Progressive Business Model Streamlines Operations, Improves Pharmacy Experience

This is part of ScriptPro’s In the Field series, which highlights ScriptPro customers engaging in unique programs that positively impact their local communities.

“The business model we run puts our pharmacists in the position to do what they were trained to do.” That’s the longstanding belief behind Smilin’ Steve’s Neighborhood Pharmacies in Vermont.

“Pharmacists today are the ‘healthcare hub’ – they have the most access to and interaction with patients, and they are on the front lines of needing to be available as healthcare providers,” says Vice President of Operations Jeff Hochberg, who directs the management teams at the four Vermont locations of Smilin’ Steve’s.

Having grown up in the business, Jeff remembers the school bus dropping him off each afternoon to his parents’ pharmacy. It was a whole family affair then, and now includes the next generation with Jeff and his brother Jason, and both of their families, working alongside their father “Smilin’ Steve.”

“We’re making the old corner store stigma of pharmacy a thing of the past. Our progressive model is helping us obtain this goal, because we don’t put the emphasis on the pharmacists to run the business. Instead, our pharmacists are actually practicing pharmacy and engaging in patient-focused activities. Each store has a Pharmacist in Charge who is responsible for the clinical side of things and a store manager who is responsible for the business end,” notes Hochberg. “It creates a teamwork approach.”

Integrated pharmacy systems maximize operational efficiency

“Historically, you would have four different systems at play in the pharmacy in order to manage operations. Every day, claims have to be reviewed in such business optics of whether they’re financially beneficial to everybody and you have to make economic decisions for the patients.” Hochberg goes on, “Small independents like us would have to take a system here and a system there and put it all together AND have somebody create some sort of exchange between all the players. Partnering with knowledgeable pharmacy system providers, such as ScriptPro, streamlines it all. Now all of this information is integrated and automated, creating a clean path for us to best navigate all of the financial and business models we need to pay attention to.”

Navigating third party contracts & reconciliation

Change is happening industry-wide and pharmacy owners need to pay close attention to what’s going on with third parties. Pharmacy Benefit Managers (PBMs) are increasingly getting negative press with their ongoing lack of transparency and the behind-the-scenes dealings when it comes to DIR fees. Hochberg says, “There have been a lot of rule changes that certainly are in independent pharmacies’ favor, and major issues around PBMs are being brought to light. I think that nationally CMS is starting to push back. That said, 2018 is going to be a very tough year and independent pharmacists are going to be targeted by PBMs looking to maximize their profits.

Rutland Pharmacy is just one of two specialty accredited brick & mortar hubs in Vermont, fulfilling a growing need in the community.

“For our pharmacy to be successful, we need to take part in as many plans as we can. Sometimes those plans can be harmful to our business integrity. It’s difficult to navigate. Having some sort of robust reconciliation system like ScriptPro’s Third Party Management System (TPMS) makes a difference. We’re very close to launching TPMS. We recognized that we must have the ability to dive into these plans and see what’s going on – how are we really being impacted with reimbursements? Are we getting paid what we should? What are our contractual agreements? As a business owner, why wouldn’t you want to look at these things yourself as much as you can?

Specialty & clinical services are the future of pharmacy

“We offer compounding services and a full line of DME. Our Rutland store is a specialty accredited hub – it’s one of only two brick and mortar accredited hubs in the state.” Hochberg adds, “This is where the business of pharmacy is going, with brand name drugs becoming increasingly specialized to specific disease states.

“Because of our specialty accreditation, we started seeing growth to that business. We quickly realized our current manual record keeping wasn’t going to be adequate for our population, and in order to achieve growth, we needed to get behind a platform that could help us. So, we’re about to launch ScriptPro’s Advanced Pharmacy Clinical Services (APCS), which is fully integrated and puts everything together. It’s outstanding. Due diligence is imperative to making sure documentation and outcomes are being tracked and monitored. You need a system that really supports this, as well as allows your pharmacists to engage meaningfully. APCS will help us do that.”

Hochberg assesses that generic drugs are 85% of their business, yet just 25% of the revenue. The brand name drugs still left on the market are typically specialty oriented, or if they’re not specialty now they’ll either go generic or will be carved in to specialty later. According to Hochberg, “This revenue is available, but it’s a very expensive business. Specialty drugs are a big investment in terms of inventory and manpower to help manage outcomes, but there are even bigger rewards. To be a player in pharmacy’s future, it’s crucial you have a great team, and a great system, to help monitor all aspects of specialty pharmacy.

Owner & Pharmacist Smilin’ Steve Hochberg (far right) offers four Vermont locations, staffed with a team of dedicated pharmacists, techs, and store managers.

Advocating for pharmacists as healthcare providers

Hochberg is actively involved in Vermont’s legislative process, advocating for transparency and bolstering the role pharmacists play in patients’ lives.

“Today, pharmacists still are not considered providers of healthcare per Medicare law. The value of information a pharmacist can provide any patient in terms of side effects and outcomes is enormous. What is being prescribed to patients is determined by insurance companies, third parties, and their formularies of what’s covered or not. That is not good medicine! Good medicine is whatever is best for the patient – and the people who know the patient best are your primary care physician and your pharmacist,” states Hochberg.

He advocates for a place at the healthcare table for pharmacy, noting that pharmacists need to work closely with state legislatures to find opportunities to increase patient access to healthcare, lower costs, and improve outcomes. “It’s going to take a lot of reform to achieve these goals. And, I would like to see states look to pharmacy to help them solve some of the problems. For example, with opioid epidemic, PMP programs could be better managed. There’s a lot of data out there yet to be utilized.

“The more informed and the more we can communicate directly with prescribers, the better our outcomes are going to be. It’s all about enhancing the ability of pharmacists to do that while also protecting them.”

Improving the pharmacist-patient experience

“When a pharmacy institutes systems to help manage all the different aspects of its business, they can afford the time for the pharmacist to truly interact with customers. We see firsthand how this instantly boosts customer service and the overall patient experience. A streamlined system also increases speed and accuracy. When you put it all together, your pharmacy instantly outshines any chain.

“You can successfully make the strategic decision to put your pharmacist out front when you have a strong team behind you with a unified pharmacy system. The focus turns to educating your patients; they want to participate in their own healthcare and rightfully they should be able to. The better systems you have in the back office and behind the pharmacy counter, the more you can put towards customer service – and the greater the return for both your patients and your practice.”

‍