Questions Answered: Pharmacists Are Key to Achieving Value-Based Care

January 2015, Vol 3, No 1 - Inside Pharmacy

In a recent interview with Inside Patient Care: Pharmacy & Clinics, Robert Thompson, Executive Vice President of Pharmacy at Rite Aid, discussed his responsibilities, the evolution of retail pharmacies, as well as innovative services offered at Rite Aid.

What is your background in retail and role at Rite Aid?

A: I became the Executive Vice President of Pharmacy at Rite Aid in 2009. Before holding this position, I worked in the chain drug industry off-and-on since 1978, holding a variety of operational roles, including 20 years at Revco Drugstores as its Corporate Vice President of Pharmacy Operations.

After Revco, I worked outside of retail pharmacy, including a period of time as Senior Vice President and Chief Operating Officer at DentalCare Partners, and for 5 years I served as President and Chief Executive Officer of Complient Corporation in Cleveland, OH. Complient was sold to a public company called Cardiac Science, and after that, I came to Rite Aid, where I have held a variety of positions.

As the Executive Vice President of Pharmacy at Rite Aid, I am responsible for the pharmacy functions, including pharmacy operations, clinical services and healthcare initiatives, government affairs, pharmacy purchasing, and managed care and pharmacy financial services. I also oversee our 2 subsidiaries, RediClinic and Health Dialog.

How have retail pharmacies evolved to accommodate changes in healthcare delivery?

A: I always say chain pharmacies are community pharmacies, too. We want—and our pharmacists want—to be members of the community, and we work very hard to ensure that our pharmacists are providing a level of care and service that the community not only deserves but needs. As you look at the evolution of healthcare in the United States, we believe that consumers are going to become increasingly engaged in managing their own healthcare, and that is probably going to be the biggest transformation that affects our industry and healthcare delivery overall.

If we can provide a proper store environment with the right resources, we will be able to deliver a variety of healthcare services that we think will bring big benefits not only to the consumers who use those services, but also in the overall effort to improve access to healthcare, to improve the quality of the healthcare that is delivered, and to drive affordability and lower overall population health costs.

There are 4 areas we are focusing on in our effort to deliver on our goal of providing the best experience possible for our pharmacy customers. Number one, we think about expanding the role of the Rite Aid pharmacist. We seek the best trained, most professional, most clinically oriented people to be the pharmacists in our stores. We certainly agree with all the Gallup polls regarding the high trust that patients put in their pharmacists. We believe that our accessibility, and having a highly skilled professional pharmacist available to engage with the patient and to help manage their healthcare, is paramount. And so, expanding the role of the pharmacist to deliver more services is very important to Rite Aid.

The second area is providing services that meet the needs of different patient populations. There are a lot of people who are interested in wellness, but there are also a lot of people who have 1 or more chronic diseases and need our help. We need to be able to meet their needs based on the level of care that they need. Rite Aid Health Alliance is a new program that is designed specifically to address the needs of chronic and polychronic patients. Rite Aid pharmacists work with specially trained Care Coaches and physicians on an ongoing basis to help patients develop the skills they need to better understand and manage their disease. Our care team members collaborate with the patient to establish health goals, eliminate barriers, and create a personalized healthcare action plan in coordination with the patient’s physician—based on objectives established by the physician. If we are successful, these people will have healthier lives, and we will help lower overall healthcare costs. To date, we have 7 physician groups participating in Rite Aid Health Alliance and offer the service at more than 60 Rite Aid pharmacies.

The third area is RediClinic, or the retail convenient care clinic. We acquired RediClinic in April 2014 and we are very excited about it, because it is another service we can provide our patients with. Currently available inside select Rite Aid stores in the greater Philadelphia, PA, and Baltimore, MD, areas, RediClinics offer care for common conditions and preventive wellness services through board certified nurse practitioners and physician assistants. We are very pleased that we could become aligned with RediClinic and look forward to bringing this care model to additional Rite Aid customers in the future.

Lastly, we are taking a close look at telehealth, because we really believe it is here to stay—it is the way of the future. Our work with telehealth began a few years ago, through a pilot with Optum Health and NowClinic. We learned a lot through that partnership and refined our telehealth strategy as a result. Most recently, we announced an exciting new partnership with HealthSpot, an innovator in patient- and provider-driven healthcare technology. HealthSpot stations offer convenient healthcare services via private, walk-in HealthSpot stations, using high-definition video conferencing and interactive medical devices. We are excited to introduce the HealthSpot stations to our customers in Akron, Canton, Cleveland, Dayton, and Springfield, OH, in the first quarter of 2015.

What innovative services do Rite Aid pharmacists provide patients?

A: On a broad scale, the primary area of focus has been immunization, and we have worked very hard to make a broad range of immunizations accessible and affordable in all the communities we serve.

