Latest / Pharmacy Podcast Network / Patients, Payments & the Path to Profitability | Pharmacist-Prescribed

Transcript

Patients, Payments & the Path to Profitability | Pharmacist-Prescribed · Pharmacy Podcast Network

0:05
Speaker 1: You are listening to the global network of podcasters dedicated
0:09
Speaker 1: to the pharmacy profession. Welcome to the Pharmacy Podcast Network.
0:30
Speaker 2: Welcome to Pharmacist Prescribed, a series about the expanding role
0:34
Speaker 2: of community pharmacists and patient care.
0:38
Speaker 3: Hey, welcome back to Pharmacist Prescribed podcast series Here on
0:43
Speaker 3: the Pharmacy Podcast Network. Today is Patients Payments in the
0:48
Speaker 3: Path to Profitability. I'm excited to have back Devin and
0:54
Speaker 3: Mary from prism It's so good to see you both.
0:58
Speaker 4: Oh, he's a pleasure.
0:59
Speaker 5: Yeah, thank you.
1:00
Speaker 3: You're listening along. There's going to be some show notes
1:02
Speaker 3: to support us. There is a podcast series that we're building.
1:07
Speaker 3: Just go out to the website, getprismarx dot com. Once again,
1:11
Speaker 3: that's getprismarx dot com. Go to the about section and
1:15
Speaker 3: you'll see the podcast library. This is going to be
1:19
Speaker 3: a lot more context to you for episode three. Upcoming.
1:24
Speaker 3: Episode one and two, we talked about the access and implementation.
1:28
Speaker 3: Today we're going to focus on sustainability. How do pharmacies
1:32
Speaker 3: actually make pharmacists lead clinical service financial viable, long term decisions.
1:40
Speaker 3: I'm curious about this and can't wait to dig in.
1:43
Speaker 6: Absolutely no, I think it's obviously it's great from a
1:47
Speaker 6: hoblic health perspective to do clinical services, but we all
1:51
Speaker 6: understand that it needs to be profitable. You know, the
1:54
Speaker 6: incentives needs to align so for patients that it's great
1:57
Speaker 6: from an access perspective, but as a pharmacy owner, a
2:00
Speaker 6: small business owner, how do you do it in a
2:02
Speaker 6: way that also benefits your business? And I think in general,
2:06
Speaker 6: the sustainability depends on three main factors. One is patient demand,
2:11
Speaker 6: which we believe is there, and there's a lot of
2:13
Speaker 6: evidence to show that. Number two is efficiency, right, like
2:18
Speaker 6: you need to be able to work this into your
2:20
Speaker 6: existing workflows and do it in a way that you
2:23
Speaker 6: don't need to increase your overhead significantly like upstaffing for example.
2:28
Speaker 6: And then you know three is appropriate reimbursement pathways, so
2:31
Speaker 6: making money for the services. I think we can all
2:34
Speaker 6: agree that pharmacists have been kind of giving away their
2:37
Speaker 6: expertise for a really long time, and that has become
2:39
Speaker 6: the norm. It's what the patients started to expect. But
2:42
Speaker 6: you've got to stop doing that. You've got to, you know,
2:45
Speaker 6: capitalize on the fact that you're experts and that your
2:49
Speaker 6: you know, your guidance is valuable. So this is kind
2:54
Speaker 6: of the pathway to implementing it in a way that's
2:58
Speaker 6: long term financially viable.
3:00
Speaker 4: And when you consider, you know, patients are already paying
3:03
Speaker 4: a lot of money every single year even for urgent
3:06
Speaker 4: care visits, right, and urgent care is usually extremely costly.
