good

medicine

Retail Independent Pharmacy |

Healthy Horizons

Dear reader,

When I walk into an independent pharmacy, I immediately feel

connected to the community. Maybe it’s the way you greet each of

your patients by name. Maybe it’s the little league baseball team

photos hanging on your wall. Or maybe it’s your unique approach to

improving the health of each person who walks through your doors.

Whatever the reason,

the power of independents, is palpable.

In this edition of

good medicine

, we focused on creating a similar

sense of community among retail independent pharmacy owners

across the country. As reimbursements continue to tighten and

margin pressures increase, this community is increasingly important.

We hope

good medicine

is a place to share best practices, educate

yourself, connect with each other and be inspired.

Each of the stories you will read were graciously offered by your

peers. They are stories filled with creative approaches to monitoring

adherence, expanding clinical services and more. These are stories

of pharmacy owners who have adapted to new challenges to grow

their businesses in new ways.

Welcome to the fourth edition of

good medicine

magazine.

Steve Lawrence

Senior Vice President, Independent Sales

WHAT MAKES A

GREAT PHARMACY

TECHNICIAN?

HEALTHY

CUSTOMERS,

HEALTHY PROFITS

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cardinalhealth.com

WELLNESS

BEYOND MEDICINE

FEATURES

TABLE OF CONTENTS

HEALTHY HORIZONS

good medicine

AN INVESTMENT IN ACCOUNTABILITY

BUSINESS ADVANTAGE

PATHWAYS TO OWNERSHIP

HOMETOWN PRIDE

WHAT MAKES A GREAT PHARMACY TECHNICIAN

SOLVING PATIENT PROBLEMS

THE RIGHT MIX

TAP INTO NEW TERRITORY

MEDICINE SHOPPE®’S FIRST TELEPHARMACY

RETAIL ADVANTAGE

HEALTHY CUSTOMERS, HEALTHY PROFITS

STRONG END TO END

FABULOUS FRONT-END

THREE REASONS PATIENT EMPOWERMENT IS GROWING IN HEALTHCARE

WELLNESS ADVANTAGE

WELLNESS BEYOND MEDICINE

ADHERENCE MATTERS

SUPPLEMENT HEALTH, FIGHTING VITAMIN DEFICIENCIES

MATTERS OF THE HEART, BLOOD PRESSURE SERVICE

FIVE IDEAS FOR FACEBOOK POSTS

THE POWER OF INDEPENDENTS

COMMUNITY ADVANTAGE

OPEN FOR BUSINESS

MEDICARE MADE EASY

THE NALOXONE LADY

A COMMUNITY PHARMACIST’S FIGHT AGAINST PRESCRIPTION DRUG MISUSE

GENERATION RX

COMMUNITY PHARMACISTS—THE KEY TO REDUCING HOSPITAL READMISSIONS

FOUR REASONS PATIENTS CHOOSE INDEPENDENT COMMUNITY PHARMACIES

LAURA DRUCKER

Essential Insights Contributor,

Healthcare Writer

good medicine

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Investment

ACCOUNTABILITY

WILL PAYERS MOVE REMOTE

PATIENT MONITORING INTO

MAINSTREAM PRACTICE?

In a country where nearly half of all adults suffer from one or more

chronic health conditions, how do you keep healthcare delivery

costs down while also giving patients access to the care they need?

It's a question that has long plagued U.S. payers and providers, and one that emerging technology

is poised to help answer.

One technology, remote patient monitoring (RPM),

is gaining increased

attention from both payers and providers in the conversation around how to provide more efficient

care. RPM refers to wirelessly connected medical devices that enable patients to be observed away

from care facilities. The devices range in form, from sensors to wearable gadgets and technology

embedded into clothing, to implanted monitors, and more. They serve different functions—checking

glucose levels, alerting if a patient falls or tracking activity levels. All are meant to help patients and

providers manage care outside of traditional settings while cutting down on the expensive toll of

reactive medicine. RPM is part of a general trend toward mobile health (mHealth)—services and devices

that deliver health benefits to patients without the requirement of a physical visit to the doctor.

At Fuse, the innovation lab at Cardinal Health, experts are looking closely

at the growing benefits of RPM for payers and patients alike.

"The more data you have, the better," said Corbin Shaw, a healthcare innovation specialist at

Fuse. "Remote patient monitoring sheds light onto those gaps that the payer currently doesn't

have insight into." This information can help providers respond proactively to issues, offering

intervention at earlier stages and minimizing the steep costs incurred in emergency situations.

RPM

SHEDS

LIGHT

onto the gaps that the payer

currently doesn’t have insight into.

Corbin Shaw, Fuse

THE PROVEN SUCCESS

OF mHEALTH

One of the earliest adopters of mHealth,

including RPM devices and telehealth, is the

U.S. Department of Veterans Affairs (VA). The

VA allots nearly half of its $100 billion yearly

budget to the Veterans Health Administration

(VHA), which manages the healthcare of

8.3 million patients, two-thirds of whom

suffer from at least one chronic illness.

Since starting its initial RPM and telehealth

program in 2003, the VHA has been able

to reduce the number of bed days of care

by 25 percent and reduce acute hospital

admissions by 19 percent, a 2014 case

study by the Healthcare Information and

Management Systems Society showed. A

$1,600 annual investment per patient in

mHealth technologies helped the VHA

decrease average costs per patient by more

than $6,500 per year. And VHA patients have

been eager to embrace the convenience

and control afforded by mHealth. Of those

offered the services, 90 percent accepted.

The benefits seen by the VHA reveal the

greater possibilities of home-based patient

monitoring. Patients—even those who suffer

from chronic illnesses—feel more secure and

empowered, while their providers are able

to track symptoms and treatment adherence

from afar, intervening before crises occur.

With the reduction in hospital visits and

lengths of hospital stays, payer costs are

decreased significantly, a small investment

per patient upfront translating into major

savings across the care continuum. Other

healthcare agencies, including the U.K.'s

National Health System, are looking to the

VHA's experience with RPM and telehealth as

a model for similar programs of their own.

HELPING KEEP PATIENTS

ACCOUNTABLE

Treatment for chronic conditions can be

complex. There are diet, exercise, and

lifestyle recommendations, appointments

to juggle, and often, multiple medications

that need to be taken regularly. Poor

adherence to care requirements is rampant

and expensive. For example, a report from

the World Health Organization shows that

direct costs attributable to inadequate

treatment control in diabetes patients is

roughly three to four times higher than

costs for those who adhere to care plans.

The problem for payers whose patients are

managing chronic illnesses like diabetes,

hypertension, coronary artery disease and

asthma, is that much of the costs incurred are

a result of medication nonadherence, mostly

in the form of avoidable hospitalizations.

MOVING RPM INTO

THE MAINSTREAM

As of 2015, 4.9 million patients were

already enrolled in mHealth care

programs encompassing RPM. Rising

market acceptance suggests continuing

growth, and payers may be best suited

to push RPM into mainstream practice.

The healthcare innovators at Fuse believe

that creativity and advancement in RPM

technology will result in wearables and

other devices that seamlessly integrate into

patients' lives, wirelessly transmitting health

data to payers and providers in real time and

allowing for proactive healthcare that reduces

wasteful spending. One example is the

concept of Bluetooth-connected devices, like

a smart scale to monitor a congestive heart

failure patient's weight, since rapid weight

gain can be a sign for hospital readmission.

"It will be interesting to see what RPM

devices and data payers and providers

will actually use and trust, as well as how

the device data will be integrated into

existing payer and provider data sets and

workflows," Fuse healthcare innovation

specialist Kristina Redgrave said.

As healthcare spending continues to grow,

payers have a unique opportunity to start

developing infrastructures that support RPM

among their patients, perhaps considering

reimbursement plans for device purchases

or incentives for good health and proper

care maintenance. Those incentives may

also be enough to push patients into action

despite any privacy and security concerns.

Though the exact mechanisms of widespread

RPM use are still unclear, the opportunity

for payers to greatly reduce spending

through RPM technology is promising.

John’s glucose data is collected and transmitted to a

monitoring center for his management program. If his

glucose levels go outside the target range, a healthcare

provider alerts his primary physician. John’s physician works

with him to adjust his treatment plan and insulin dosage.

To better manage his diabetes

and avoid more hospital visits,

John has been given a remote

device for continuous glucose

monitoring from his health plan.

John avoids

going back to the

hospital and no

additional costs

are incurred.1

good medicine

According to a National Institutes of Health

report, between $100 and $300 billion is

spent annually on care costs related to

nonadherence, a sum that represents three to

ten percent of total U.S. healthcare spending.

"We see the potential for RPM to enhance

medication adherence measures," said Tom

Halterman, vice president of medication

therapy management at Cardinal Health.

"Medication nonadherence is a huge

and costly problem, and technology like

RPM could give patients the support

and accountability they need for better

day-to-day health management that can

also avoid costly episodes of care."

$100–300

BILLION

ANNUAL COST ON NONADHERENCE

HOW REMOTE

PATIENT

MONITORING

COULD BE USED

ACROSS THE

HEALTHCARE

CONTINUUM

FOR A PATIENT:

cardinalhealth.com/essentialinsights

good medicine

Business

ADVANTAGE

Life is full of transition, even with the ownership of your

pharmacy. You may be thinking about succession planning,

retiring or buying another pharmacy. The Cardinal Health

Pharmacy Transition Services (PTS) team has you covered.

We provide consultation to all community pharmacies,

regardless of distribution affiliation.

Let us help you form your game plan.

We recommend planning at least three years in advance so you can:

• Maximize the value of your pharmacy

• Learn about opportunities for buyers or sellers

• Become informed of your financing options

• Leave your patients and employees in good hands

Need help planning for your future?

We have just what you need.

The information provided by the Pharmacy Transition Services team is not intended to be legal, tax or

accounting advice service. You should consult with professional advisors familiar with your particular

factual situation for advice concerning legal, tax and accounting matters before making any decisions.

Get your

pharmacy valuation

consultation today!

Learn more by visiting

cardinalhealth.com/

pharmacytransitionservices

For questions, please email

PTS@cardinalhealth.com

good medicine

Kevin Duane had student loans and hadn’t bought his

first home when he explored pharmacy ownership.

He was just 27 years old.

This young pharmacist, now 29, knew he wanted to purchase

Panama Pharmacy where he was helping to grow the business,

but wasn’t sure he could realistically afford it. He also didn’t

know where to begin. When he learned that Cardinal Health

had a team that could help, he connected with Chad Sanders of

Pharmacy Transition Services (PTS).

Kevin recalls his experience with Pharmacy Transition Services.

“Wow, what would I have done without this service? It was first

rate. Chad threw scenarios at me, and I immediately felt it was

possible. He had contacts at the bank and some life experience.

PATHWAYS TO

OWNERSHIP

KEVIN DUANE

PharmD

Panama Pharmacy, Jacksonville, FL

PTS PUT ME

OVER THE HUMP

IN GETTING THE DEAL DONE.

I don’t know what I would have done

without this service.

It was complex—the prospective budgeting and sales and profit

forecasting. He had good contacts with accounting firms and

attorneys and also had some timely and relevant articles that he

would send.

Chad knew all the pitfalls of deals in Florida and would break

it down and explain the “whys.” Toward the last 90 days of the

deal, there were a bunch of moving parts. Between banks and

appraisers, there were eight different people we had to work with,

but Chad was the point person. He filtered through all the noise

and showed me where to focus my attention.”

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FIRST-TIME

PHARMACY

OWNER

Pucci's Pharmacy has been serving the Sacramento,

California area for over 75 years. As one of the oldest

independent pharmacies in the area, it is a community

pillar. Tom Nelson, who owned the pharmacy for

37 years, strengthened Pucci’s reputation in serving

all patients with compassion. As he contemplated

retirement he wanted to leave his legacy in good hands,

so it would continue to be operated as it had been for

70+ years—with personalized touch and personal care.

MATCHING BUYERS WITH SELLERS

Clint Hopkins and Joel Hockman were interested in community

pharmacy ownership. Clint was working at an independent

pharmacy, and he and his husband, Joel, owned a home senior care

business. They learned from their financial planner about a seller

quietly searching for a buyer. That’s when they met Judd Wilstead,

Director of Pharmacy Transition Services (PTS) for

Cardinal Health.

Although that first sale did not come to fruition, Judd assisted them

with a nationwide search that lasted over the course of a year. The

search lead them to Pucci’s Pharmacy in March 2016.

They knew Pucci’s was the right fit from their first meeting with Tom.

“While we were excited about each pharmacy we looked at when we

visited with Tom, we knew this was the community we wanted to

be a part of. It mirrored our Dallas community—close-knit, diverse

population with strong personal relationships.”

During the initial visit, the three spent several hours driving around

town together, with Tom pointing out all the medical providers in

the area. “We went back to our cars and stood there talking for at

least an hour. We told him he would have an offer from us by the

next week,” recalled Joel.

GETTING THE RIGHT ADVICE

Clint and Joel kept in close contact with Judd during the purchase

process. Judd continuously monitored the progress, provided guidance

and the tools to evaluate the business and worked with the bank. “It’s a

delicate balance. The seller wants a dollar amount. The buyer is looking

at financial statements knowing the purchase price must match financial

obligations and a salary for themselves. Judd did a good job of setting

expectations on both sides of the table,” said Clint.

Less than two months after their official offer, Clint and Joel became the

new owners of Pucci’s on July 1, 2016.

BECOMING PART OF THE COMMUNITY

Clint and Joel affectionately refer to Tom as the mayor of Sacramento.

