TOP TOOLS AND SERVICES
At Drug World Pharmacies, President and CEO Heidi Snyder is making the most of the Elevate Provider Network, AmerisourceBergen’s pharmacy services administrative organization (PSAO), and as a member of Good Neighbor Pharmacy (GNP).
Snyder is the second generation to run Drug World Pharmacies, with locations in Cold Spring and Croton-on-Hudson, New York. One location is a full-line pharmacy, and one is a department in a supermarket. Her son, Mark Snyder, works in the business as well.
Elevate and GNP make a suite of critical services available, according to Heidi Snyder, ranging from expert guidance via business coaching to comprehensive data-supported business and clinical metrics, to services such as claims reconciliation and marketing support with a dedicated advertising budget. It’s a big portfolio that underpins much of what happens at Drug World Pharmacies, which works in concert with Rx30’s pharmacy management software and a point-of-sale system from Summit. “These are tools that allow us to work on our business, rather than in it,” says Snyder. “We use Elevate not just to help ensure day-to-day tasks like reconciliation, inventory management, and clinical interactions with patients get done right, but to set the strategy for our business as well.”
Pharmacist Cliff Holt’s flagship Hurricane Family Pharmacy in Hurricane, Utah, has been open for nine years. Over that time, Holt has built the business with the intelligent use of a technology suite that addresses the needs of the pharmacy’s three main components: retail dispensing, a compounding lab, and what Holt calls the adherence lab, which is where he does medpacks and strip packaging. “We started with me, one tech, and two cashiers,” Holt says. “We now have 38 employees, among whom are six full-time pharmacists, 14 technicians, two RNs, and three delivery drivers. We’re now one of the busier independents in Utah.”
CPESN: Financial Incentive Aligned with Pharmacy
Ravin Shah, pharmacist and owner of A1 Pharmacy and Surgical Supply in Lexington, N.C., has taken advantage of the fact that his pharmacy system from BestRx was the first to become certified by CPESN USA for Pharmacist eCare Plan capabilities. “I was a very early supporter of CPESN and initiated the relationship between BestRx and CPESN USA so that we could use our existing pharmacy management platform to further enhance patient care, compliance, and quality of life,” says Shah. “The platform provides a financial incentive for doing what is already aligned with our pharmacy’s mission.”
Holt’s focus is on efficiency, and he’s found that the best way to achieve this is by minimizing distractions — forget multitasking. Holt is leveraging PioneerRx pharmacy software linked to remote staff via a VPN (virtual private network), a voice over internet protocol (VoIP) phone system, the Beacon pharmacy inventory management from TCGRx, and dispensing automation from Parata and Eyecon to create an environment in which pharmacists and technicians place their full attention on the task at hand.
And finally, there’s Carter High, R.Ph., who is director of legislative affairs for Best Value Pharmacies and owner of the Rhome, Texas, location. Best Value Pharmacies is a collection of 14 pharmacies that seeks to leverage the advantages of chain operations while keeping the independent mindset that centers each pharmacy firmly in its community and brings a level of services to patients that the big-box stores just cannot provide.
Best Value Pharmacies built out a multilocation management platform on Computer-Rx pharmacy software and a proprietary workflow engine. High’s Rhome Pharmacy will also be piloting enhanced pharmacy services documentation tools via CPESN USA (Community Pharmacy Enhanced Services Network), with the goal of rolling these out across the group.
GETTING THE MOST FROM YOUR TEAM
While technology’s role is central in pharmacy, we’re going to start by talking about the people. This is fitting, since Heidi Snyder puts such a strong emphasis on hiring the best team members at Drug World Pharmacies and then empowering them to do their best each day. She has also found a lot of value in making extensive use of the business coaching Good Neighbor Pharmacy offers. “The coaching helps us really focus on areas we can work on to see the most improvement,” says Snyder. The coach typically reviews key data with Snyder at each session. “You can learn an awful lot about your business in a short period of time from the data,” she notes. But just as important as learning about your business is getting an outside perspective and motivation. “You can talk about what you know you need to do in your pharmacy,” says Snyder, “but when you know your coach is going to follow up, you’re so much more motivated to get to work.”
