community and strengthen his business. By creating the Free Vitamin Club, he addressed all three of these needs and produced very encouraging results.
Marty tells us where the club is today and what else he’s been up to since 2012.
What is the Free Vitamin Club?
After a conversation with another pharmacist at the American Associated Pharmacies (AAP) Annual Conference, I developed this program. I got started by contacting Mason Vitamins — they provided me with private label vitamins customized for individual parties. I ordered children’s chewable vitamins and put a Thrift Drugs private label on them, with each bottle costing only $0.89.
I’m happy to say that the club is still in place! However, the private label has become hard to get a hold of at a reasonable price, so now I use Cardinal Health’s product, Children’s Multivitamin. The price is $0.80 today. Our store has about 100 kids, ranging in age from 2 to 12, using the multivitamin.
How did the Vitamin Club help your store, then and now?
I wanted to figure out a way to get families into the store and over the last 10 years, I noticed that the market was really moving toward vitamins.
So I got to thinking even bigger: How could I offer even more help to an even larger demographic?
I wanted to offer compliance packaging, where you put all of the drugs a patient takes into one package (either blister packs or pouches) to help a customer adhere to their drug regime. Medications are organized by dose, days of the week and the time of day that the patient needs to take them. I started this a little over a year ago, and so far, more than 80 patients are using this service. I’ve been told it takes the “did I or didn’t I?” guesswork out of the daily process because they can see what medications they have already taken. It keeps them compliant and has been especially effective with the aging population as it helps them take their medicine correctly. I charge only $5.00 per patient per month.
What else are you focused on now?
We’re also preparing for clinical services in our pharmacy. It’s not quite here yet, but it is in the making. Soon pharmacists are going to get paid to help monitor their patients. I feel like we see our patients more than most professionals involved in their care team do.
If a patient hasn’t had their A1C check and comes to see me 12 times a year, and they only see their doctor two to four times a year, now is the time that we need to learn how to do care plans necessary for medical billing.
We’re also talking to and working with Mississippi’s Department of Health and the Centers for Disease Control to learn more about getting access to funding for specific programs for our patients. This is the future of pharmacy. It’s been in the making for about five years, and it’s only a matter of time before Mississippi receives a major payer contract to provide patient services. All of this will eventually lead to us providing better service and care to our patients, which will ultimately help them with their overall care journey.
My goal is to have our customers and patients see us as more than just a traditional pharmacy, but as a resource they can come to for both care and their prescriptions.