Rite Aid pharmacists have done a great job building our immunization program. We provide a broad range of immunizations, including 13 different immunizations depending on state regulation. The more work we do on immunization, the more we find that there is still a great deal of misunderstanding and misinformation surrounding immunizations in the community. Statistics indicate that vaccination rates are dropping, and we are committed to doing everything we can to ensure that immunizations are widely available, and that people can get them at their convenience, but most importantly that they actually get them. To this end, last fall we introduced Vaccine Central, a multifaceted online platform designed to help raise awareness about vaccines and promote vaccinations. Available at riteaid.com, visitors can complete an immunization evaluation, track their personal immunization history, and find other educational resources on immunizations.

In addition to immunizations, another innovative program we have undertaken is medication therapy management, which includes comprehensive medication reviews. We are designing our own programs and services to make sure that we have the opportunity to close gaps in care and identify opportunities to improve medication compliance and adherence. We participate in all of the available medication therapy management programs like Mirixa and Outcomes, and work with our pharmacists to deliver those interventions. Our pharmacists really have to be at the forefront of driving appropriate medication use, and we are working very hard to educate them on how to deliver these interventions in an effective way. Every Rite Aid pharmacist has also attended motivational interviewing training, because we believe that these conversation techniques help our pharmacists identify obstacles patients may be encountering.

We have also invested in new technology in our pharmacies to support additional medication therapy management program interventions.

Recently, we rolled out quite a unique program called “Quit for You.” It is a consultative approach to determine patients’ readiness to change or quit tobacco products, and it is delivered by the pharmacist. It offers patients a variety of options about how to approach smoking cessation based on their individual readiness and prior quitting attempts.

We have a number of other pilot programs in place around the country, including pharmacogenomic testing. In this pilot program, the pharmacist is trained to collect a DNA sample using a buccal swab. Our pharmacist then works with the physician in the event that the patient does not have the proper geno­mic profile for the particular medication, in making the appropriate therapeutic change.

We are excited about opportunities like these. We have a lot of innovative programs and services we are exploring, all with the goal of expanding the role of the pharmacist, making best use of technology, improving access to healthcare services, and providing affordable and convenient options for the patients in our communities.

How do retail clinics contribute to disruptive healthcare innovation?

A: The time for the convenient care retail clinic model, like RediClinic, has finally come. I think consumers are beginning to understand the value of the model. What we are trying to do is be part of an overall healthcare delivery network. Given the accessibility problem and the shortage of primary care physicians in the United States, we know that RediClinic can be part of the solution.

To be clear, we do not want to displace our patients from their primary care physicians, and that’s why we work hard to ensure that our approach is one rooted in collaboration—not competition. However, there is opportunity; if a patient’s primary care physician is not available—because there is a flu epidemic, for instance, and they are not available for 2 days—our clinics present an attractive alternative.

In addition, we think that if we are collaborative with physicians, then hopefully we can be a gateway for those people looking to find a primary care physician. We want to make sure that if a patient comes in, is new to the community, and needs a primary care relationship, that we can meet their immediate needs and perhaps help them find the right primary care relationship to help manage their health going forward.

How do you think the model for retail clinics will evolve or change in the next 5 to 10 years?

A: We are aiming to create a network of RediClinics that are integrated into the overall healthcare system within a particular community, with the ability to easily exchange electronic medical records, and ensure a continuum of care between RediClinics and primary care or specialty care.

Today, the nurse practitioner clinic model or the convenient care clinic model is focused on acute care. That is really important. It is a very cost-effective way to provide acute care treatment.

Going forward, I believe we will see a shift in care models, with chronic care management opportunities moving closer to where the patient actually lives. Ultimately, this should lead to more effective overall management of those patients.

Once electronic medical record interoperability issues are solved, there is going to be a dramatic transformation of healthcare delivery, and improved care coordination. Improved exchange of medical records will position nurse practitioners to support additional chronic care management activities in addition to our pharmacists. In the same way, improved medical device technology will lead to improved diagnostic and biometric capabilities.

Simply put, today, healthcare exists in a lot of silos. The healthcare delivery system of tomorrow is ideally without silos. That means everyone has to really have the same motivation and the same idea about how care is best delivered and best managed. That’s going to be challenging, but it is achievable.

“Everything we are working on, from immunizations to medication therapy management, disease management, and health coaching, is all about trying to constantly improve health outcomes for patients, and measure them,” Robert Thompson concluded. “Pharmacists are key to solving the cost of healthcare problem in the United States. If we can get patients to take their medicines, stay on their therapies, and help them avoid medication misadventures, we can not only improve their health and well-being, but we can help save billions of dollars in healthcare costs every year.”

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