Sharing Data: The Future of Community Pharmacy
A number of pharmacy vendors are moving ahead with integrating the Pharmacist eCare Plan into their system. QS/1, for example, recently achieved Level 2 eCare Plan capability. Just what is the eCare Plan? “The Pharmacist eCare Plan is a standard endorsed by the Pharmacy Health Information Technology Collaborative and serves as a standardized, interoperable document for exchanging medication-related activities, plans, and goals for individuals needing care,” says Troy Trygstad, Pharm.D., Ph.D., VP of pharmacy and provider partnerships at Community Care of North Carolina. With Level 2 capabilities, Trygsatd notes, vendors can provide the capability for their pharmacy customers to begin participating in clinical documentation and care planning workflows for all of their patients, as well as the sharing of data with other care team members. “This is the future of community-based pharmacy practice,” says Trygstad.
The coaching can motivate across the business, too. “There’s something for everyone — from the cashier, to the pharmacist, to the technician, to me and Mark,” she says.
For example, Snyder called an all-hands meeting for one of the business coach’s visits, which motivated all of Drug World Pharmacies’ team members to think about a part of the business they wanted to tackle. “Somebody picked up social media, somebody picked up antibiotic calls, somebody picked up taking pictures and posting them,” says Snyder. “Somebody picked up doctor detailing. There are really so many different parts of the pharmacy that can benefit from the attention of a motivated team member.” Just one more good example from that meeting with the Good Neighbor Pharmacy business coach: Team members came away understanding how valuable it is to the pharmacy’s bottom line to look for opportunities to add a complementary OTC (over the counter) product to a customer’s purchase.
TYOH… What’s That?
It stands for Toot Your Own Horn, and it’s the motto at Drug World Pharmacies. It means do something good for the business and its customers, and don’t be shy about letting everyone know. “It’s part of our bonus plan for our pharmacists and managers,” says Snyder. “And it’s also something that we encourage all our team members to do.” For example, a team member received a gift card as a reward when she took the initiative to put together chocolate roses with tissue paper and a piece of string, with the idea that they’d sell better in a bundle. If you aren’t encouraging your team members to TYOH, why not?
And then there’s the built-in networking effect of bringing in the business coach, who sees and shares what’s working at other GNP pharmacies. Snyder herself is always ready to share where she’s having success, too. “We don’t have to run our stores alone,” she says. “There are so many resources out there for you, whether it’s what a PSAO like Elevate Provider Network can bring, or a conversation you have with your fellow pharmacy owners. Why reinvent the wheel when you can learn from other pharmacists and other owners?”
PRIORITY ONE: EFFICIENCY
Have you ever timed how long it takes your staff to enter a prescription into your pharmacy system? Cliff Holt sure has. He learned that it took Hurricane Family Pharmacy technicians between three and a half to four minutes to do the data entry, with phones ringing and people asking questions. How long can this take without interruptions? Holt knows this, too: about 35 seconds. The obvious solution was to put the data entry technician in a space without distractions. At the same time that Holt was considering how best to do this, two of his technicians left. One had a baby and the other moved 120 miles away.
Rather than seeing these departures as a problem, Holt saw a solution. Why not use his VoIP phone system to its utmost and route calls to these two technicians working remotely? And why not connect them to the PioneerRx pharmacy system over a VPN? Now one technician working remotely answers calls from opening until 4 p.m., and the other handles the calls until closing. When you call, there’s no indication that you aren’t reaching the pharmacy itself. The technician on duty typically concludes 80% of the calls that get routed to a person by the IVR (interactive voice response), and can easily transfer the rest. And she’s otherwise in a distraction-free environment that allows her quickly to enter prescriptions that are called in and work e-prescribing, fax, and refill queues when she’s not handling a phone call. “It is crazy how silent the pharmacy is and how much more efficient we are,” says Holt. “We’re also keeping trusted and valued employees working for us remotely and saving a technician FTE in the pharmacy at the same time.”
As Cliff Holt shows, you can achieve some impressive results by taking advantage of the connectivity available these days. Getting the 14 Best Value Pharmacies locations that are spread over 200 square miles connected has been a big challenge, according to Carter High. But it’s a challenge that the group has met. Over time the group’s CTO, Jason Carter, has been able to use the pharmacy management system and the pharmacy’s workflow software to build a centralized flow of data on everything from fills and prescription inventory to clinical intervention opportunities and financials.
High offers several good examples of the impact of this connectivity. First, on the inventory side, the centralized data means that Best Value Pharmacies has group-level insight via reports and can task one manager with, for example, finding out what’s not moving in one store but may actually be in high demand at another location.
