How are retail pharmacies evolving to accommodate changes in healthcare delivery?
AJ: A lot of the retail pharmacy chains have recognized the fact that they can play a pretty significant role in community-based care, primary care, and acute care. The reason for that is many of them are sitting on retail footprints, feuding about their geography and their brick and mortar stores that are accessible to over 80% of the US population. Leveraging that retail footprint in the community and playing a role in primary care, for example, is an opportunity for them to expand their business into areas that would create new revenue streams for them.
What is the role of the retail clinics in this capacity?
AJ: Retail clinics have been around for quite a while now. They started out as occupational health clinics on employer worksites. They have evolved into more acute care settings, where you can go and get primary care. You can have an office visit, just like you would with your primary care physician. The role that they are playing is really to extend access to the community. There are a lot of people in this country that either do not have access or cannot get to a primary care doctor, whether it is because we have a primary care physician shortage, or they live in a geography where it is not easily accessible, or they lack transportation. Retail clinics are filling that void by creating a place where, as a destination, people can go and get the kind of care that they would get in a primary care physician’s office.
How are changes in retail pharmacy impacting the consumer?
AJ: The retail pharmacy has been around a really long time. It has traditionally been seen as a destination for you to just go pick up your medications. We have under-
leveraged the profession for a long time. Pharmacists were relegated to sitting behind the counter and counting out pills into a vile.
It is part of our ecosystem from a provider’s standpoint that is very underutilized. The role of the pharmacist is one that we ought to value, and, frankly, elevate to the highest level of their license and give them an opportunity to share in the delivery of care for patients. They are very well educated. They have face-to-face relationships with the patient and can have a meaningful impact on a patient’s outcomes.
The fact that we are finally repurposing that profession and respecting it and giving pharmacists a role where they cannot only be an advocate, but potentially a provider of care, I think extends the profession, and also gives us the capacity that we need in healthcare to give people access to providers where there may not be one.
What patient group have you seen take advantage the most of retail clinics?
AJ: Interestingly enough, there is a misconception out there that retail clinics are frequented by moms and young kids. Typically, you might think there might be a mom who has a little kid with an upper respiratory infection or is going in for some medications that are low-end prescription needs.
What we have actually seen in the studies is that it is mostly the people who are on Medicare that are accessing the retail clinics. Again, it is convenience. They also like the ability to go in without an appointment, and they like the ability to be able to get their medications conveniently with a pharmacist who they already have a relationship with that might be sitting 20 feet away from that clinic.
The population, as it gets more comfortable with retail clinics and sees them as a valid and legitimate place of service; the volume is going to grow and you are going to see much more diversity of users.
There are statistics, however, that indicate that the majority of those users are still women. I still think there is a perception that it may not be a safe environment for people who want to have a more private conversation, and, of course, there are limitations on the scope of practice of a nurse practitioner.
The guideline basically is we can only diagnose things from the waist up. They can’t do a full diagnosis of anything more serious than an acute episode, if you will.
How is the healthcare team inside and outside the pharmacy coordinating patient care?
AJ: This is an exciting area, because we are seeing for the first time much more collaboration and alliances being formed between the retail pharmacy community and what we consider the traditional provider community.
If you think about the expansion of retail pharmacies in hospital footprints, for example, 340B is one of the reasons that a lot of the pharmacies are entering the hospital space. It is typically an entry point for them to help with the supply chain and the cost of drugs. What it ends up becoming is a relationship where they can then manage patient care, do clinical interventions, and help with adherence and outcomes.
We are starting to see formal alliances and partnerships being created between hospitals, provider systems, physician systems, and pharmacies for the first time in a long time. It is actually the foundation of accountable care organizations, and whether or not they continue to mature remains to be seen. What is promising is the fact that they are sharing data.
For example, they are starting to share information on pharmacy dispensing platforms that typically were not found in the electronic medical records in the past. There is much more openness now to sharing that data bilaterally and using it to intervene for clinical outcome improvement.
What key opportunities and challenges lie ahead for retail clinics?
AJ: I think the biggest opportunity for retail clinics is to continue to prove their model and to demonstrate that they are going to be partners in the value chain and not just threats to the provider community. That they can be there as physician extenders, as excess capacity that can be utilized by the physician, and as individuals, pharmacists in particular, who have face-to-face relationships with patients that can be leveraged for better results.
I think some of the challenges they face, quite frankly, are in regulatory restrictions and the fact that we are continuing to operate in an environment that has not caught up with the evolution of the business models. We still work against restrictions around licensing, cross border, state-to-state transfer of goods and services and the disparity of regulatory requirements that we have to comply with from state to state, not to mention the federal level.
The complexity of the regulations is, in many ways, stifling this innovation. If we could get our elected officials to recognize what efficiency could look like, we could strip a lot of waste out of the system and, frankly, deliver some savings.
“If you haven’t been in a retail clinic lately, and if you haven’t talked to a pharmacist that counsels patients, I would tell you to go experience it for yourself, because I think you’d walk away very surprised at how far they’ve come,” Ms Jung stated in her concluding remarks.