3:12
Speaker 4: A lot of times you're not going to see a
3:13
Speaker 4: doctor either, you're going to see kind of a mid
3:16
Speaker 4: level and it's so much more accessible to just go
3:22
Speaker 4: to the pharmacy and actually see a farm d at
3:26
Speaker 4: that point, right, And you know, urgent care clinics they
3:31
Speaker 4: also they don't accept a lot of different types of appointments,
3:35
Speaker 4: so like they're not doing basic vaccinations, they're not doing
3:39
Speaker 4: STI or TESTA treats for some things, they're not doing
3:43
Speaker 4: birth control consults, a lot of the things that pharmacists
3:46
Speaker 4: can do, and are doing urgent care oftentimes. I mean,
3:50
Speaker 4: I've tried to go to urgent care for birth control
3:52
Speaker 4: and they tell me we don't do that. So there's
3:56
Speaker 4: obviously this gap that exists, and you know, patients are
4:01
Speaker 4: used to paying for urgent care visits up to one
4:05
Speaker 4: hundred to one hundred and fifty dollars per appointment, so
4:08
Speaker 4: if we can take and translate even a fraction of
4:10
Speaker 4: that business and dollars over to the pharmacy, everybody can
4:15
Speaker 4: be happy. And it's not so about to have a
4:17
Speaker 4: weight line in the er and urgent care.
4:19
Speaker 6: Yeah, then from a patient perspective, they go to one place,
4:21
Speaker 6: they get their men, they go home. They don't have
4:23
Speaker 6: to then go to the pharmacy after the fact, and
4:24
Speaker 6: usually an urgent care you wait right like, it's not instantaneous.
4:28
Speaker 6: And the other thing is that even with low volume
4:30
Speaker 6: of services, we're not talking about twenty thirty appointments a day,
4:34
Speaker 6: we're talking about one to two, three four appointments a day,
4:36
Speaker 6: you're making reasonable additional revenue without disrupting you know, dispensing,
4:43
Speaker 6: and you're actually getting new patients and you're getting more.
4:45
Speaker 5: Dispensing revenue as well.
4:47
Speaker 6: So, you know, we think the clinical services they fail
4:50
Speaker 6: when they're treated as add ons rather than integrated operations.
4:55
Speaker 6: And it really needs to be workflows that are streamlined
4:59
Speaker 6: with optimized staff roles. So for example, you know, pharmacists
5:04
Speaker 6: are super busy. I mean everyone's really busy, right, but
5:06
Speaker 6: pharmacists time is valuable and needs to be protected, and
5:10
Speaker 6: so having a way for you know, the pharmacy technicians
5:13
Speaker 6: to do some of the front of the house administrative efforts,
5:18
Speaker 6: you know, helping with the patient recruitment side. You know,
5:20
Speaker 6: these things become really exponentially important to building and maintaining
5:25
Speaker 6: clinical services in a retail pharmacy.
5:29
Speaker 4: And yeah, I mean realistically, Todd. You're you're a small
5:32
Speaker 4: business owner too, so you know, repeatable processes and just
5:37
Speaker 4: perfecting a workflow is really what shines, right, and you
5:45
Speaker 4: get good at it, you get more reps in, you
5:50
Speaker 4: become better at that service time and time again. So
5:54
Speaker 4: make it repeatable, make it billable, and embed it into
5:57
Speaker 4: your daily operations and practice, just like any other small
6:01
Speaker 4: business does, and it becomes financially viable and a great
6:06
Speaker 4: service to add to the customers and patients.
6:09
Speaker 6: And then your whole staff knows how to do clinical services.
6:11
Speaker 6: It's like a new new skill unlocked, right, And you
6:15
Speaker 6: can start small with one service, but that can.
6:17
Speaker 5: Be expanded upon over time. So that's the other key.
6:22
Speaker 3: I love it because it's a system that's ready to
6:26
Speaker 3: go and being able to plug in a process to
6:29
Speaker 3: it is going to build the systems. Just like you said, Mary,
6:33
Speaker 3: to repeat it over and over again, So all right,
6:37
Speaker 3: let's pretend we got the process figured out, we have
6:40
Speaker 3: implementation ready prisms in place. Now we need patient demand.
6:45
Speaker 3: We need to dig into creating demand somehow. And I
6:49
Speaker 3: don't want to spend a lot of money on marketing.
6:53
Speaker 3: So how can pharmacies find and engage patients for clinical
6:57
Speaker 3: services without worrying about a whole bunch of marketing. Maybe
7:01
Speaker 3: I'll be able to market later, but what about in
7:03
Speaker 3: the beginning.
7:05
Speaker 6: Yeah, I think it's if you build it, they will
7:07
Speaker 6: come kind of scenario. But they need to know that
7:09
Speaker 6: it's there, right, And so the awareness side is important.