Then on the clinical side, the group can gain a unified view of medication therapy management (MTM) activity at the different locations. “We use both Mirixa and OutcomesMTM,” says High, “and we’ve established a centralized, HIPAA-compliant feed of all the local data from these platforms. Our stores do have some patient overlap, and so we can see all of our MTM opportunities across the pharmacies and make sure that just one pharmacist is managing the MTM, rather than a patient getting calls from different pharmacies that both have him in their systems.” Much of this data flow is facilitated by the pharmacy’s workflow software, which gives CTO Jason Carter the ability to build customized flows without the need for a lot of IT infrastructure.
High notes that another service that Best Value Pharmacies has found invaluable for facilitating its multilocation model is HIPAA-compliant email and cloud storage from Entrvst. The pharmacies use these services for quickly and securely communicating about clinical and operational issues, and for uploading documents such as invoices and receipts to the cloud. “This makes a wide range of documents easily accessible for our central office,” says High. “It keeps everyone on the same page.”
Staying on the same page while operating multiple locations is a top priority for Cliff Holt, too. He’s found reporting, reconciliation, and pricing services from Pharm Assess to be invaluable for keeping an eye on his entire enterprise. “I use these services more as the owner, than my staff does at store level,” says Holt. “But it really does help me to be able to have a weekly snapshot of everything that’s going on.”
USING SPACE WISELY
Running out of space is often a good problem for a pharmacy to have. It usually means it’s growing. But that doesn’t make it any easier to solve, with typical solutions being a move or a remodel. Cliff Holt has been fortunate enough to have this issue at Hurricane Family Pharmacy, and was planning to do a major remodel before he had a chance encounter with technology that offered him a different course.
Work Smarter, Not Harder
For Al Roberts, Pharm.D., and Travis Hale, Pharm.D., co-owners of Remington Drug in Remington, Va., it’s not easy to identify a single change that has had an overwhelming effect on their success. But they certainly see connecting with new technologies that allow them to “work smarter, not harder” as a real game changer. They’ve been able to help their pharmacy grow, benefit their patients, and add a new revenue stream opportunity by using Amplicare’s iMedicare tool to compare Medicare Part D plans in seconds, and Amplicare Restore to recommend over-the-counter supplements that can help their patients with the common side effects of nutrient depletion, eliminating discomfort that can often be a barrier to adherence.
“I was out at TCGRx’s home office in Wisconsin,” says Holt. “I was there looking for new packaging automation, but kept looking over at this model pharmacy setup they had with this shelving system that I thought was so cool.” This was Beacon, a modular, high-density storage system that uses pick- and put-to-light technology to manage prescription inventory. “We brought this in about a year and a half ago, instead of doing a remodel,” says Holt. “We installed over the weekend and immediately reduced our footprint for drug storage by 50%, with a lower cost than construction and no dust.”
Beacon didn’t just impact prescription storage either. It has a direct effect on filling efficiency as well, according to Holt, by ensuring that a product that isn’t handled by automation is just steps from the filling counter. “We have 50% of our scripts coming out of our robot,” he says. “The next 25% to 30% are within reach of the filling stations because we have storage drawers beneath the counter. And then everything else is simply three steps away in the Beacon shelving.” While on the theme of efficiency, Holt made a point to mention that what isn’t counted by the robot goes through an Eyecon tabletop counter. “I would never have a pharmacy without one,” he says. “We have three Eyecons in Hurricane, and I’ve got at least one in all the rest of my stores.”
LET YOUR TECHNOLOGY DO THE THINKING
There’s another big change that comes from using Beacon, notes Holt. Inventory is now assigned to shelf locations by computer logic, which means that he can let software do the work of figuring out the best, most efficient location for each bottle. The system then simply directs the staff to the correct bottle for filling each prescription by lighting up an LED, of which there are seven different colors allowing for up to seven technicians to be at work at the same time — plus, there’s a mobile unit.
This system means that there’s no struggling to keep things alphabetized and no dealing with issues such as opening a second bottle of an expensive drug because the staff didn’t see the one that was already open. And the software directs the staff to the best bottles to fill from, such as return-to-stock or those with the shortest expiration dates.
