Contemporary Pharmacy Practice: Turning Challenges into ... · Learning Objectives 1) Discuss how...
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Contemporary Pharmacy Practice: Turning Challenges into Opportunities Presented by: Karen Agro, PharmD, MSc 2015
Transcript of Contemporary Pharmacy Practice: Turning Challenges into ... · Learning Objectives 1) Discuss how...
Contemporary Pharmacy Practice: Turning Challenges into Opportunities
Presented by: Karen Agro, PharmD, MSc
2015
Acknowledgements & Disclosures Sponsored by: } An unrestricted educational grant from Apotex Inc
Disclosures: } Karen Agro has no conflicts to declare but discloses she
has received honoraria for this and other programs sponsored by Apotex Inc.
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Learning Objectives 1) Discuss how pharmacy practice has changed over time
& the reality of today’s changing business model
2) Compare how pharmacy practices have evolved in various countries, especially the challenges faced in North America
3) Explore how pharmacists have added value to the global healthcare team
4) Discuss options for creating a manageable plan for increasing patient-focused services and differentiating your practice
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How has pharmacy practice changed?
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Evolution of Pharmacy Services
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Evolution of Pharmacy Services
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If you could change one thing in your practice, what would it be?
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The reality of today’s changing business model
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Payment models are changing q Financial pressures on margins
q ↓ dispensing revenue
q Changes in generic drug reimbursement (Canada)
q ↑ in non-dispensing reimbursement activities (Canada)
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Pharmacy practice is changing
Influencers in Pharmacy Practice
Environmental Factors
Pharmacist Culture
Scope of Practice
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Scope of Practice
Pharmacist Clinician
Patient Care-Dispensing
Medication Therapy
Management
Drug Information
Documentation
Collaboration
Safety & Quality
11 Source: NAPRA Model Standards of Practice for Canadian Pharmacists, March 2009
Environmental Factors
q ↓ margins
q Need to manage ↑ volume without increasing costs
q ↑ staffing pressure – to do more with less
q Technology - to free up pharmacist’s time
q Roles - team collaboration, or lack thereof
q Proximity and rapport with physicians
q Influx of educated pharmacy graduates
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New pharmacy graduates
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“ . . .the profession is on the verge of a crisis: the number of pharmacy jobs has dried up
but the number of pharmacy students keeps growing. “
www.newrepublic.com
“New pharmacists may be getting equivalent hours but those hours are
distributed among different employers and they probably aren’t getting benefits”
www.canadianhealthcarenetwork.ca
Population demographics are changing
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} Boomers – people born 1946 – 1964
} Oldest boomers already over 65 years of age
} Boomers make up ~ 24% of the total US population
} By 2030, about 1 in 5 Americans will be over 65
} ~ 2/3 of all seniors over 65 have 1+ chronic diseases
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The Boomers are here
www.cnn.com/2013/11/06/us/baby-boomer-generation-fast-facts/ & www.history.com/topics/baby-boomers
Why focus on Boomers?
} Boomer demand has always outstripped supply
} Impact on health care, long-term care, care at home
} Impact on the “sandwich generation” – in home care needs
16 www.kaiserhealthnews.org/stories/2012/march/01/parent-trap.aspx, http://business.financialpost.com /2012/09/29/supersizing-the-sandwich-generation/, McLean’s Magazine, Sept 15, 2014
Pharmacist Culture
Pharmacist personality traits:
q Lack of confidence
q Fear of new responsibility
q Paralysis in the face of ambiguity
q Need for approval
q Risk aversion
17 Source: Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice
change. CPJ 2010; 143(1):37-42.
Pharmacist Culture q Pharmacists can be described as thorough, careful,
attentive & compliant
q Valuable traits where attention to detail can avoid dispensing errors
q Many pharmacists have shifted from scientist to patient-centred practitioner
q More need to shift from a focus on technical aspects to patient care and decision making in situations of uncertainty
18 Source: Rosenthal M, Austin Z, Tsuyuki RT. Are pharmacists the ultimate barrier to pharmacy practice
change. CPJ 2010; 143(1):37-42.
How have pharmacy practices evolved?