7:12
Speaker 6: There's a lot of things that you can do for
7:14
Speaker 6: free actually, right, you know, to build that patient awareness
7:18
Speaker 6: and make a commitment to building you know, the services.
7:21
Speaker 6: So for one, you know, many pharmacies have foot traffic.
7:25
Speaker 6: You know, we've worked with some pharmacies that are in
7:26
Speaker 6: grocery stores for example, Like that's great, right, there's a
7:30
Speaker 6: lot of foot traffic.
7:31
Speaker 5: So you need to leverage things like that.
7:33
Speaker 6: Even if you're a pharmacy with lower foot traffic, it
7:36
Speaker 6: can still be you know, helpful to recruit the patients
7:39
Speaker 6: that are in the store through you know, printed posters
7:43
Speaker 6: with a QR code that they can scan to create
7:45
Speaker 6: their prison profile. For example, if you are on a
7:49
Speaker 6: corner of a busy intersection, like having the sign on
7:51
Speaker 6: the outside, right, Like just the basic stuff that is
7:55
Speaker 6: cheap but increases awareness.
7:58
Speaker 4: The next one would definitely be reaching out to your
8:00
Speaker 4: existing patients. I know, even during the clinical trial or
8:04
Speaker 4: trial participants reached out to you know, the women who
8:10
Speaker 4: were only had one or two months left on their
8:12
Speaker 4: contraceptive prescription, especially in the rural locations, that was a
8:19
Speaker 4: hotbed opportunity, right because they don't want to have to
8:22
Speaker 4: drive one two hours to get back to their general
8:26
Speaker 4: practitioner or OBIGNE to go get that script refilled. It
8:31
Speaker 4: was much easier for that patient to just go, oh,
8:34
Speaker 4: I can get my script field today while I'm already
8:36
Speaker 4: picking up you know this super refil perfect let me
8:39
Speaker 4: do that. So reaching out to the existing patients letting
8:42
Speaker 4: them know that this opportunity and offering now exists. Definitely
8:48
Speaker 4: reaching out to the ones that only have one or
8:50
Speaker 4: two months left on their prescription. But even like beyond that,
8:54
Speaker 4: because so many patients are used to having to book
8:57
Speaker 4: at least like ninety days in advance with their doctor
9:00
Speaker 4: at this point, Like you know, reaching out at the
9:03
Speaker 4: right time and just ensuring that these people still want
9:07
Speaker 4: on that medication is.
9:08
Speaker 6: Helpful, super easy, right because you already have that data
9:11
Speaker 6: in your pharmacy management system. So I know, we've worked
9:14
Speaker 6: with a lot of pioneer RX you know, pharmacies that
9:17
Speaker 6: use that pharmacy management system, and like you can run
9:19
Speaker 6: your own report real quick and literally get every patient
9:22
Speaker 6: that has ever filled a prescription for contraceptives, and then
9:26
Speaker 6: you can have a tech to do outreach when it's slow,
9:29
Speaker 6: and I mean that's just that's not only free, but
9:31
Speaker 6: it's highly targeted. The other thing is having the front
9:34
Speaker 6: of house staff having have a script, right, Like if
9:37
Speaker 6: you're going to initiate contraceptive services, for example, every female
9:41
Speaker 6: of reproductive age that enters the store, someone should mention
9:44
Speaker 6: that you do that service. They may not need it
9:46
Speaker 6: right now, but you're raising awareness and that will help
9:50
Speaker 6: them tell their friends and it will help kind of
9:53
Speaker 6: build that up.
9:54
Speaker 4: And we say, you know, we give these examples for
9:57
Speaker 4: contraception because you know that was that is our launch point, right,
10:02
Speaker 4: that was our clinical trial, and we have a lot
10:05
Speaker 4: of data to support that.
10:06
Speaker 2: But realistically we're now released releasing new modules that includes
10:13
Speaker 2: diabetes management, weight management, hypertension management, allergies management.
10:18
Speaker 4: Wellness, women's health wellness. So you look in and you're
10:22
Speaker 4: getting these patients in that are on you know, they're
10:26
Speaker 4: taking medications for diabetes or hypertension or anything else, and
10:30
Speaker 4: it's hey, do you do you need to look at it?