Clint says, “He introduced me to everyone. We hosted dinners with

doctors, nurses and physician assistants. We attended health events,

chamber events, met other pharmacists in town and introduced

ourselves to the LGBT Chamber of Sacramento. We were essentially

saying, ‘Tom was your pharmacist for 37 years. I’m going to be your

pharmacist for the next 37.’”

CLINT HOPKINS

PharmD

& JOEL HOCKMAN

Pucci’s Pharmacy, Sacramento, CA

1991

The Nelsons moved Pucci's

Pharmacy to its present location at

& J Street, which was formerly

the home of Sims Hardware, a

Sacramento institution in itself.

2016

Clint Hopkins &

Joel Hockman became

the new owners of

Pucci’s Pharmacy.

1930

Peter A.

Pucci opened

Homeland

Pharmacy at 19

Street & Broadway.

1932

Peter &

his brother Dino

opened Pucci’s

Pharmacy at 10

& J Street.

1948

Peter & Dino moved

Pucci’s Professional Pharmacy to

and I Streets, sensing that

Sacramento would be expanding

to the east of downtown.

1979

Peter & Dino

retired & sold their

business to Tom &

Linda Nelson.

good medicine

FINDING THE

RIGHT FIT

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ROB COCKMAN

PharmD

Midtown Pharmacy, Whitsett, NC

First Pharmacy of Martinsville, Martinsville, NC

Medicap® Pharmacy, Burlington, NC

Edgewood Pharmacy, Burlington, NC

STRATEGIC

GROWTH &

PHARMACY

ACQUISITION

Rob Cockman built Midtown Pharmacy from the ground-up in

2003. Changes in the reimbursement landscape ten years later

prompted him to consider expansion, allowing him to share

profits between two stores.

Rob also hoped to delegate some of the counter work in exchange for

more time with his young family. “All of my children are under the age

of 13. It goes by in a blink of an eye. Before you know it they will be

grown up and out of the house. I don’t want to miss them growing up,”

said Rob.

He opened his second store, First Pharmacy Martinsville, in 2013.

Fast forward two years. A pharmacist in the same North Carolina region

was contemplating retirement. He and Rob were familiar with one

another from church and shared a similar vision of pharmacy in the

future. They approached Pharmacy Transition Services (PTS) about a

possible sale. “They ran the figures—valuation of store, prior year’s tax

returns, current financials, script count—and came up with a range for

the store value.

He could have just as easily sold to a chain store and walked away.

But PTS made it so you could look at the

numbers

on a piece of paper and say, this

MAKES FINANCIAL SENSE

FOR BOTH PARTIES.

In 2015, Medicap® Pharmacy became Rob’s third store.

Now the owner of three pharmacies, Rob was approached by another

pharmacist planning to retire. Working with PTS once again, he

confirmed the asking price was well within the price point for the store

type and bought Edgewood Pharmacy, bringing his ownership count

to four.

HOW HE’S GROWN

Rob’s first step was getting enough traditional script volume

between the stores that he could step away from the counter. Then

he determined the specialty of the business based on the area. At

Midtown Pharmacy the focus is a breast pump business, at Medicap®

Pharmacy the specialty is compounding, and at Edgewood Pharmacy

it’s travel vaccinations.

“There is not a one size fits all for how you grow. It depends on niches

in your community. You are more successful when you are immersed

in the community and when people see you as a true community

pharmacy.”

After being on the counter for 15 years, running multiple stores is a

refreshing challenge for Rob. “Now I have the flexibility to be able

to leave at four o’clock to see my son play basketball. The tradeoff is

I have four stores and am managing four inventories, more people,

more management and more paperwork.”

WHERE HE WANTS TO GO

He aims to visit every store every single week. With his fourth

acquisition, he brought on his brother to run operations such

as HR, compliance and Continuing Education so he can focus on

how they grow the business. Rob would like to own six stores

but is open to more.

“When you have one store the strategy and day-to-day management

of the pharmacy is on you. It’s very different to give up control and

have other people run the retail part of your store. It takes capital or

willingness to take on debt, so there is some risk tolerance involved.”

good medicine

ANGIE GLOTZBACH

PharmD, RPh

Glotzbach Pharmacy, Fowler, IN

AS AN INDEPENDENT,

I FEEL LIKE I’M MORE OF A

PARTNER ON THE

HEALTHCARE TEAM

AND NOT

JUST THE PERSON WHO IS FILLING THE SCRIPT.

A medication error. It’s the reason Angie Glotzbach became a pharmacist.

“A nurse wrote the wrong prescription for my grandpa. The doctor signed

it without even looking at it and sent it to a mail order pharmacy who

didn’t know my grandpa from Joe. He took an antihistamine instead of

medication to lower his blood pressure.

By the time of his next doctor’s appointment six months later, enough kidney

damage had been done that they started him on dialysis.”

Angie believes that if her grandpa’s prescription would have been filled at a

pharmacy like hers, the error would have been caught.

GLOTZBACH PHARMACY

When Angie was in pharmacy school, she and her grandpa would drive around

town. He would point out the local pharmacy and say, “This is going to be Angie’s

Pharmacy.” “I told him that he was crazy because I was going to work for a chain

where I’d have less stress.” But as it turns out working for a big box retail was not

for her.

She approached the owner of her local pharmacy, Shari Stembel, who was running

it for her late-husband. It was important to Shari to keep the pharmacy local. The

two hit it off and within a couple of months they had connected with Brett Fortier

in Pharmacy Transition Services.

Angie recalled, “Brett’s goal was that there wasn’t anything to stop it from going

through—to keep as many independents out here without having to sell to the

big box. They gave me the opportunity to talk through financial avenues I hadn’t

thought of and made both the seller and me aware of each next step.” Less than

six months later, in June 2016, the sale was finalized. Angie was now the owner of

the local pharmacy, just like her grandfather had predicted.

The changes to independent pharmacy ownership have been eye-opening for her.

She is no longer racing the clock to check a prescription that is due for someone

who is not even there. If she wants to spend a half an hour with a patient who just

got a new diagnosis, she can. “As an independent, I feel like I’m more of a partner

on the healthcare team and not just the person who is filling the script.”

A GRAND-

DAUGHTER’S

JOURNEY TO

PHARMACY

OWNERSHIP

LESLIE DAVIS

PharmD

Davis Drugs

Attica, IN

hometown

pride

hometown

pride

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How one pharmacist is challenging long-term

care’s status quo and diversifying her business.

There is no place Leslie Davis would rather be practicing

pharmacy than in her hometown of Attica, Indiana. Her

community connections run deep. She builds close

relationships with her patients and helps them in a way

that makes them feel valued.

When Leslie noticed that her least compliant patients

were in long-term care, she knew she had to help. “I know

everyone in this community. They are important to me

and it bothered me that they weren’t getting the best

care they deserved.” She grew increasingly concerned

with complacency in long-term care and saw the need

for a cultural shift. She approached the owner of the local

nursing home to explore interventions Davis Drugs could

provide that would improve the quality of care. Leslie met

with the owner on a Friday, who happened to be in the

process of selling the facility. By Monday, she offered to

sell to Leslie instead.

Although not in her original business plan, Leslie purchased

the nursing home in May 2016. The acquisition created an

opportunity to provide better care in her community, which

is her ultimate goal. The supplementary benefit of this

diversification was an additional revenue stream.

Integrating the pharmacist’s role in the nursing home

Owning both a pharmacy and nursing home provides

residents with the benefits of the pharmacist-patient

relationship. Since purchasing the nursing home, Leslie has

integrated the pharmacist’s role in the facility, ensuring

residents receive the same level of care as patients who

come into the store. “We are doing much more than

reviewing their chart once a month, which is the minimum

requirement in long-term care. We know their drug regimens

and who they are as a person so we can best monitor their

health and improve outcomes,” stated Leslie.

Genetic testing and a Meds-to-Home program

are two

examples of how Leslie is advancing the level of care and

striving to make each and every day for a resident the best it

can possibly be.

Genetic testing

Every resident receives genetic testing,

allowing drug therapy to be individualized for optimal results.

Meds-to-Home program

Before any resident is discharged,

a pharmacist provides one-on-one medication education,

giving patients the tools they need to focus on re-acclimating

themselves once they arrive home.

Leslie’s dedication toward the residents is evident. In fact,

when she purchased the nursing home she earned her

nursing assistance license so she would be able to aid the

nursing staff in meeting the residents’ needs.

Expanding to assisted living

Leslie is taking her pursuit to change the culture of long-

term care one step further, forming a partnership with an

assisted living facility scheduled to open late summer 2017.

The partnership will allow her to apply the same pharmacist-

patient relationship with these residents and will build upon

the business that the nursing home acquisition created. The

additional beds from the assisted living facility will provide

increased revenue opportunities.

While Leslie has created a diverse portfolio and her

prescription volume has significantly increased, it’s not

the bottom line that has motivated her to pursue these

acquisitions. It has always been about the people in Attica,

Indiana—her hometown—and how she can meet the needs

of each and every person she encounters.

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PROBLEM SOLVER

Most technicians develop some savvy when it comes

to solving problems in the pharmacy. Maybe it’s as

easy as calling an insurance company for a patient

when the claim won’t go through, or discovering how

to finagle your printer to get the labels to print.

A super pharmacy technician, or SuperTech, as I like to

say, will use every roadblock that presents itself as a

chance to figure out how to move it. Technicians who

address problems with fervor and critical thinking are

better at dealing with difficult situations on the fly,

whether that be a busy short-staffed pharmacy, or a

very angry patient. Pharmacists

will appreciate this tenacity as

well, as they can focus more

of their time using their

clinical expertise to

counsel patients.

WHAT MAKES A GREAT

PHARMACY TECHNICIAN?

PROACTIVE

It’s inevitable that problems will happen, and

sometimes we can’t solve them as quickly as we’d like.

The SuperTech understands that being honest and

upfront with patients, providers and colleagues about

an issue is the best way to provide clear expectations

and a positive outcome. This makes the difference on

the front end rather than reactively cleaning it up on

the back end.

QUALITY

OF WORK

If I were to list technician resume buzz

phrases I hear all the time, “attention

to detail” would be at the top of the

list. We know details are important.

But more important is your intention

when dealing with those details.

Technicians who take pride in their

job and exhibit a strong sense of

ownership over their work are precise,

diligent, and responsive. Not because

you asked, but because they don’t

ever want you to have to.

EAGERNESS TO LEARN

Everyone has worked with someone who insists it’s “not my job” to

do this or that. No one likes taking out the trash, but it needs to be

done. Some tasks require delegation to a pharmacy technician when a

pharmacist’s time is needed elsewhere. The best SuperTechs are eager

to receive this delegation. They understand that each opportunity to

acquire a new skill can increase their expertise and bolster their position

as an important asset in their field.

EMPATHETIC

Trust can be more important to a patient

than the cost of their prescription.

Pharmacy technicians who make the

effort to understand where their patients

are coming from know how much of a

difference this makes when one of those

aforementioned problems pops up.

Patients who trust you and know you care

about them and their family will return

that empathy in-kind on that day your

entire computer system goes down.

We looked to

NICOLE BERNABE

for answers. Nicole is a

Certified Pharmacy Technician and a Customer Success

Specialist at TelePharm and was a 2016 PTCB Pharmacy

Technician of the Year finalist.

Here are the top five

traits she looks for in a super pharmacy technician.

As any pharmacist knows, pharmacy technicians have

important roles and responsibilities in the pharmacy.

This poses the question:

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JD FAULKNER

General Manager,

Williams Bros. Health Care Pharmacy

Indiana and Illinois

Williams Bros. Health Care Pharmacy is creating customers for life by solving patient

problems and exceeding their expectations. They are continuously seeking the next

“new thing” in pharmacy in order to be ahead of the game, and they diversify every

two to five years. Read about three of their recent ventures, including a Meds-to-Beds

program, Safe Home Solutions and Pharmacogenomics.

MEDS-TO-BEDS PROGRAM

Patients have meds before leaving the hospital

Prior authorizations handled

Medications affordable for patient

Comprehensive medication reviews

Capture refills

A key driving force for Williams Bros. and the hospital is preventing a 30-day readmission rate. They’ve

seen initial success. With more than 2,500 patients through the program, the pharmacy has seen only a

six percent readmission rate. The hospital rate dropped from 12 percent to 11 percent in that same year.

“Two of our pharmacies have implemented the program and two other hospitals have expressed interest.

We are retaining 50 percent of these patients, which is in-line with the retention rate for meds-to-beds

programs. There is a 75 percent influx of new patients coming from the program because others in the

family often follow.”

SAFE HOME SOLUTIONS

Making homes safer is a new market entry for Williams Bros. By completing a home assessment they identify

areas that increase the risk of falls or accidents. The contractors focus much of their work in geographical

areas where there are allotments to make homes accessible for residents, such as VA, Medicaid/Medicare and

the low-income housing authority areas.

The bathroom is a high-risk area for the elderly and the main area that needs safety improvements.

patient problems

SOLVING

The current owners of Williams Bros.

are fourth generation pharmacists.

Their great-grandfather started the

original pharmacy in 1899.

When they revived the pharmacy

in 1988, they had five employees

in one location.

NOW IN 2017

475+

EMPLOYEES

PLUS FULL CONTINUUM OF PATIENT SERVICES

LOCATIONS

“We can install barrier-free showers with a rubber lip on

the shower front that allows wheelchair or transport chair

access. Tub steps make it easier to step into and out of the

tub. We can redo toilet seats, add grab bars. In the kitchen,

we lower shelves to make it easier to grab things. We also

focus on exterior ramps and lifts for a bedroom.” A lot of the

business is cash driven which reduces the burden of billing

to insurance companies.