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Internationally . . . Australia: } Medication use reviews via home visits, government $ } Blood pressure measurement, cholesterol screening
New Zealand: } ↑ over-the-counter access Middle East: Growth dependent on stability of region Triage role, due to many products available without a Rx
20 JAPhA 2009; 49 (1): 4-10, Tomorrow’s Pharmacist 2009, p44 URI: 10975891, www.nzherald.co.nz/lifestyle/news/article.cfm?c_id=6&objectid=11333195, Am J Pharm Ed 2008;72(6), Article 133
In North America . . . USA
} Medication Therapy Management (MTM)
} Collaborative Drug Therapy Management (CDTM) } Authorizing refills } Dose adjustments } Disease state management } Collaborative prescribing
} Immunization
} Speciality certification
21 Albanese NP, Rouse MJ, J Am Pharm Assoc 2010:50:e35-69
Canada’s Challenge Drug system reform
} ↓ Decreased generic pricing
} Generics 20-50% of brand
} 18% of brand for top 10 molecules
} Elimination of professional allowances (ON)
} Pressure on margins, and staff
} ↓ wages
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Canada’s Opportunity Expanded scope
} Conducting medication reviews
} Providing emergency prescription refills
} Adapting prescriptions
} Making therapeutic substitutions
} Prescribing for minor ailments
} Initiating prescription drug therapy
} Ordering and interpreting lab tests
} Administering injections Some services reimbursed by public payers
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Canada’s Opportunity Expanded scope: medication review 2014 } 80% of provinces reimburse: } Range: CDN$52.50-$150.00 } Follow-ups: CDN$15.00-$25.00 Expanded scope: Immunizations } 70% of provinces pharmacist-immunization } Range: CDN$7.00-$20.00 Regulated Technicians: 70% of provinces
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How have pharmacists added value? We know . . . q 1 in 9 ER visits due to a drug related cause1
q Over 2/3 of visits preventable1
Many studies of pharmacists adding value . . . Asheville Project2: CV risk reduction education & follow-up q Medication use: ↑ 46.5% q CV-related medical costs: ↓ from 31% to 19% q CV event rate: ↓ 53% q CV hospital visits: ↓ 50%
25 1.CMAJ 2008; 178(12):1563-9, 2.Bunting BA, et al. J Am Pharm Assoc 2008;48:23-31.
Create a manageable plan for patient focused services & differentiation
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#1: Decide what you want to do: products +/- services
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Based on your one practice change idea, how would you
implement it?
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What is a service? } Any activity or benefit that one party can offer to another
that is essentially intangible and does not result in the ownership of anything.
} May or may not be tied to a physical product.
Kotler P. Principles of marketing. Pearson Education Canada (Toronto). 2002
Service Characteristics
Intangible Can’t be seen, tasted, felt, heard or
smelled before purchase
Inseparable Can’t be separated from their
providers
Variable Quality depends on who, when,
where & how
Perishable Can’t be stored for later sale
or use
Services
© Kotler P. Principles of marketing. Pearson Education Canada (Toronto). 2002
What services can you do now? Service Revenue?
Y N ?
Patient counselling & relationship building
Adherence & call-backs Seniors’ focus (dosettes, blister packs, pill splitters, large print labels)
Speciality compounding Disease specialization Medication Therapy Management
Expanded scope – making a case to regulators & payers?
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Can services generate revenue? Actual vs Potential There are costs . . . } Time } Overhead - salary, benefits, utilities, rent, marketing
There are revenues . . . } Direct } Indirect
} Companion sales, } Increased customer base } Job satisfaction } Loyalty . . .
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Quality Product or Service
Customer Satisfaction
Customer Loyalty
Profitability
en.wikipedia.org 33
Loyalty Model
Based on your one practice change idea, how could you generate revenue from it?
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#2: Create a plan 1. Select a service design
2. Choose an operating focus
3. Get your team on board
4. Create and communicate a value message
5. Create demand
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1. Select the Service Design
Production line approach
Self-service approach
Personal attention approach
2. Choose an Operating Focus 1) Customer treatment (personal, friendly)
2) Speed or convenience (fast, prn, scheduled)
3) Price
4) Variety (piggy backing, one-stop shopping)
5) Quality (tangible goods, the experience)
6) Unique skill
3. Get your team on board
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How to engage in a change process?
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Unfreezing Moving
Moving
Refreezing
Langton N, Robbins SP, Judge TA. Organizational Change In Organizational Behaviour: Concepts, Controversies, Applications, 5th Canadian Ed 2010, Pearson Canada, Toronto.
Time
Good
Poor
Strategic Performance
Anticipatory Change
Reactive Change
Crisis Change
How urgently do you need to act? The Crisis Curve
Strategic Analysis and Action (5th edition) © 2002 Pearson Education Canada
Time
Good
Poor
Strategic Performance
Anticipatory Change
Reactive Change
Crisis Change
Readiness for Change
Strategic Capability
Readiness for change & strategic capability
Strategic Analysis and Action (5th edition) © 2002 Pearson Education Canada
“ . . . Results are a function of human behaviour. Behaviour is a function of attitude.
. . attitude is a function of the cultural environment . .
If you want to achieve results, you must change the cultural environment . . . You change the culture by laying out the
principles and then walking the talk religiously.”
Tom Stephens, MacMillan Bloedel
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4. Create & communicate value & demand
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Who does a good job at sending their value message?
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5. Creating a demand for services } Optometrists
} Dentists
} Doctors
} Pharmacy . . .
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“As goods and services become commoditized, the customer experiences that companies create will
matter most.”
Harvard Business Review, 1998
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