KEYING ON INVENTORY
While Cliff Holt has seen a big impact from this new way of organizing his physical inventory, he has also found tools for managing ordering to be important. Hurricane Family Pharmacy has recently started using OrderInsite as part of a set of services offered by its new buying group. “We can seamlessly order from three different wholesalers, not just our primary,” says Holt. The process begins with the suggested order generated by PioneerRx, which is then brought into OrderInsite and divvied up into three buckets that optimize for availability, pricing, and other parameters. Holt also uses OrderInsite to track inventory usage across his locations and move underutilized stock to a location where it’s needed. “We keep our inventory fresh,” says Holt, “which is critical, especially with multiple locations.”
Carter High reports that Best Value Pharmacies is also managing stock across its locations, and offers some good examples of just what they’re looking for as they do this. “We take a look at a number of data points,” says High. “For example, what was the last-use date for a particular item? Is it a brand name? Does it exceed a financial threshold?” When an item raises one of these flags on an inventory report, it triggers a look into just what’s going on. Is the inventory actually still on the shelves? Even with the perpetual inventory system Best Value Pharmacies uses, there can still be inaccuracies. If it is there, what steps does the location need to take to address the issue? “These reports can actually make us notice that there’s an issue with a particular store, and then we can say, ‘Let’s do an inventory and see where we’re really at,’” says High.
Care Plans as Powerful Tools
Cliff Holt’s pharmacy system vendor, PioneerRx, has made an intentional push toward making clinical services an integral and efficient part of the community pharmacist’s practice. A prime example is med sync, which allows for so much more than refills — it becomes the foundation for a pharmacy’s clinical services. Aside from a proven adherence boost, med sync helps the pharmacist incorporate chronic disease management services into the monthly refill call. Care plans give pharmacists another powerful tool to document clinical activities, with the pharmacy gaining the ability in PioneerRx to automatically start care goals based on specific criteria and longitudinally track patients on their journey to better health.
LEVERAGING RETAILING EXPERTISE
While prescription inventory may be where most of the money is tied up in many pharmacies, don’t ignore your front end, advises Heidi Snyder. The freestanding Drug World Pharmacies location is, perhaps, exceptional in that it’s really more of a general store for the town, according to Snyder, offering a wide-ranging shopping experience for customers. “We have a very exciting and always-changing front end,” says Snyder. “We make sure that we are listening to the small community that we’re in, finding out what they are looking to buy when they walk in the store.” Snyder also stays on top of retail opportunities by reading the Good Neighbor Pharmacy-produced Retail Remedy magazine every month, of which you can see an example at abcretailremedy.com. “This shows us the newest products,” she says. “It also shows us current promotions and has shelf talkers, too.” The advanced features that Snyder has through Good Neighborhood Pharmacy and Elevate Provider Network tie in here, since her membership comes with an advertising budget and support for creating ads — for example, on Facebook. “For instance, I know this month we’ll run a 50%-off coupon,” explains Snyder. “I’ll promote that using Facebook, but we don’t have to know how to create that Facebook ad ourselves. Elevate has experts who guide us through the process. I just go and share it with the groups I want to reach on Facebook.” This is a smart way to ensure the pharmacy is getting the most value out of the discounts it offers.
DATA, DATA, DATA
There’s so much data available within your technology, it takes some thought to be sure you are using it effectively. There’s nothing worse than spending your time digging down into the wrong details for your financial reports, for example. According to
Carter High, Best Value Pharmacies uses its centralized flow of data to review a variety of financial metrics both by location and group wide when needed. Among these metrics are reimbursement per unit or per prescription and dollar amount spent on payroll to produce a given amount of revenue.
Is Your Sync Program So Successful It’s Overwhelming Your Workflow?
Hurricane Family Pharmacy has a big med sync program. According to Cliff Holt, the program includes close to 60% of prescription volume, with the target to reach 75%, ultimately. “A strong med sync program is huge for efficiency and for managing operating costs,” says Holt. But success here can also create some unexpected head- aches, as Holt discovered when his highly motivated sync tech was firing off so many baskets for filling that the flow was causing anxiety further down the dispensing bench as the orders piled up. This sync technician happened to be looking for a few more hours, and Holt had a pharmacist who was interested in getting an early start to the day. A little creative thinking, and problem solved. “I said, well, what happens if we fill our med sync prescriptions an hour and a half before we open three days a week?” says Holt. “My technician got the extra hours she wanted. We reduced the distractions, which ended up making the whole process so much faster that we saved a 40-hour tech FTE [full-time equivalent].” And right there you can chalk up another big win at Hurricane Family Pharmacy for staying focused instead of succumbing to the distractions of multitasking.