PHARMACOGENOMICS

Williams Bros. offers pharmacogenomics testing at seven

retail pharmacies and two long-term care (LTC) pharmacies

where there is a focus on using the testing for psychiatric

care. A provider has to order the test for insurance billing

purposes, so Williams Bros. is utilizing a retail pharmacy

marketer and nurse liaisons in the LTC sector to promote the

offering to both medical directors and providers.

They receive a commission from the lab tests and, more

importantly, see this point-of-care offering as a way they are

advancing patient care. The test removes the trial and error

of prescribing.

“The results provide about 30 pages of information—that’s

a lot of pages for one patient. That’s where we can come

in as pharmacists. We can take those 30 pages, turn it into

a one-page consult to the patient’s provider and show our

understanding of how medications interact with certain

enzymes. The provider can act on that information right

away and can make any necessary medication changes.”

good medicine

Raied (Ray) and Saad Dinno grew up in a pharmacy.

Their father acquired Keyes Drug of Newton, Mass.,

in 1985 and still opens the store at 7 a.m. every

weekday. “People come to get their prescriptions

filled on their way to work or they stop in to say

hello after getting their coffee next door,” says Ray.

“If my dad has an appointment and is away that day,

people will ask if he’s okay. He is very loyal, and so

are the customers.”

These brothers continued in their father’s

footsteps. They purchased Acton Pharmacy and

West Concord Pharmacy, bringing their total

ownership count to three.

The Dinnos operate a strong compounding

business. In 2014, they expanded Acton Pharmacy’s

compounding lab from 400 to 1,200 square feet.

In 2016, they built a state-of-the-art compounding

lab at Keyes Drug.

The labs compound non-

sterile, patient-specific medications and are USP

-compliant while also meeting the more

stringent USP requirements regarding

the handling of hazardous substances.

Acton Pharmacy is accredited by the ACHC/

Pharmacy Compounding Accreditation Board.

Keyes Drug, with its new lab, is now in the process

of gaining its accreditation.

Existing floor space was needed to build the Keyes

Drug lab, but these second-generation pharmacists

made sure they did not lose retail space. “The front

of the store is very important for both sales and

image. We installed a new shelving system with

narrow shelves and added new carpet, paint and

RAIED DINNO

RPh

& SAAD DINNO

RPh, FIACP, FACA

Dinno Health

Acton Pharmacy, Acton, MA

Keyes Drug, Newton, MA

West Concord Pharmacy, Concord, MA

Compounding is the science of

customizing a medication to a

patient’s particular need. For

patients who may be allergic to

an ingredient in a commercially

prepared medication or for

someone needing a drug in

a specialized dose and form,

compounding is the solution.

Dinno Health specializes in

compounded medications for

health issues that include:

•

Pediatric illnesses

•

Autism

•

GERD/Colic

•

Hormone replacement therapy

•

Diet restrictions

•

Mitochondrial disease

•

Dermatology

lighting,” says Ray. The exterior of the pharmacy

is undergoing change as well, with new digital

signage designed to let passersby learn about

health and wellness and see up-to-date

information on the pharmacy’s offerings.

The renovations are just one way the Dinnos

keep their business fresh. They recently

expanded more fully into nutrition and wellness,

hiring a Director of Health and Wellness

who has extensive knowledge of nutritional

supplementation. She provides private

consultations and hosts a monthly lecture series

at Acton Pharmacy where local practitioners are

invited to speak on a specific health topic.

A loyal staff at all three locations has helped

propel the business forward. “We use an

employee newsletter and hold regular events

to recognize employees that have reached a

milestone,” says Ray. “The number of employees

with over 20 years of service grows every year.

Our employees are as important to our success

as we are.”

Beyond the services they offer, Ray and Saad

make sure they always have a presence

at the three stores so that the customers

know they are accessible. “It’s more than

filling prescriptions and convenience,” says

Saad. “People want a familiar face that they

can trust, with whom they can discuss very

personal matters. We want our patients to feel

a connection when they enter our pharmacies

whether with us or with our team members.”

the right

WHY

COMPOUNDING?

In areas where patients may

not have direct contact with

or access to a pharmacist, a

TELEPHARMACY

is a solution

to providing care. Below we

explain how telepharmacy

in three different types

of communities can help

pharmacies become more

efficient and take better care

of their patients.

good medicine

cardinalhealth.com

Rural

EXPANSION

URBAN

EXPANSION

After running a stable pharmacy for years, Rachit Shah, RPh,

SureCare Pharmacy, was ready to expand his operation. He

found an opportunity as a new community health center was

in the works miles down the road. Knowing how important

pharmacy access is in regards to medication adherence rates,

Rachit wanted to open a pharmacy inside of the community

health center. But he had questions, like could the prescription

count support a full-service pharmacy?

Rachit discovered the concept of telepharmacy, which seemed

like a perfect fit for the health center. A trusted colleague then

pointed him in the direction of TelePharm—an industry-leading

retail telepharmacy software solution. “We looked at other options,

but they were way too expensive,” he said, when discussing

telepharmacy options. “TelePharm was easy and affordable.

It made sense.”

In using TelePharm’s digital platform, Rachit was able to successfully

open a remote-dispensing site inside of the community health

clinic. Thanks to Rachit and TelePharm, patients can walk out of the

clinic with their prescriptions in-hand, a convenience that can help

improve patient outcomes.

“Currently we are trying to open more locations and any new

pharmacies we open will definitely be telepharmacies,” Rachit said.

1,400 people. That’s the population of Barry, Illinois, and the number

of people that didn’t have local access to a pharmacy until Pharmacy

Plus came along. In March 2015, Byron Berry opened a telepharmacy

in Barry, Illinois after the local pharmacy closed more than two

decades ago.

“When I saw an opportunity to bring service back to the area, I

thought it looked like a good thing to try,” said Byron, on being

open to try new pharmacy technology. “I’ve been very pleased

with our telepharmacy in Barry. We’re providing a service that

wasn’t there before.”

Before 2015, the rural-based patients of Barry had access to a local

clinic but no pharmacy. After seeing their local physician, they would

have to drive out of town to acquire prescription medication. This

proved to be horribly inconvenient for patients, and sometimes the

weather made the trek nearly impossible. It didn’t make much sense,

and Shawn Rennecker, Mayor of Barry, took note.

“We did a lot of community surveys in terms of what residents wanted

to see in regards to quality of life features,” Shawn said. “One of

those that kept coming out in a lot of our feedback is the need for a

pharmacy. It’s one of those losses that we wanted to get back.”

People living in rural and underserved communities are currently

experiencing a gap in healthcare. Thanks to Pharmacy Plus and the

advent of telepharmacy, the patients of Barry, Illinois now have local

access to essential pharmaceutical care.

TELEPHARMACY

good medicine

tap into

new territory

Opened in July 2016, Colee’s Community Pharmacy is a retail

telepharmacy located in Crossing Healthcare’s new 340B clinic in

Decatur, Illinois.

Patients at the clinic can walk out the door with their prescriptions

in-hand thanks to the services provided by the telepharmacy. After

remotely reviewing and verifying each prescription, Dale Colee,

Pharmacist-in-Charge at Colee’s Community Pharmacy, counsels

patients through a tablet computer screen located at the pick-up

counter. Dale, a pharmacist for over 40 years in the Decatur area, has

embraced new technology.

“As healthcare costs continue to rise, this technology can hopefully

help keep the additional labor costs away from the customer while

still providing great customer service,” said Dale Colee, PIC at Colee’s

Community Pharmacy. “Independent pharmacies need to adapt to

patient needs and technology trends, and we are excited to bring

this to the Decatur area.”

Colee’s Community Pharmacy is the third independent pharmacy

owned by Dale and Rita Colee, but it’s their first location opened

as a telepharmacy. According to the patients, they love having the

pharmacy within the clinic.

340B

TELEPHARMACY

BENEFITS OF TELEPHARMACY

• Provides patients in medically underserved

areas access to a pharmacy

• Operates in areas where a traditional

pharmacy would not be feasible

• Expands your business cost-effectively

• Helps combat slim margins and

declining reimbursements

• Extends the reach of the pharmacist

while improving care

Telepharmacy is not available in all states.

good medicine

cardinalhealth.com

How were you inspired to become a pharmacist and own a retail independent pharmacy?

When I was in high school, I had to write a career research paper and just happened to explore pharmacy as the topic. After I decided to

pursue that career path in college, I always kept the dream of owning a pharmacy in the back of my mind. After I graduated, I went to work

for a pharmacy chain until one day about a year after graduation, I received a flyer from Medicine Shoppe® International, encouraging me to

open my own store. My husband, who works as a farmer, thought I was crazy when I asked him what he thought of the idea of me becoming

a pharmacy owner. “Take a chance on me this year,” I told him, “and if it doesn’t work out, I can always go back and work for a pharmacy

chain.” That was in 1994. Today, my husband has been one of the biggest supporters of me opening my second pharmacy location—Poehler’s

Pharmacy, a member of the Medicine Shoppe® Family.

Speaking of your second store, we hear you’re going to offer

Telepharmacy

technology in your new location.

Tell us a little bit about Telepharmacy and what inspired you to take the plunge to try it.

Telepharmacy is a technology that allows prescription medications to be dispensed by a pharmacy technician as advised by a “remote”

pharmacist. It’s been popular in more rural areas of the country, and because of Illinois state laws, it’s becoming more common here as

well. As an existing community pharmacy owner, I was able to make valuable connections with members of my community and those in

surrounding areas. A neighboring village that I make prescription deliveries to approached me one day to ask if I’d be interested in opening

a Telepharmacy in their small community of about 600 people. I told them I’d be very interested and I found the perfect location when one

of the village’s local doctors reached out to me and asked if I’d be interested in opening a small location in her newly remodeled office. We

opened our doors in November, and it’s the first Medicine Shoppe® store to use Telepharmacy technology.

Do you have any goals or aspirations in mind for your new Telepharmacy? What would you consider a

successful first year in business?

TelePharm says that a successful and sustainable Telepharmacy should fill at least 40 scripts a day with one technician. I’d love to get to

the point where one technician isn’t enough to meet our demand. I’ve already had community members telling us that we’re going to be

busy—so I’d love to be filling 60 or 80 scripts a day by the end of our first year. I’d also like to offer Dispill® services in the second location.

In the doctor’s office, we will serve a lot of mothers and their children. It will be a great opportunity to connect with and build a loyal,

long-term customer base.

As of March 2017, we’ve been filling about 15–20 scripts a day, and have seen good over-the-counter sales, despite our small front-end.

I know of another telepharmacy in Illinois that took nine months to get to 40 scripts a day. I’m confident that we’ll get there as well.

LADONNA POEHLER

RPh

Medicine Shoppe® No. 1339

Newton, IL

We caught up with LaDonna Poehler from Medicine Shoppe® No. 1339 to ask about her newest

adventure in pharmacy ownership—

TELEPHARMACY.

Read about LaDonna’s story and how she’s

been able to build a successful

(and growing!)

business since she opened her store in 1994.

Medicine Shoppe

’s

TELEPHARMACY

first Telepharmacy

good medicine

How have you been innovative when adopting new

services or technology, and how do you think that’s

affected your success in ownership?

Pharmacy practice has changed a lot since 1994—when I opened my

first store, about 70 percent of our business was cash, compared to

now, where 90 percent of my patients get their prescriptions through

insurance coverage. It can be challenging to keep on top of all of the

changes in the healthcare system and remain competitive, so we’ve

adopted some niche services. We offer local delivery, Dispill® Packaging,

and a convenient double drive-through window. We provide flu,

shingles, pneumonia and TDAP vaccinations and hold hearing-aid

clinics every Thursday to help us generate new foot traffic. We focus on

MTM services and medication synchronization. We also service a local

assisted living facility with all of their prescription needs.

Do you have any advice for aspiring pharmacy owners,

particularly women who are considering ownership as

a career option?

Find what will work for you! I opened my store very soon after I

graduated college—I didn’t wait to start a family and then pursue

ownership like a lot of people. I had my son about six years after I

opened my store, and he grew up in my pharmacy. It might not be

feasible for every owner to open a store right after school, but I’d

encourage them not to “rule it out” immediately. My store was my

“baby” before I had a baby—and I was able to commit the time and

effort 100 percent because of where I was in my life at the time.

So let’s talk about work-life balance. How has owning

your pharmacy helped you manage a family and

outside life that sometimes comes with competing

priorities? What advice would you give to women who

might be struggling with the thought of ownership

because they feel it would be

too much?

It’s a lot of work. However, because I own my store, I was able to set my

own schedule and make time with my family a priority when I needed

it to be. I set aside one day a week that was totally devoted to my son

and me—and my employees and my patients knew and understood

my schedule and my priorities. My son would go to daycare during the

day but would spend time at my pharmacy every evening. My son has

seen both my husband and I’s entrepreneurial spirit, and we know he’s

going to pursue his own business one day as well. He’s been selling

sweetcorn since he was seven years old.

Have you thought at all about your store’s legacy

and what you might consider when thinking about

transition planning?

Since my son will likely follow in his father’s footsteps and pursue

farming as a career, my pharmacy legacy probably won’t live beyond

me in my family. That being said, I’ve had a young girl work in my

pharmacy as a technician for three years, and one day she told me she

could see herself being a community pharmacist full-time. She’s now in

pharmacy school and pursuing her degree. I told her that I would give

her 10 years after pharmacy school to work, have a family and find what

works for her. Then she could work full-time in my store for three years

while we develop a transition plan together. I’m excited to possibly

pass the torch on to another female owner down the road.

Any final words of advice or encouragement to our

Women in Pharmacy community?

Owning a pharmacy is an investment—in time, finances and emotion.

It’s not a job for the faint of heart, but it’s all worth it. I joke that I don’t

have a typical “9–5” job because it wouldn’t be any fun. I encourage

anyone considering ownership to just go for it. It’s a process of trial and

error and constant learning, but I’ve been able to

own

my career, and

make it work for my family and me. You can do it too!

good medicine

Retail

ADVANTAGE

good medicine

“We are capturing the evolution happening

in the country. There are very sophisticated

individuals who are looking at health in a

new way. They are addressing the underlying

causes of their symptoms and want to

optimize their health, including evaluating

adjuncts to the many pharmaceuticals they

may be taking,” said owner Scott Porter.

Sandpoint Super Drug’s response to this

movement was to dedicate more time and

resources to their professional nutrition

department. “The nutrition department is

not contradictory to the pharmacy. It’s not

even offered as an alternative. It’s merely

supportive and in addition to what people

are already doing,” said Scott.

Last year, the department had leveled at

$9–$10,000 a month. After expanding their

offerings of high-quality, clinically effective

products, the store experienced a 400

percent revenue increase over a 13-month

time period.

SCOTT PORTER

RPh

Sandpoint Super Drug

Sandpoint, ID

HOW

SANDPOINT

SUPER DRUG

CAPTURED

THE

NUTRITION

MOVEMENT

The primary work is done up-front in

educating customers and assisting with initial

product selection when they are in the store

searching for a probiotic. Scott says he is less

interested in selling a particular product than

educating customers. “When a customer

feels the product they bought is effective

they come back to get it again. They tell

their friends.”

Scott expects profits to continue to increase,

without the risk of seasonal fluctuations. Sales

are still growing approximately $1,500/month,

generating a projected gross profit of over

$200,000 for 2017. With margins of more than

45 percent, Sandpoint Super Drug’s strategy

is proving to be tremendously successful.

Scott believes it’s a market ripe for

independent retail pharmacies to enter and

openly shares his experience with others.

“Just give me a call if you’d like to come see

what we’ve done or want some help,” he said.

healthy profits

HEALTHY CUSTOMERS,

Located in a small rural town in Idaho,

POPULATION 7,500

Sandpoint Super Drug sells

$40k+

/MONTH

IN SUPPLEMENTS

Including $8k

in probiotics

That’s more than $1k/day.

Expanded

from 8 to

31 linear feet of

shelving

USED

A REFRIGERATOR

30 in. W

Worked with a consultant

to develop the right product

mix—

668 SUPPLEMENTS

including 91

probiotics

Created educational

material

for the customers

& a

PLACE TO SIT

AND TALK

Dedicated a

part-time person

to work the

department

SUPPORT

CUSTOMERS

DISCOUNTED

almost

20% OVER RETAIL

to compete

with

big-box stores like

Amazon and Costco

SPENT NOTHING

SCOTT’S ADVICE TO

RETAIL INDEPENDENT

PHARMACIES LOOKING

TO ENTER THE MARKET

Gave EDUCATIONAL TALKS

to local groups &

wrote

weekly

articles for

the paper

ON ADVERTISING

& SIGNAGE

Start with foundational

products:

a probiotic,

Vitamin D with K, multivitamin,

omega 3’s, magnesium &

inflammation support.

Slowly add to your selection

as you get more familiar.

Allocate additional time

to learning

the product

differences and prepping for

one-on-one interaction with

the customers. Remember you

are not diagnosing or treating.

Understand that you may

spend

15–20 minutes with

a customer

& it may take

days before they come

back to purchase.

Dedicate refrigerator

space—

while not all probiotics

need to be refrigerated

there

is a perception that they do &

they will sell better grouped

together in this manner.

Retail independents have a huge opportunity to create

stronger conversion on the front-end. In fact, only 6 out

of 100 customers leave a chain store without buying

something in the front-end, but 56 out of 100 customers

leave an independent store without buying something in

the front-end. This conversion conundrum required us to

build a premiere healthcare retail-focused team of advisors

and tools in order to help them thrive in the market place.

Cardinal Health recently introduced the Retail Operations

Consultant (ROC) and our go-forward strategy called

CORE

Customer Operations Retail Excellence

THIS NEW GO-TO-MARKET STRATEGY GIVES RETAIL

INDEPENDENTS WHAT THEY’VE BEEN ASKING FOR:

•

A dedicated, trusted retail operations consultant

to help with the front-end.

•

Retail direction, education and training.

•

A consistent method for operating the front-end

business and remaining competitive.

•

CORE is driven by the in store Retail Health Assessment

(RHA). ROCs execute an RHA per store to collect viable

data around plan-o-gram resets, inventory levels,

program penetration and customer pricing.

Introducing our premiere, retail-focused powerhouse,

driven to convert front-end sales for independents

CUSTOMER RESPONSE HAS BEEN PHENOMENAL.

We conduct surveys to

understand the value of the ROC and the retail health assessment. They have told

us clearly that

CORE IS DRIVING STORE SALES AND PROFITABILITY.

We strive

to help keep our retailers competitive with a strong retail presence.

Steve Light, VP of Consulting

good medicine

cardinalhealth.com

JENNIFER HARE

PharmaCare, Cumberland, MD

good medicine

HOW DOES A COMMUNITY PHARMACY COMPETE IN THE RETAIL SPACE?

BY WORKING SMARTER, NOT NECESSARILY HARDER.

Working smarter means delegating the roles within the independent pharmacy, according to

Jeff Olson, owner of Montross Pharmacy. Jeff is passionate about his front-end and has been an

early adopter of the Cardinal Health CORE program. “The program has enhanced our ability to

be more competitive, to have the brands that our peers have.”

The planograms and marketing are reviewed with the store every other week, which Jeff

equates to the same face-to-face personal touch of a pharmacist. The enhanced reports

provided with CORE prompted Jeff to move the location of his eye and ear allergy products,

which had been ranked 11th in sales. The move resulted in the products jumping to the top five

in sales—a change he says wouldn’t have happened without this program. Montross Pharmacy

is now keeping the top 50 brand and Leader™ products in stock and three to four products

deep to ensure they don’t miss out on any sales.

CORE HELPS THE INDEPENDENT PHARMACY OWNER

COMPETE WITH & NEUTRALIZE SOME OF THE

COMPETITIVE ADVANTAGES THE BIGGER CHAINS

have in their business model. The owners who have the desire to succeed are

missing out by not utilizing the program. It’s no longer a stressor in my life.

The paradigms have changed for community pharmacies and Jeff is a forward-thinking owner,

implementing additional changes to attract customers.

REWARDS CARD

Jeff saw a rewards program as a way to improve traffic in a coupon-driven

society. The program saw 500 enrollees in less than six months.

How it works:

Members receive five points for every prescription and one point for every dollar

spent outside the pharmacy. With 100 points, they receive a five dollar coupon off their next purchase.

Montross Pharmacy also sends birthday cards to members with a five dollar punch card and

to non-members with information about signing up. They also promote the program to

healthcare professionals.

The program, which captures sales trends and age demographics, showed they were not

accessing the 20–30 age group. With the help of the Cardinal Health planograms, Jeff changed

the baby section. He purchased low-cost diapers of the most popular brands and reduced the

sale price in order to compete with the big box stores.

HEALTH & BEAUTY

Jeff believes a professional looking health and beauty section will

help make the pharmacy a destination for the community square in which it is located.

By installing professional displays with the top three selling cosmetic brands, he hopes to

capture female customers who are in filling prescriptions. His ultimate goal is to expand the

cosmetics section beyond the three brands.

TOP 10 REASONS TO JOIN

CORE

END CAP PROGRAMS

MERCHANDISING PROGRAMS & CHECKLIST

POS SMART REPORTS

TEMPORARY PRICE REDUCTION PROGRAM

WOW PROGRAM

LEADER BRAND

PRODUCT STOCKING

UP-TO-DATE INDUSTRY NEWS

PERSONALIZED GUIDANCE

MERCHANDISING & PRODUCT ASSISTANCE

WELL-TRAINED FRONT-END PERSONAL CONSULTANT

“What else is in the pharmacy that I need?” Jennifer

Hare, Marketing and Public Relations Director for

The PharmaCare Network, wants to anticipate their

customers’ answers. “In our business, no one gets up in

the morning excited to go to their pharmacy to purchase

meds that are for a disease or condition they wish they

never had. Often, the cost means they have to decide

between purchasing their medication and putting

food on the table or heating their home. Despite those

challenges, we have the opportunity to satisfy their

needs and to create a fulfilling experience.”

Jennifer believes that consumers will give a pharmacy

only one more chance if the over-the-counter product

they want is not on the shelf. The Cardinal Health CORE

program is helping PharmaCare’s seven locations

eliminate empty spaces and prompting those with

stagnant layouts to switch up product category

placement.

“The planograms are very good. We see the new products

and what is being nationally advertised. A customer

asked for the new Flonase®, and we had it.”

Jennifer uses the

POS SMART REPORTS

as a tool with

her staff. “If we are down in a category one month, such

as first aid, it prompts me to ask if there were holes in the

section or enough was ordered.”

CORE, which they have been using since June 2016, has

ignited each store to look at what is working for their

location. Jennifer’s initial goal was for store personnel to

be more aware of Order Express. They started to carve

out the time, and within eight months they were all

looking at it consistently.

PharmaCare has taken the Retail Health Assessment

one step further. In addition to reviewing items such as

inventory and shelf labels, Jennifer has created additional

checklists for her stores to improve the day-to-day

operational tasks.

For PharmaCare, CORE has been a springboard in

evolving their operational excellence and setting the

ground work to make sure they aren’t missing any

front-end opportunities.

JEFF OLSON

RPh

Montross Pharmacy, Winterset, IA

good medicine

cardinalhealth.com

AJAY DESAI

PharmD

Oval Pharmacy

Bronx, NY

The original front-end section was 500 square feet and hadn’t been upgraded in years. Ajay

hired contractors to draw-up a new floor plan that included increasing the size of the OTC area

by 50 percent. “Appearance matters. If we can improve the flow for the customer and make

products look neat and organized, they will be more likely to make a purchase,” he stated.

Ajay worked with Pedro Cruz, a retail operations consultant with Cardinal Health, to revise the

contractor’s original floor plan. Tapping into his retail experience and art education, Pedro

created traffic patterns to increase purchase opportunities. Changes included moving skin care

closer to the checkout and relocating OTC products to the back of the store to increase impulse

purchases. The placement of the gondolas were another unique enhancement. Situated at an

angle on each side of the front entrance, they draw the customer to walk through the aisles on

both sides of the store.

Oval has improved its bottom line by re-purposing existing square footage and

improving the shopping experience. “Within two months of implementing the re-design

and re-merchandising, front-end sales were up more than 30 percent,” said Ajay.

Oval Pharmacy has been serving the community since 1927. Like many

pharmacies in the area, it was operating with limited square footage.

Ajay Desai saw an opportunity to expand that square footage through

an innovative re-design when a long-term lease was secured in 2015.

FRONT-END

Fabulous

good medicine

THE RISE OF DIGITAL HEALTH

Fuse, the Cardinal Health innovation lab, is

studying the rise of digital technology on patient

empowerment. “Patients are tracking health

data both digitally and non-digitally, actively

shopping for doctors using online reviews and

comparing both doctor and procedure costs using

price transparency tools,” said Kristina Redgrave,

a healthcare innovation specialist at Fuse. “In

addition, they’re using new patient-facing services

such as genetic testing and conducting their

provider appointments via telemedicine solutions

such as live video.” She cites the popularity of

emerging services and products like Teladoc

(a telehealth site that allows patients to “see”

doctors virtually from the privacy of their own

homes or other more convenient locations),

wearable technologies like FitBit® and doctor

review sites like Zocdoc as examples.

SHIFT IN ATTITUDE

The shift in attitude of what defines a patient-

provider relationship is another key driver of the

patient empowerment movement.

Donald Berwick, former president of the Institute

for Healthcare Improvement and administrator

of the Centers for Medicare & Medicaid Services,

wrote in the Journal of the American Medical

Association (JAMA), that healthcare delivery can

be divided into three eras. The first was the era

of the “noble doctor” who was a trusted source

of information and whose orders were not

questioned by the patient. The second era—our

current one—is largely centered on accountability

and measurement. Berwick now calls for the

healthcare system to move toward a third era,

which would focus on principles of cooperation

(particularly cooperation between doctor and

patient) and prevention.

Corbin Shaw, another healthcare innovation

specialist at Fuse, has also seen a fundamental

change in the broader patient-provider

relationship, including doctors, nurses,

pharmacists and others delivering care. “The key

to empowering patients is to engage patients.

Patients are now viewed as valuable members

of the care team and their engagement is critical

in creating a comprehensive care plan,” Shaw said.

“It must be said, though, that in order to achieve

this engagement and empowerment, good

communication and rapport must be built with

providers, who still need to take time to make

sure patients are making truly informed healthcare

decisions.”

The key to empowering patients is to engage

patients. Patients are now viewed as valuable

members of the care team, and their engagement

is critical in creating a comprehensive care plan.