At Drug World Pharmacies, Heidi Snyder is also keeping a close eye on the data. “You can improve your business, whether it be sales, profit, or finding which doctors have prescribed the most,” she says. That last example is interesting, and shows how your pharmacy data can really help set a strategic direction. Snyder lists several questions you can answer through your prescription and prescriber data. Are you seeing as much prescribing as last year? What’s your profit per prescription per doctor? Are there doctors working in specialties for which some prescriptions have more profit than others?
Another area where data is going to be king is in patient care and clinical interactions. Snyder is already putting technology to work in this area, with the pharmacists at Drug World Pharmacies having access through the Elevate Provider Network to PrescribeWellness. “We get access to data about our patients’ adherence through this and that enables us to see the best opportunities for med sync, for example” says Snyder. “We can see the people who have missed refills or who meet certain criteria, such as the number of medications or specific disease states. This kind of real data is one of the reasons that our pharmacies consistently rate with five stars. Our pharmacists see this data and they take action.”
Track Order Entry to Eliminate Errors
Eliminating distractions and keeping your focus on order entry is a key way to address one of the major challenges to eliminating dispensing errors. That’s because the most common error activity that is tracked happens at the order entry stage, according to data from SoftWriters, whose FrameworkLTC pharmacy management system can record occurrences at all steps an order passes through, broken down by employee or error type. Are you tracking internal errors as they happen and getting the valuable insight into where the errors are occurring in your pharmacy?
And once your pharmacists are taking action, the next challenge is to document it, creating a new trove of data that will be a major asset for your pharmacy. Carter High is getting out in front of this need by making Rhome Pharmacy the Best Value Pharmacies pilot location for CPESN USA’s enhanced pharmacy services model using the Pharmacist eCare Plan data standard. “This is the tool that we really need for documenting the care interactions we’ve always had with our patients and the advice we’ve always provided to prescribers, as well as the more structured interactions like MTM or med reconciliation,” says High. “We see the enhanced clinical services networks as central to really solidifying the good relationships we have with physician offices by creating a record of how we’re helping their patients get positive outcomes.”
DO YOUR DOLLARS MAKE SENSE?
With the wide array of technology out there for better managing such varied aspects of pharmacy operations, there’s one thing to be careful about, notes Carter High, who is a member of the National Community Pharmacists Association’s technology committee. He reports that an interesting theme has come out of recent conversations in that group. “There are so many add-on services these days,” says High. “This is good, because if you have a need, there’s probably a solution out there for it. But two problems come up when you sign up for a variety of these. First, you find yourself moving out of your pharmacy management software a lot and into another tool, whether it’s software on your servers or a cloud-based product. That disrupts your workflow. Then on the financial side, we see our margins getting ground down by all these ancillary fees. You bring these tools on to get a job done, but at the end of the month you’ve spent another $2,000 on top of your core platform fees, and that can make it really challenging to keep your level of service up or even keep your doors open. So one thing to remember is that you really have to watch your dollars and cents.”
There’s never a good time to stop looking for ways to improve your pharmacy operations. As long as you plan on turning the lights on tomorrow, you should be thinking about what to do next. “It’s very easy to just get to work at 8 a.m. and leave at 6 or 7 and realize that, well, I didn’t touch my goals at all,” says Heidi Snyder. Her Drug World Pharmacies offers a great example of what you can do when you are willing and eager to bring in an outside perspective and find the partners who can bring you the services your pharmacy needs to succeed.
Cliff Holt’s advice is to not be afraid to do things a little differently. “I have a ton of technology in my stores,” he says. “And I’m always ready to pull the trigger on the next thing. We build a piece at a time, but we learn with each step and can apply all that as we open new stores.” As each element of Holt’s operation proves itself, he can then package together the right pieces and ramp up a new location quickly. “I have the confidence to say, OK, this is the technology suite that goes into one of our stores,” he says.
Keeping an eye on the horizon is important too, notes Carter High. “Enhanced clinical services networks are the biggest thing out there for us right now,” he says. “I think this is going to be really interesting. As we gain the ability to bill for more services, we’re going to see how we can turn that big wheel and demonstrate just how effectively we are complementing physicians and other providers in improving care for our patients.” CT
Will Lockwood is a VP and senior editor at ComputerTalk. You can reach him at email@example.com.