BRIAN WU

PhD

Essential Insights Contributor,

Healthcare Writer

is growing in healthcare

THE KEY TO EMPOWERING

PATIENTS IS TO

ENGAGE

PATIENTS.

Patients are now viewed as

valuable members of the care

team and their engagement

CRITICAL IN CREATING A

COMPREHENSIVE CARE PLAN.

Corbin Shaw, Fuse

Patient empowerment is

growing and continues to

shape how healthcare is being

delivered. Three important

factors are driving the behaviors

of the more informed healthcare

consumer: the rise of digital

health, a shift in attitude around

the patient-provider relationship

and cost constraints.

According to Dr. James Weinstein and his fellow authors in a

Health Affairs article, current thinking supports replacing informed

consent with the informed choice process.

This process should include:

1. The provision of balanced, evidence-

based information on all options;

2. Discussion of risks and benefits of each option,

explained in a way that is accessible to a patient;

3. Elicitation and clarification of patient values and

preferences in decision-making; and

4. A treatment decision arrived at through discussion

between the doctor and patient.

The authors advocate for shared decision-making using decision

aids. Objective, credible data and decision support tools can

equip hospitals and providers to lead the informed choice process,

according to Brian Fuller, vice president of value-based care for

naviHealth, a Cardinal Health company. naviHealth offers decision

support tools to help identify, predict and optimize an appropriate,

customized, patient-centered care plan for patients, particularly

those facing transitions in care or post-acute care.

Cardinal Health Chief Medical Officer Shaden Marzouk said

Berwick’s third era is becoming a reality, noting that “Paradigms

are shifting to more coordination of care, and cost constraints are

forcing multiple disciplines to work together for a patient.”

COST CONSTRAINTS

Cost constraints are also prompting more patients to become

increasingly active in making healthcare decisions for themselves

and their family members. “Patients know these decisions impact

both their physical and financial health,” Redgrave added.

Dr. Marzouk says these financial pressures are causing stakeholders

to look at other sites for delivering more cost-effective, convenient

care. “The rise of urgent care centers, clinics in pharmacies and

retail clinics are all examples of consumer-driven healthcare

choices,” Marzouk said. “I see a continued shift toward more

easily-accessible sites like one’s phone, storefront locations and

pharmacies that could be more affordable for patients.”

Patients may now have more interest in controlling their healthcare

costs, as more Americans have been moved into consumer-driven

health plans with higher deductibles by their employers, who are

searching for ways to control their health benefit expenses.

There is a growing awareness that patients who are educated

and empowered to make sound healthcare decisions tend to

have better outcomes, which can save money, particularly in

the management of chronic diseases. In their full article, Dr.

Weinstein and his fellow authors emphasize that research has

shown that informed, empowered decisions can increase patient

comprehension of benefits and risks of options, foster realistic

expectations, decrease conflict and indecision, increase patient

participation and lead to decisions that help to reconcile patient

values and choices.

It’s clear that the rise of digital health, a changing attitude about

the role of the patient and cost constraints are all contributing

to a new era in healthcare, where decisions will be driven by a

collaborative relationship between empowered patients and their

healthcare providers.

REASONS

PATIENT EMPOWERMENT

good medicine

Wellness

ADVANTAGE

good medicine

Bobbie Barbrey, RPh, CCN has been a

pharmacist for more than 30 years. “Like

many pharmacists, I thought drugs were the

answer for people’s health. I dispensed those

routinely and watched as we achieved results

in many cases. My dad had advanced heart

disease and was one of those patients you

see who goes from one medicine to another

medicine to another medicine. Being a

pharmacist, I was very optimistic that the next

drug would work, that it would be the magic

that was going to make the difference. As I

saw that not happening and he passed away, I

realized there was a shift occurring in me.”

In 2001, he decided to open his own business

and, more importantly, shift to practicing

pharmacy and wellness from a functional

perspective. He saw the opportunity to

make a difference in people’s lives, not just

dispense medication but also to educate

and navigate on lifestyle, diet and targeted

nutritional supplementation.

He became interested in reviewing labs

from a functional standpoint, seeing what

results may be trending out of line and might

relate to different health conditions without

it being an extremely high or a low number.

He was fascinated with energetic medicine

and purchased a BioMeridian, an energetic

device that assesses the overall health of

the individual and inflammation of a point

in the body. “When you start working with

the root-cause, you’ve got to find the source

of inflammation,” says Bobbie. His passion

is trying to figure out why patients have the

conditions they do and, more importantly,

how he might be able to help them.

Bobbie started providing consultations, to

which he now dedicates all his time, while his

daughter Kaylan Barbrey, also a pharmacist,

manages the pharmacy. When he started,

there was no blueprint for this type of work,

and he was providing consultations at no

charge. But over time the word spread, and

now he is booked two months out.

BOBBIE BARBREY

RPh, CCN

Medicap® Pharmacy

Raleigh, NC

The consultation fee is $150. There is a small

fee for additional labs, which build in his time

to review the results.

“I think it’s important that we all move in that

direction. We’ve given it away for so long.

I recommend developing the expertise so

people are willing to pay for that expertise.”

DEVELOP EXPERTISE—

INTERPRET LAB RESULTS,

TEACH LIFESTYLE AND DIET—

SO PEOPLE ARE WILLING TO

PAY FOR THAT

EXPERTISE

The BioMeridian is one of many tools at

Bobbie’s disposal. He can create requisitions

to have labs done at LabCorp and perform

urinary labs, saliva testing of hormones and

blood spot testing for vitamins, adrenals and

cholesterol—it’s an integrated practice. “I

knew when I started the business that you

can’t survive just filling prescriptions. We

supported people’s health with supplements,

and because of that we had the opportunity

to create a profit, allowing us to keep doing

what we’re doing. This year, we will reach

over a half million in annual supplement sales

which was my personal goal.

I get to witness people getting

better.

I get to see their eyes light up.

Bobbie believes the potential to grow his

business came from helping find solutions

and guiding people down a new path—it

wasn’t about selling supplements. “I am

blessed because I get to interact with this

population. It is a drop in the bucket for the

number of people that don’t know about

their choices to change their health and

improve their wellness. It’s what gets me up

in the morning to come to work.”

The patient is asked to complete and

submit intake forms and current lab

results prior to their initial consultation.

Bobbie can order labs, if necessary.

•

Initial Consultation—75 minutes.

Bobbie and the patient review

symptoms, labs and history for

potential exposures. He performs the

BioMeridian test. Bobbie gives the

patient a plan he or she can execute.

•

Visit Two—45–60 days

later

the

patient returns. The BioMeridian

test is repeated to look for a change.

Ideally, they share how much better

they are feeling.

•

Visit Three—

If the patient is still

not at optimal health, Bobbie

tests for a toxic burden. “Everyone

has one; it’s whether it’s affecting

their health,” he says. He often

recommends using homeopathy to

help eliminate the toxic burden.

integrative

consultation

beyond medicine

Wellness

good medicine

cardinalhealth.com

Chuck Obeid

RPh

SHEEHANS PHARMACY

Plains, PA

Interventions:

“We use the Drug Adherence

Work-up (DRAW) tool so the patient doesn’t

feel defensive when we are asking them why

they may not be taking a certain medicine.

There may be a valid reason they aren’t

adhering and we want them to tell us why.”

Workflow:

The pharmacists regularly check

the platforms for TIPs. Pharmacy students

update clinical information, making it fairly

easy to integrate MTM into their workflow.

“We are high volume, yet we still have a lot of

patient interaction.”

Challenges:

“The challenge can be that a

patient on one medication tends to think they

have more control and are less likely to think

about side-effects or interaction. They may

think they don’t need the assistance.”

E. Jane Orr

PharmD

VILLAGE PHARMACY

Duffield, VA

Create patient buy-in:

If Jane recommends a change that is not urgent and the patient has an

upcoming doctor’s appointment, she may write a handwritten note to their physician for the patient to

hand-deliver at their next appointment. “When patients have been on something for a long time, it can

be difficult to change, especially for older patients. This makes them part of the process.”

Interventions:

She focuses not only on medication adherence but usage. “I can catch when they may

be using a medication incorrectly—a long-acting insulin, for example. I have them show me how they

are using it. The issue they are experiencing may not be because it’s written incorrectly.”

Communication with physicians:

When Jane noticed that the pharmacy had a low volume of diabetic

patients prescribed statins, she took lunch to the doctors’ offices in the area and discussed with them

the gap and the importance of a diabetic patient being on statins. The percentage of the pharmacy’s

patients on statins increased from 65–85 percent. “I have about a 70 percent success rate in getting

things changed with physicians. I’d like to be at 100 percent. But it’s still a win if I get a note back from

the doctor with a reason the patient hasn’t been able to tolerate the alternative drug.”

Henry Lee

PharmD

KM PHARMACY

Flushing, NY

Communication with patients:

His employees

speak various dialects of Chinese, helping

overcome the language barrier. “More than that,

we are easy to talk to. We don’t hide behind the

counter.” Henry starts a conversation by sharing

foods that may interact with their drugs. It builds

trust, and they start to ask him about their other

medicines or health issues.

Impact:

Patients are filling their medications on

a more regular basis so there has been a positive

financial impact.

Building rapport:

“In my area, there is a one to

two hour wait time to see the doctor. If they have a

question or have a small cold, they come see me to

determine if they need to go to the doctor.”

CMR matters to the patient. “

We did a CMR

with a patient on 15 medications. Her ankles

were very swollen and had become progressively

worse. I reviewed her medications and noticed

she was on amlodipine and gabapentin, both of

which can cause edema. After speaking with the

patient’s doctor we were able to discontinue both

medications, and the swelling resolved quickly.

She also admitted that she was struggling to keep

her medications straight so we set her up on our

monthly pillbox program. She was so grateful that

she bought the pharmacy staff lunch.”

good medicine

Hemant Desai

RPh

, Nisarg Patel

RPh

& Paul Echefu

RPh

CASTLE HILL COMMUNITY PHARMACY

Bronx, NY

Adding value:

Hemant views the measures as a significant opportunity for the pharmacist to help with

the patient’s well-being, to add value to the healthcare system and to improve revenue. “It’s not just about

refilling the medication. It’s about improving patient care.”

Action plans:

“We noticed a patient had been on six months of a particular medication, but we didn’t

know that he was on another medication and was experiencing muscle pain. When we performed the

CMR we asked about each and every medicine and how he was feeling. We identified his muscle pain

was the result of a statin. We called the doctor and asked to have the medicine changed. That was an

action plan,” shared Nisarg.

Going above and beyond:

“By doing CMR on each and every patient, we got to know where to intervene

in patient therapy,” says Hemant. The pharmacists attribute their success to working as a team focused on

going above and beyond. “When a patient goes to the emergency room and receives a medicine, there are

typically no refills and the patient needs to see their Primary Care Physician (PCP). By the time they get an

appointment, there may be a gap of a week to ten days. I call the PCP to see if a refill can be authorized or

to see if perhaps the original medicine needs to be changed. That medicine may not have been working

and that is why they ended up in the emergency room. We don’t know, but we are investigating and are

being a part of the healthcare team and the solution. It’s not hard; it just takes time,” said Nisarg.

Communication and workflow:

Paul learns a lot by sitting with the patients. “It’s very necessary. The

whole thing is going well with my workflow because I find it easy to communicate with them about their

medications and, if necessary, to offer alternatives to the doctor.”

Adherence tools:

“EQuIPP® helps, as does synchronizing meds. Dispill® is helpful for our patients who

have difficulty remembering,” says Hermant.

Paul Winger

RPh

& Chad Rindy

RPh

THE MEDICINE SHOPPE® PHARMACY NO. 2065

Chippewa Falls, WI

Adherence tools:

“The Dispill® medication planners are an important tool that improves adherence for

our patients. For others not on med planners, we implemented a medication synchronization program.

We typically contact doctors’ offices upon filling the last 30 days of maintenance medications. Proactively

renewing those expired prescriptions streamlines the renewal processes.”

“In addition to the traditional consulting techniques that improve adherence, I create cognitive dissonance

by mentioning the organ systems that can be negatively affected by non-adherence. I also explain the

disease pathophysiology in layman’s terms. That technique is not for every patient, but I find it effective

and it certainly serves as a teaching moment,” says Chad.

Relationships:

Paul Winger, owner, attributes their high performance ratings to the store’s pharmacist,

“Chad is the driving force behind the success. He develops personal relationships and is congenial.”

Abigail Vasquez

CPhT

& Mary Ann Longoria

CPhT

FRY’S PRESCRIPTION PHARMACY

San Benito, TX

Being proactive:

The pharmacists have embraced

CMRs as an extension of their work. They are

proactive with patients and insurance, using

information from iMedicare and Pioneer Rx. Mary

believes that by focusing on compliance and

adherence now, they will be in a good position if

the processes become mandatory.

Team-work:

“It moved from one person to every

person at the pharmacy being involved. We

genuinely care and the customer can feel that. It’s

more personal. We have a special area set aside for

conversations but beyond that, we’ve trained the

technicians to discuss that ‘it’s not just about the

refill; it’s about your health’, says Abbie

Changing behaviors:

One to two people a day are

dedicated to calling patients to remind them about

their refills, but now customers are calling four

days before their refill is due.

Community pharmacists play

a central role in patient care.

More patients are benefiting from

pharmacist’s interventions through

Comprehensive Medication Reviews (CMRs)

and OutcomesMTM TIPs. We spoke to some

pharmacies who have achieved successful

performance scores to learn about their

approach and how the process can be

mutually beneficial for both the pharmacy

and the patient.

good medicine

cardinalhealth.com

ESTROGEN CONTAINING HORMONES CAN CAUSE

VITAMIN DEPLETIONS.

B vitamins are involved

in millions of biochemical reactions throughout the

body.

Being low on B vitamins can cause many

problems—

slowed metabolism, depression, poor

memory, muscle pain, weakness or a headache,

stiffness, fatigue, nausea and anxiety are just a few

of the dozen of symptoms that can occur as a result

of a B vitamin deficiency. As part of our standard of

care at Williamsburg Drug, I recommend a B-Complex

Plus supplement.

DEB SCHOCKLIN & KELLY AUTHIER

RPh

Williamsburg Drug

Williamsburg, VA

IMPACT

Kelly believes these initiatives highlight pharmacists’

capabilities to show a distinct tie between nutrition,

prescriptions and medical health. “A woman who came in

for a medication review was having difficulty sleeping and

feeling depressed. We found something in her medication

that was contributing. We consulted with the doctor about

tapering a certain medication and tweaking the time of

day another medicine was taken. I suggested some lifestyle

changes and supplements. I received a wonderful note

from her saying she had never had anyone just sit down

and listen to her and explain how to improve her situation.”

VITAMIN

DEFICIENCY TESTS

Patients are tested for general

zinc deficiency with the Zinc

Taste Test. The patient swirls

5 ccs of zinc for 5–10 seconds.

Depending on what they

taste or don’t taste indicates

a level of deficiency. If an

additional zinc supplement is

recommended, the test can be

repeated months later.

MEDICATION

REVIEWS

Scheduling medication reviews allows

Kelly to look at the big picture—labs,

vitamins, supplements and medications

—but also a person’s lifestyle. “If they

are homebound, vitamin D might play

a bigger role. If they are vegan, I look

for vitamin deficiencies and test for a

hemoglobin A1c level for risk factors into

diabetes. I discuss family history and

stressors that can have effects on their

disease state.”

In an environment filled with discussions of reimbursements, preferred

networks and PBMs, Deb Schocklin, owner of Williamsburg Drug says,

“There is a lot of pressure for pharmacies today that

we can’t control, but we are always looking for the

next thing we can offer that will be helpful in meeting

people’s needs.”

By empowering the staff and continuing to reinvent itself in response to

the times and to pharmacy and healthcare landscape changes, Deb says

Williamsburg Drug is operating at a level of patient care where they can

be effective. “It keeps us fresh and provides us with a purpose every day.

We don’t worry about competing with the chains.”

Most recently, that has meant addressing vitamin depletion caused by

certain medications. Kelly Authier, the PIC at Williamsburg Drug, has

spearheaded these efforts.

PRESCRIPTION BAG TAGS

listing possible side effects and related supplements

Kelly developed

bag tags

that are included with the filled prescription.

The tags are color-coded and, so far, have covered estrogen containing

hormones, proton pump inhibitors, antibiotics and statin therapy. They list

the possible side effects and recommend supplements that may help.

Kelly will expand the bag tags into other medications. For the medicines that

don’t yet have a bag tag, she has a pink pen that the staff teases her about.

“I write supplements they may want to consider on the bags. I want to keep

the conversation going.”

Estrogen

Proton pump

inhibitors

Antibiotics

Statins

FIGHTING VITAMIN DEFICIENCIES

supplement

health

good medicine

At Mark’s Pharmacy in Cambridge, Nebraska, high-touch healthcare

and innovation came together. The pharmacy initiated a blood

pressure service, with the goal of engaging patients and integrating

this care into the total healthcare team.

The premise was that many patients on anti-hypertension medications were not tracking their blood

pressure or were not doing so consistently. Their sporadic readings may be written on a little slip of paper

to share with their physician during an annual exam.

But while they may see their physician just once a year, Mark’s Pharmacy knew that these patients are

generally filling their medications monthly and could leverage that relationship to improve outcomes.

MARK MCCURDY

Mark’s Pharmacy

Cambridge, NE

THE BRAINSTORMING

Mark McCurdy, RP, owner of Mark’s Pharmacy,

was exploring potential avenues pharmacists

could cover as the profession moves forward with

Nebraska’s State Department of Health—how to

use the access they have and add a care element

to it. From that partnership, the blood pressure

service was born.

Mark’s Pharmacy would become a primary

resource in educating and empowering patients

to monitor and manage their blood pressure,

lifestyle and related medications with the goal

of improving blood pressure control and related

health outcomes.

There were locations in town doing readings,

but those readings weren’t getting back to the

provider. They saw this as a “simple” fix.

ESTABLISHING THE SERVICE

STEP 1:

Using MedSync™ Advantage data,

patients that were non-compliant with their

blood pressure regimen were identified. The

pharmacy identified 462 patients who had been

prescribed anti-hypertension medications, 369

of whom were compliant. The pilot program

targeted the 93 non-compliant patients. The

service was also directly marketed to patients

taking blood pressure medications via bag stuffers

during refills of these medications. Local medical

practices and cardiology groups that routinely

provide care to patients in the pharmacy service

area were educated to the elements of the program

and encouraged to refer patients.

STEP 2:

Participants purchased an automatic

monitor and were encouraged to collect as

many readings as possible. Measurements were

collected monthly, either via enrollees bringing

their monitors into the pharmacy for monthly

downloads or via collection during pharmacy

delivery of medications to the enrollee’s home.

Being in a rural area, the latter collection method

was an important offering. Atypical results were

documented and addressed through interaction

with the prescriber. Interventions were filed with

insurance providers when available.

STEP 3:

Upon enrollment in the program, each

patient identified all care providers. On a quarterly

basis and when requesting refills on blood

pressure medications, a pharmacist provided a

clinical summary of the patient’s blood pressure

results, including quality of readings, the range

of readings, an average of readings and notation

to the provider that all results are available upon

request at the pharmacy.

The process to download results and send them

to prescribers took under two minutes and readily

fit into the overall pharmacy workflow.

Not having to create new processes or purchase

new equipment made the development of the

service simple and easily replicable for other

pharmacies.

Initially, there was a lot of excitement to participate

because patients had close attention being paid to

them. As the novelty wore off, Mark’s Pharmacy

conducted monthly reminder calls to the patients.

Only four dropped out of the initial pilot group—

three of those were because they moved to a

long-term care facility. People are very appreciative

of the attention and had a lot of trust. “It’s high-

touch,” Mark stated.

Importance of pharmacist

interventions

“We had a patient who suspected there

was an issue with his blood pressure,

but he didn’t want to go the clinic.

He came here. We screened him and

educated him on the importance of

going to the clinic that same day. He

made an appointment right away.”

Increased engagement between

pharmacist and physician

“We are giving the physicians results

monthly, and they know the origin and

quality of those readings. The clinical

decisions are a lot better. Physicians

are making drug therapy changes

in-between the patient visits. Now we

are seen as health professionals, rather

than vendors.”

Mark has received “tremendous”

feedback from patients and physicians

alike. In addition, the pharmacy

experienced financial gains through

improved refill rates and compliance

with STAR Ratings. The success has led

Mark to develop a diabetes outreach

program as Phase 2.

BLOOD PRESSURE SERVICE

Matters of the heart

good medicine

cardinalhealth.com

What would you do

One of our readers has a question.

Can you help?

I need to make a decision and am looking for

your feedback.

What advice would you offer to a person who

is struggling with

apps.facebook.com/my-polls

What products would you like us to offer?

What is your biggest challenge as a caregiver?

What vitamins do you take every day?

Run a poll

using Facebook’s poll app

Our research on the Cardinal Health

Voices of Care

Facebook page

uncovered that followers “liked”

inspirational images and quotes

more than any other type of post.

inspiration

The three words I like to hear most are

If I could go anywhere right now I would go to

Gearing up for Thanksgiving travels. This year I am

headed to

The one skill I want to learn this year is

People love to

fill in the blank

Post pictures of team meetings.

Don’t be afraid to show goofy pictures—staff with their pets, with customers

(

with their permission of course

), new baby, engagements and graduations.

If you sponsor a sports team or the school play, share photos!

Share pictures

of your team

Ask for advice

your patients love to help others

ive ideas

FOR FACEBOOK POSTS

www.ncpanet.org/convention

THE

place to share and

build your own plan for

profits, opportunities,

and solutions

FRONT-END

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EXPANDING

OPPORTUNITIES

DIMENSION

Your exclusive access to educational programs

covering all of the dimensions of your pharmacy

business,

hundreds of industry partners showcasing

their latest products, services, and technology, countless

opportunities to network and share ideas with peers

who’ve been there, done that, and will show you how,

and new profit-boosting opportunities to make your

business more successful. See you in Orlando.

Claim your $150 discount by

registering before August 1.

NCPA ANNUAL

OCTOBER 14-18, 2017

CONVENTION

TELLING THE STORY OF INDEPENDENTS

DEANN MULLINS

BPharm, CDE

Favorite inspirational quote from Gail Larson—

TO CHANGE THE WORLD,

TELL A BETTER STORY

As NCPA President, Mullins is telling an important

story—about why independent community pharmacy

matters and how pharmacists can create a movement

towards meaningful aggregation within the profession

and with the larger healthcare community.

We spoke to Mullins about her 2016–17 term priorities,

which include furthering collaboration between

pharmacists, doctors and payers, and focusing on

improving the healthcare system as a whole.

How do you see furthering collaboration between

pharmacists and physicians?

Our healthcare system is broken and together we can

fix it. Right now our system focuses on sick care in a

fee-for-service model. Providers get paid to do things

people—to write prescriptions and order tests.

We overuse and overtreat and overmedicate. And we

undervalue what keeps us healthy.

I believe in a world where prescribers, pharmacists, nurses and payers

quit competing and start collaborating to design a value-based system

of care that benefits everyone. Right now we have a silo approach with

the PBM model that has pharmacy as a cost center. We need to break

down the walls and start to look at healthcare decisions as a whole.

We can improve outcomes and we can lower healthcare costs.

We need to unite in two directions—within our profession and

with the larger healthcare community.

UNITING WITHIN OUR PROFESSION

One example is the NCPA Innovation Center. As a supporting

organization within NCPA, it was founded to assist and speed up

the evolution of independent community pharmacy in our rapidly

changing healthcare environment. We are investing in local networks

and the infrastructure to help them be successful.

UNITING WITH OTHER HEALTHCARE PROFESSIONALS

There is a growing movement of doctors who are done with the status

quo healthcare system. There is a call for a broad-based grassroots

movement that will drive societal change.

There is a template for wise healthcare spending and a call-to-action

called the Health Rosetta. And then there’s ZDOGGMD, aka Dr. Zubin

Damania, a Stanford trained physician who is using musical parody, an

additional alter ego Doc Vader and honest conversations via FB live to

further the conversations about Health 3.0.

As NCPA President, I’m reaching out to the leaders of this movement to

build support and relationships.

THE POWER OF

INDEPENDENTS

good medicine

cardinalhealth.com

good medicine

MOVING THE NEEDLE

State Representative John Forbes, D-Urbandale

What can independent owners do?

At a minimum, be a member of NCPA.

Write the check. With more members,

come more victories. We increase our

strength by speaking with one voice. If

you are a current NCPA member, support

the NCPA Legislative Defense Fund (LDF)

by writing a check. Your financial support

is important. Make the call to your

elected officials when the NCPA askes for

your support.

The future isn’t a place where we are

going to

, it’s a place that we are going

to create. And that comes with dollar

signs and advocacy.

FROM PHARMACY TO LEGISLATOR

JOHN FORBES

BSPharm

WHAT DO YOU DO WHEN NO

ONE IS REPRESENTING YOUR

AREA OF BUSINESS?

YOU RUN FOR

ELECTED OFFICE

In 2012, Forbes was elected to the Iowa

Legislature where he spearheaded PBM

transparency legislation. “The PBM industry

is one of the most unregulated insurance

industries in the country. We know,

unfortunately, consumers are being put at risk

by paying higher co-pays and pharmacies are

put at risk with lower reimbursements,” stated

Forbes.

Increased regulatory laws passed in 2014 and

2015 were unfortunately overturned by a

higher court. Forbes is pressing forward. “We

are going to continue to pursue legislation to

regulate the PBM industry in the state of Iowa,

revamping the proposed legislation.”

As a pharmacist, Forbes is in a unique position

to understand the complexities of healthcare.

As an Iowa state legislator, his main focus is

healthcare policy and budgeting for the Iowa

Medicaid program.

Presented with APhA’s 2017 Hubert H.

Humphrey Award this past March, Forbes was

recognized for his legislative contributions.

Forbes is moving the needle and is an

advocate for his fellow pharmacists. He

believes it’s imperative other pharmacists get

involved too, taking the time to educate and

lobby their state and national elected offices.

He shares some ways pharmacists can make

their voices heard.

MAKE YOUR VOICE HEARD

Educate your legislators: Legislators are

bombarded with emails on a variety of topics

and it’s hard to be an expert in all areas. PBM

contracting, for example, can be complicated.

As pharmacists, we can explain topics to

legislators. If they understand it, they are

more likely to sign onto the bill.

Lobby lawmakers against one-sided

PSAO contracts—

We need to level the

playing field. As more and more legislators

understand the impact this is having not only

on pharmacies but also on patient co-pays,

the more likely there will be legislation passed

that will make it fair for both parties.

Lobby federal lawmakers to pass

provider status—

Provider status is critical

to the long-term viability of our profession.

Without it pharmacists are not going to be

able to get reimbursed for the services we

provide, especially around MTM. If patients

aren’t taking their medications correctly, it

has a huge impact on overall healthcare costs.

We have to show federal lawmakers that

every dollar spent on MTM will result in

a four to five dollar ROI, but they also have

to realize that return doesn’t happen in a

few months.

AGGREGATION MEANS

TO UNITE

PEOPLE.

PEOPLE UNITE WHEN THEY SHARE

A BELIEF. AND A SHARED BELIEF—

I THINK IT CAN CHANGE THE WORLD

DeAnn Mullins, BPharm, CDE

good medicine

Community

ADVANTAGE

October 19, 2016

I have experienced first hand this

morning what kind of people run

Rivertown Pharmacy Inc. My child

has strep and needed an antibiotic.

Thanks to a wonderful friend who

called it in and an amazing man,

Mr. Dale at the pharmacy, who went

to the store, got her antibiotic and

texted me where I could pick it up.

That’s real Christian behavior

people. I am completely humbled

and grateful.

good medicine

LESLIE TODD

RPh

& DALE TODD

Rivertown Pharmacy, Conway, SC

“We had three feet of water in the store.

We weren’t in a flood zone so didn’t have

flood insurance,” says Dale Todd, who owns

Rivertown Pharmacy in Conway, South

Carolina with his wife and pharmacist, Leslie.

Dale recalled that by Monday morning

Cardinal Health had deployed seven

people to help clean up the store and do

an inventory to see what could be salvaged.

They were back up and running by lunchtime,

serving patients by way of the pharmacy’s

drive-thru window.

Only one year later, they were faced with

Hurricane Matthew. In preparation, the

Todds moved merchandise and computers to

higher ground. They also sandbagged, which

resulted in fewer inches of water seeping

into the building. Still the sheet rock and

insulation was damaged and had to be

ripped out. Cardinal Health sent a team a

second time.

Unfortunately, the reprieve was only

temporary.

When the rivers absorbed all the

water from Matthew, dams broke in North

Carolina, and the city of Conway, South

Carolina flooded yet again. It was the third

flood Rivertown Pharmacy faced in the

span of one year. Two feet of standing water

surrounded the building, and this time

customers could not access the pharmacy.

As the only pharmacy in town offering

delivery, they service a lot of “memaws and

papaws” that don’t drive or don’t need to

be driving, as well as three assisted living

facilities. It was critical to the Todds to not

interrupt any service during the floods.

Roads by the pharmacy were closed, but at

the end of the street was a high spot where

several cars could park.

The staff walked

through two feet of water to meet people

and drop off their prescriptions, and then

back to the pharmacy.

They operated in this

manner for almost a week, never losing focus

on their customers’ needs.

for

business

YOU DO WHAT YOU HAVE TO DO,

WHATEVER IT TAKES

FOR THEM TO GET

THEIR MEDICINES.

PEOPLE HAVE TO HAVE

THEIR MEDICINE.

THE STORM CAME ON A

SUNDAY,

WITHOUT WARNING,

BRINGING HEAVY FLOODING.

October 19, 2016

I know Walmart or Walgreens would

NOT walk in the water and mud to

deliver my prescription.

Rivertown

Pharmacy Inc. rocks!

Customer testimonials

good medicine

cardinalhealth.com

Selecting a Medicare Part D plan can be overwhelming for the

aging population. During each annual open enrollment period

from October through December, Bill Means, RPh, owner of

Medical Center Pharmacy of Hickory, sits down with his patients

and helps them select a plan. Non-patients can take advantage

of the service, as well.

“We have the knowledge background to pick programs better

than the other available sources since we deal with the

medications on a daily basis. This knowledge makes it much

easier to sit down and show the patient the monthly costs, not

just for their Medicare Part D premiums but for the medications

as well. If there are medications the patient is taking that aren’t

going to be covered under their current program, unlike the

other sources, we can dig a bit deeper to find alternatives that

may be covered.”

The business implications in going the extra mile are clear. “It

allows us to keep our patients and bring in new ones. The other

sources may sign up patients for the least expensive plan causing

them to have to go through mail order. As the pharmacist, we can

make sure the patients are well-informed about all the Medicare

Part D plan choices they have available and can help them make

the best choice for the pharmacy they use. You might be losing

patients to other pharmacies if you aren’t doing this.”

Bill uses iMedicare

to obtain the plan options for each patient.

The iMedicare program links to the pharmacy computer system,

allowing the patient’s medications to be pre-loaded. It only

takes 15 minutes to obtain plan reports for the patient, and only

five additional minutes for new patients not in the pharmacy

computer system.

BILL MEANS

RPh

Medical Center Pharmacy

Hickory, NC

Bill, along with Rob Cockman, RPh, at Midtown Pharmacy in Whitsett, NC,

held a series of calls with other Cardinal Health community pharmacy

owners to share their best practices in this area. Both of these pharmacists

embrace the opportunity to help other owners better understand the

significance of the open enrollment period with the opportunity to build

stronger relationships with the communities they serve.

Phil Piercy, Territory Sales Manager with Cardinal Health, has seen

the impact. “He helps them to understand their plan options which is

invaluable for those patients on fixed incomes where every dollar matters.

They are so relieved. You cannot put a price on reassurance,” he stated.

Medicare

made easy

RETAINING PATIENTS: Advising Customers on

Medicare Part D Plans

good medicine

Pauline Vargo answered a

phone call in the spring of

2015 that would eventually

lead to her being affectionately

named

The Naloxone Lady.

Her community of Allentown,

Pennsylvania was facing a

heroin epidemic.

ACCORDING TO THE DRUG

ENFORCEMENT AGENCY (DEA),

IN 2015, THERE WERE AT LEAST

3,383

OVERDOSE

DEATHS

IN THE STATE, WITH ABOUT

NINE DEATHS PER DAY.

PAULINE VARGO

RPh

Medicap® Pharmacy No. 8360

Allentown, PA

In response to the crisis, Lehigh County was

conducting a blind survey, assessing whether

pharmacists in the county carried naloxone.

The caller was role-playing a mother whose

daughter was struggling with addiction.

Pauline’s pharmacy, Medicap® No. 8360, didn’t

carry it but she researched the possibility.

“It took some time to figure out how to get

it and I learned I had to order 2,000 nasal

adapters at a time, but it was possible.”

Pauline was the only pharmacist in Lehigh

who followed up with the caller. They asked

her to participate in educational outreach

efforts and paired her with an addiction

specialist physician and the Center for

Humanistic Change. Together, they educated

all the school nurses in Lehigh County, as

well as parole officers, prison guards and

sheriffs. Their presentations extended to the

community institutions that planned to have

naloxone on hand. At the height of the efforts,

Pauline was giving two presentations a week.

Initially, attendees who were interested in

obtaining naloxone after the presentation

had the opportunity to get in touch with the

pharmacy. However, Pauline soon realized

that many of these individuals were, “in it

higher than knee deep with a loved one.”

At the same time, in response to the ongoing

epidemic, Pennsylvania’s Physician General

signed a standing order for naloxone. The

order allows the state’s residents to obtain

naloxone without a prescription from their

doctor. With the standing order in effect,

Pauline created a naloxone request form to

accompany the event registration.

Attendees complete the form in advance,

providing their name, address, insurance

information and order of preference for

the three available forms of naloxone

(NARCAN nasal spray, EVZIO® Auto-injector,

or Naloxone Hydrochloride Injection).

Pauline fills the prescription type according

to insurance coverage, bills ahead of time

and distributes after the meeting. She says

it’s the same as delivering the prescription

to them but reduces the lag time that

previously existed.

“I know many patients who have gone into

a local pharmacy chain, and the staff looks

at them like a deer in a headlights. Once

someone has a bad experience they most

likely won’t seek it out again. My entire staff

is educated—they tell patients that we carry

all three forms and can educate them on how

and when to use it.”

Now a couple of years into the initiative,

the audience has changed. There are more

community groups, such as Partners for a

New Beginning, an organization of families

with a loved one affected by heroin.

But it’s essentially the same message.

WE ARE STILL IN A

CRISIS SITUATION.

IT’S AN EPIDEMIC.

IT HAS HELPED A LOT

OF PEOPLE,

at least put them at

ease, having the naloxone and knowing

what to do in a panic situation when

someone is overdosing.

Naloxone

Lady

the

good medicine

cardinalhealth.com

Like many community pharmacists across the country, Christofano is deeply committed to

educating his patients and others in his community about prescription medication misuse. “A

community-based pharmacist is the most accessible healthcare provider in a community,” he

says. “I think that comes with a responsibility for trying to improve the health of the community.”

He is particularly focused on the dangers of misusing opioids, a significant problem in his own

Westmoreland County. (According to overdosefreepa.pitt.edu, there were 174 overdose-related

deaths in Westmoreland County last year alone—up from 61 deaths in 2011.) It’s an epidemic

that impacts people equally regardless of age or socioeconomic status, Christofano says.

“I believe that we have to be proactive in the fight against

prescription drug abuse,” he says. “When we educate

people, we can be preventative, and start to get out in

front of the epidemic.”

Christofano’s leadership on this issue has garnered a string of honors: The Pennsylvania

Pharmacists Association gave him the Commonwealth of Pennsylvania Pharmacist of the Year

Award in 2015 and the Pennsylvania’s Generation Rx Champions Award in 2016. He also received

the 2016 Ken Wurster Community Leadership Award from Cardinal Health, and was named the

2016 Ohio State University College of Pharmacy Distinguished Alumni.

STARTING THE CONVERSATION

Building from the educational resources available from

Generation Rx

(see following pages),

Christofano created an interactive presentation about medication safety and opioid abuse that

he customizes depending on the age of his audience.

When he first started this work several years ago, finding people willing to hear about the

problem of prescription drug misuse was a challenge, he says. “I started with high schools—

I reached out to school boards, to school superintendents, to school teachers, to school nurses.

I just wanted to have the conversation about the epidemic. Sometimes people were resistant,

but once they learned some of the statistics, they wanted to learn more, and wanted to be sure

their students and the parents heard the message, too.”

Christofano has now presented his education program in all of the school districts in

Westmoreland County.

He’s also extended his partnerships far beyond schools, and speaks regularly with audiences in

community centers, churches and shopping malls. In the first few months of this year, he held

15 community training and education sessions. “Public officials, including Westmoreland County

Commissions, the District Attorney and county coroners have all attended and participated in

our question-answer sessions,” he says.

Christofano also serves on the Westmoreland County Drug and Alcohol Commission and the

Council for Substance Abuse and Youth board. “These organizations are doing great work in

fighting prescription drug abuse, and I’m proud to partner with them. They also help connect

me with lots of new audiences.”

ED CHRISTOFANO

RPh

Hayden’s Pharmacy

Western PA

AMERICA’S

BIGGEST

DRUG ABUSE

PROBLEM IS

NOT ON THE

STREETS.

IT’S IN OUR

MEDICINE

CABINETS.

prescription drug misuse

A COMMUNITY PHARMACIST’S

fight against

good medicine

REMOVING TEMPTATION

One of Christofano’s key messages is about the importance of proper drug disposal. He points

to the Centers for Disease Control and Prevention statistic that shows that prescribers in this

country wrote 259 million opioid prescriptions in 2012—enough for every American adult to

have their own bottle of pills.

“Keeping these medications in the home is risky,” Christofano says. “They’re tempting—

anybody who wants to begin abusing prescription drugs knows that medicine cabinets

are the best place to get them. I encourage everyone to go through their medicine

cabinets and pull out every unused or expired prescription and get rid of it.”

To make that as easy as possible in his community, he says, each of his pharmacy locations

have permanent drop boxes available to anyone, 24/7.

NALOXONE RESCUE KITS

Christofano also uses his presentations to educate audiences about naloxone. “Many people

aren’t aware of what naloxone is; some people think that distributing it might encourage

more drug use. But there’s not evidence to support that fear. And about 28,000 people in the

U.S. died from opioid overdose in 2014. Many of those deaths could have been avoided with

immediate access to naloxone.”

He’s worked with the Westmoreland Drug and Alcohol Commission and the Council for

Substance Abuse and Youth to get naloxone rescue kits into area high schools, and has written

policy and procedures for the administration and storage of the kits. “It was important to

me that naloxone is available at all times, and not behind a locked office door on the school,”

Christofano says. “My staff and I train first responders, teachers and parents to administer

naloxone.”

Christofano has also worked with the Pennsylvania

Pharmacists Association to include best practices

in the use of naloxone on the Association’s

website

papharmacists.com/naloxone

The page includes guidance for practicing pharmacists

in dispensing naloxone, educational materials that

pharmacists can share with their patients and a list of all

pharmacies in the state that currently dispense naloxone

rescue kits.

“We can save lives with naloxone, and then we can help get

people into treatment,” Christofano says. “That’s got to be

a big part of the fight to end the opioid epidemic.”

Each of his pharmacy

locations have

permanent drop

boxes available to

anyone, 24/7, to get

rid of unused or

expired prescriptions.

good medicine

cardinalhealth.com

Prevention education:

Generation Rx offers a suite of age-appropriate

resources to educate everyone—from elementary school students to

seniors—about prescription drug misuse, and to encourage action in

communities across the county. Generation Rx has three simple,

effective messages:

•

Take medications exactly as prescribed, and don’t share your

medication with others.

•

Store prescriptions securely, and dispose of medications properly.

•

Teach others about using medications safely.

Consistently, 94 percent of youth who participate in Generation Rx

sessions report that they “would not share my prescription drugs with

others,” and 96 percent of adults say they “won’t use prescription drugs

that are not prescribed for me.”

Pharmacists are among our most effective allies in carrying the

Generation Rx message. Each year, we join with 40 state pharmacy

associations to honor Generation Rx Champions—pharmacists

who demonstrate outstanding commitment to raising awareness

of the issue. In addition, more than 90 pharmacy schools have

Generation Rx programs.

Drug take-back:

Nearly 70 percent of those who misuse prescription

drugs get them from family members or friends, and often from the

medicine cabinet, according to the National Survey on Drug Use and

Health. Properly disposing of unneeded or expired medications is one

of the simplest ways everyone can help prevent misuse.

Our Generation Rx Medication Disposal Grants support nonprofit

organizations across the country as they build or expand medication

Fighting

Prescription

Drug Misuse

Through Generation Rx, the Cardinal Health Foundation, in partnership

with The Ohio State University College of Pharmacy and many others at the

local, state and national level, is engaged in the fight against prescription

drug misuse. Generation Rx takes a multi-pronged approach, providing

prevention education, increasing participation in drug take back programs,

supporting community collaborations and encouraging prescribers to limit

opioid prescriptions.

disposal programs in their communities. Grantees are bringing pharmacists and

youth to the table as they raise awareness and create new partnerships.

Funded organizations will report various outcomes of their work, including the

total pounds of medications collected and the number of pharmacists, student

pharmacists and youth involved in the program.

Community collaborations:

Generation Rx supports a variety of community

work. We know that ending prescription drug misuse and eliminating the

opioid epidemic requires the medical community, service providers, educators,

government, law enforcement and treatment professionals to work on these

issues together.

We have a long history of supporting community-based organizations, many of

them in communities where Cardinal Health has a presence. We support youth-

led prevention programs, public awareness campaigns and bringing medication

safety education into schools. We are currently elevating our work in schools

through a new pilot project in Ohio called Collaborate. This program will match

teachers with pharmacists who want to help educate students in kindergarten

through 12th grade about the dangers of prescription drug misuse.

Limiting opioid prescriptions:

As many as one in four people who receive

prescription opioids long term for non-cancer pain become addicted to them.

The Generation Rx Best Practices in Pain Medication Use & Patient Engagement

Grants support the work of healthcare organizations as they engage patients

and healthcare providers in reducing the number of opioids prescribed for pain

management. Early pioneers in this work have shown that reducing opioid

prescriptions leads to a decreased reliance on them, better quality of care,

better patient outcomes and overall decreased cost of care.

Generation Rx grantees will report outcomes in terms of morphine equivalents,

pain management and patient satisfaction.

good medicine

Safe medication practices for life.

Brought to you by:

GenerationRx.org

5,500

AMERICANS

Approximately

misuse a prescription painkiller,

sedative or stimulant for the

first time every day.

(2013 National Survey on

Drug Use and Health)

reported having misused or

abused a prescription drug

at least once in their lifetime.

(Partnership for Drug-Free Kids)

5 MILLION

TEENS

In 2012, about

OR NEARLY 1 IN 4

2 MILLION

AMERICANS

More than

suffer from substance use

disorders related to prescription

opioid pain relievers.

(DrugAbuse.gov)

71.3

OF PRESCRIPTION

DRUG OVERDOSE

DEATHS INVOLVED

PRESCRIBED OPIODS.

(CDC)

In 2013

80 AMERICANS

DIE EVERY DAY

from a prescription

opioid overdose.

(CDC)

More than

cost of prescription opioid

abuse in the United States.

(Centers for Disease Control

and Prevention (CDC))

78.5

BILLION

A YEAR

GET THEM FROM FAMILY

MEMBERS OR FRIENDS, OFTEN

FROM THE MEDICINE CABINET.

(2013 National Survey on Drug Use and Health)

Of those who misuse

prescription drugs, nearly

OF PRESCRIPTION MEDICATIONS

GO UNUSED IN THE U.S.

many of them stored in easy-to-

access cupboards or drawers.

(Pharmaceutical Research and

Manufacturers of America (PhRMA))

2.8

MILLION

POUNDS

is properly disposed

(Geisinger Center for

Health Research)

11% OF

UNUSED

MEDICATION

Only about

good medicine

cardinalhealth.com

E3 GRANTS make healthcare as effective and efficient as possible

E3 Grants support work to increase the effectiveness, efficiency and excellence of healthcare. Since 2008, the

Cardinal Health Foundation has invested more than $8 million in this program, providing grants to hundreds

of hospitals, health systems and other health-related organizations. These grants support work designed to

achieve two goals:

•

Improve patient outcomes and

•

Reduce healthcare costs

According The National Institutes of Health, it takes an average of 17 years for evidence-based practices to be

fully implemented into healthcare practices. Yet within a year or two, many of the E3 grantees are affecting

change, reducing readmissions to hospitals, reducing lengths-of-stay and, most importantly, saving lives.

Learn more at cardinalhealth.com/patient safety

The Cardinal Health Foundation E3 Grant program supports healthcare

organizations as they work to improve medication safety for high-risk

patients through care transitions. Grantees often partner with community

pharmacists, who educate patients, engage them in self-care and help

them avoid re-hospitalizations. Here we highlight some of their successes.

“For most patients, community pharmacists are the most accessible and trusted of their healthcare

providers,” says Toni Fera, PharmD, an independent healthcare consultant. “That gives community

pharmacists a particularly important role in supporting high-risk patients post-discharge, when

medication-related problems are common.”

Supporting patients through care transitions takes time and multiple contacts, she says. “Every

visit to the pharmacy provides an opportunity to educate and engage the patient. It’s an ongoing,

participatory process—a matter of the pharmacist taking a long journey with the patient.”

Through the Alliance for Integrated Medication Management (AIMM), Fera is coaching a group of E3

Grantees in a multi-year learning collaborative designed to help them achieve scalable, sustainable

improvements in medication safety. In the case studies that follow, several pharmacists engaged in

the collaborative share their insights.

COMMUNITY PHARMACISTS

The key to reducing

hospital readmissions

good medicine

KELLEY-ROSS PHARMACY GROUP

& VIRGINIA MASON HEART INSTITUTE

Seattle, WA

“Pharmacists are very good at identifying medication-related

problems,” says Josh Akers, PharmD, Pharmacy Manager and

Residency Director at Kelley-Ross, a Seattle-area independent

pharmacy group. “That gives us a unique opportunity to improve

medication safety.”

Akers is the lead pharmacist in

Heart to Heart,

an E3-funded

program created by Kelley-Ross and Seattle’s Virginia Mason Heart

Institute to reduce hospital readmissions for heart failure patients.

The program supports patients as they return home from Virginia

Mason or from three area skilled nursing facilities (SNFs).

Kelley-Ross pharmacists have full access to electronic health

records (EHRs) for all patients in the program. Once a patient is

discharged, a pharmacist does a thorough review of the EHR, then

schedules an in-home visit.

During that first visit, within 48 to 72 hours of discharge, the

pharmacist provides medication education and reconciliation, and

notes any medication or therapy-related issues in the EHR.

The pharmacist continues to check in with the patient over the next

three months, with two more home visits and multiple phone calls.

With each contact, pharmacists use motivational interviewing to

engage patients, Akers explains. “Through motivational interviewing,

we learn what the patients’ goals are—and then we can show how

medications will help to achieve those goals.”

OF THE 50 PATIENTS ENROLLED IN THE PROGRAM

LAST YEAR, ONLY 4 PATIENTS (8%) WERE READMITTED.

The rate of readmissions for heart failure patients not in the

program is 20 percent.*

HEART TO HEART IS

REDUCING HOSPITAL READMISSIONS.

Helping

heart

failure

patients

achieve

their

goals

good medicine

cardinalhealth.com

SENIOR SERVICES OF SOUTHEASTERN VIRGINIA (SSSEVA)

& HAMPTON UNIVERSITY SCHOOL OF PHARMACY

Norfolk, VA

“Going into the home takes medication therapy management to the next level,”

says Ebony Andrews, PharmD, RPh, and Chair of the Department of Pharmacy

Practice at Hampton University School of Pharmacy. Each semester, she

supervises fourth-year pharmacy students as they make home-visits to post-

acute patients through SSSEVA’s Hampton Roads Care Transitions Program.

In this program, after the student does a thorough medication review with

Andrews or another faculty pharmacist, he or she visits the patient at home with

a SSSEVA transitions coach; the supervising pharmacist participates virtually

through a HIPAA-compliant telehealth system. The student talks with the patient

about new medications, encourages the disposal of old medications, and looks

for fall risks and other barriers to safety. Within a week or two, the student checks

in with the patient again with a follow-up phone call.

What’s more, the program is giving students an experience that’s

likely to impact the way they practice pharmacy, Andrews says.

“When students see patients in their homes, they see the whole

patient. Suddenly, the importance of the pharmacist’s work comes

together in a new, much more powerful way.”

NOW IN ITS THIRD YEAR, THE PROGRAM SERVES ABOUT

350 SENIORS A YEAR. THE 30-DAY READMISSION RATE IS

9–10 PERCENT,

compared to the baseline rate of 19.6 percent

for patients with similar diagnoses not in the program.*

THE COMMUNITY HEALTH CENTER

OF BLACK HILLS (CHCBH)

Rapid City, SD

“All of our patients face many barriers to medication adherence,”

says David Farber, PharmD, Director of Pharmacy at CHCBH, a

federally qualified health center. “They lack financial resources and

transportation, some have family issues, some are homeless. I can’t fix

everything, but I can help them better manage their health.”

Farber works with regional hospitals to identify soon-to-be discharged

patients to engage in its E3-funded project,

Improving Patient

Safety through Medication Adherence.

Eligible patients are the

uninsured or underinsured with multiple chronic diseases; about

20 patients are currently enrolled.

A medication synchronization program allows them to pick up

all prescriptions on a single day each month. Patients who have

particularly complicated medication regimens benefit from a service

that packages exact dosages in color-coded calendar cards labeled

with the time of day medications should be taken.

THE PROGRAM IS DESIGNED TO MAKE IT

AS EASY AS POSSIBLE

FOR THE PATIENTS TO

GET & TAKE THEIR MEDICATIONS.

“When a patient comes in to get prescriptions each month,” Farber says,

“I go over each medication, explaining what it’s for and any potential

side effects. I don’t rush anyone, and the patients know they can stop

back in anytime we’re open.”

Simply being available to the patients helps him improve medication

safety, Farber says. “Our monthly conversations take some time, but

they let me get to know the patients, what their needs are and what

might keep them from taking their medications as they’re prescribed.”

Supporting

seniors

at home

Breaking

down

barriers

medication

adherence

*The decreased rates highlighted in this article are estimates that were prepared separately

by Virginia Mason Heart Institute and Senior Services of Southeastern Virginia.

There are many perks to your pharmacy

that patients won’t be able to find

anywhere else. Services such as smoking

cessation, at-home delivery and wellness

consultations likely aren’t offered at

competing pharmacies in your area.

The personal, individualized attention

and care you give to your patients is

second to none.

PERSONALIZED

PATIENT CARE

ABOVE-AND-BEYOND

CUSTOMER SERVICE

Your independent community pharmacy

is called a community pharmacy for

a reason; your business supports the

community. Not only does your business

create jobs for pharmacists, pharmacy

technicians and non-pharmacy employees

in the area, but your business gives back to

your community, as well. Your employees

may volunteer at charitable functions,

educational events or community health

fairs, for example.

Source: PBA Health

Patients today have many options to choose from when determining

where they want to fill their prescriptions, buy over-the-counter (OTC)

medications or receive their patient care services, such as immunizations.

But what makes a patient choose an independent community pharmacy

over larger national chains or big box pharmacies?

With any decision, a consumer will weigh the pros and the cons.

It’s important to know what makes independent community pharmacies

stand out, so you can focus on providing features patients are looking

for to grow your patient base.

SUPPORTING THE

LOCAL ECONOMY

Although you may not think of your front-

end as the strongest selling point of your

pharmacy, your patients may come in your

pharmacy just for your front-end.

For example, if you offer one-of-a-kind,

local gifts and products made by local

artisans or vendors in your community,

this gives patients a reason to frequent

your front-end over a dollar store or

national chain pharmacy.

A UNIQUE

FRONT-END

Unlike large retailers, your pharmacy

business is a family. The friendly,

thoughtful service you provide is what

keeps your patients coming back.

The little touches you offer, such as

personally calling a patient back on the

phone, your pharmacy’s welcoming

atmosphere and the timeliness of your

prescription refills, are just a few ways that

contribute to the superb customer service

you provide.

4 REASONS

patients choose

INDEPENDENT

COMMUNITY

PHARMACIES

cardinalhealth.com

MEDICINE SHOPPE, and MEDSYNC are trademarks of Cardinal Health and may be registered in the US and/or in other countries. All other marks are

the property of their respective owners. Lit. No. 1RBC7-639458 (06/2017)

good medicine

Celebrating Community Pharmacy 2017

The information provided in “good medicine” (the “Magazine) is for information purposes and serves to further enhance the goals of Retail Independent

Pharmacy. Cardinal Health uses reasonable care in preparing the Magazine. However, Cardinal Health does not guarantee the accuracy or completeness

of the materials, and makes no representations about the suitability of the information and services for any particular purpose. The content provided in

this Magazine is not intended as a substitute for professional advice. You should consult with professional advisors familiar with your particular factual

situation for advice concerning legal, tax and accounting matters and rules and regulations governing the practice of pharmacy.

Cardinal Health Magazine

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Apply this example's core structure, strategic pacing, and structural hierarchy directly to your own topic.

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