10:32
Speaker 4: Do you want to sit down and look at your
10:33
Speaker 4: medications and have come up with a new game plan
10:36
Speaker 4: for twenty twenty six to get you healthier? Right, Like,
10:39
Speaker 4: that's an easy conversation where you can tell a pharmacist
10:43
Speaker 4: can now really be more part of your care plan
10:46
Speaker 4: and again kind of create a i'll say, a better
10:50
Speaker 4: patient relationship with the individual rather than just so transactional
10:56
Speaker 4: at the counter where it's usually a pharmacy tech handing
10:59
Speaker 4: them a medication and then getting that prescription in return. Right,
11:03
Speaker 4: this is now having full conversations that feel more collaborative
11:09
Speaker 4: than oftentimes seen at a doctor's office because the doctor's
11:13
Speaker 4: no offense and doctors are often so busy. You get
11:16
Speaker 4: to see them for two or three minutes and they're
11:18
Speaker 4: on the computer the entire time. This is a conversation.
11:22
Speaker 6: Yeah, Well, and then you know like she mentioned the
11:24
Speaker 6: diabetes management or hypertension. I mean you can run that
11:26
Speaker 6: report too in Pioneer r X or any other PMS.
11:29
Speaker 6: You can also do provide her outreach. So maybe there's
11:32
Speaker 6: a couple collaborative physicians in your area.
11:34
Speaker 5: That have a lot of patients that have diabetes.
11:37
Speaker 6: Like that's where you tell them, Hey, I am happy
11:40
Speaker 6: to be the in between here. You know, you're prescribing
11:43
Speaker 6: the anti hypertensive, but I'm here to like help increase
11:47
Speaker 6: the efficacy through counseling with the patient.
11:50
Speaker 5: And I can do some even.
11:51
Speaker 6: Diet and exercise and behavioral change counseling, and their patients
11:57
Speaker 6: will have a better outcome because of it. So I
11:59
Speaker 6: think they're that like outreaching to the right community providers
12:04
Speaker 6: in the area, letting them know you're doing it. We
12:06
Speaker 6: even had some sites that were reaching out to large
12:09
Speaker 6: chain stores in the area because those stores aren't doing
12:12
Speaker 6: the services. So let's say patients are going to CBS
12:15
Speaker 6: and they ran out of a prescription for contraceptive or
12:18
Speaker 6: for you know something else they can then you know
12:22
Speaker 6: that pharmacist will know, hey, well, if you go down
12:24
Speaker 6: to you know, your local independent pharmacy, they can provide
12:27
Speaker 6: that service today.
12:28
Speaker 5: You don't have to wait.
12:29
Speaker 4: And because we're connected to the Shure Scripts network for
12:31
Speaker 4: new prescriptions, they can still send that patient right back
12:34
Speaker 4: if they want. If the patient still says, well, I
12:36
Speaker 4: want to stay with my CBS pharmacy, you're unlocking a
12:39
Speaker 4: whole new clinical service.
12:41
Speaker 6: I prescribe it to the original pharmacy if you want so,
12:44
Speaker 6: or you don't have to. So the point is that
12:46
Speaker 6: it unlocks all of that, and all of that's free, right.
12:49
Speaker 6: And then local PR. You know, we had a couple
12:52
Speaker 6: customers that were in very rural areas and they knew
12:55
Speaker 6: the local newspaper owners and whatnot, and they ran you know,
12:59
Speaker 6: PR campaigns locally that said, hey, you know, this pharmacy
13:03
Speaker 6: is stepping up to fill in the gaps. And not
13:05
Speaker 6: only does that make you look great, but it also
13:07
Speaker 6: increases awareness that you're doing clinical services.
13:11
Speaker 4: And yeah, I mean once once you create that clinical
13:15
Speaker 4: service and people know about you and they're aware of it,
13:18
Speaker 4: that patient provider relationship really grows and expands because people
13:23
Speaker 4: don't they don't want to switch providers unless they have to. Yeah,
13:29
Speaker 4: but a lot of patients look at prescriptions as a
13:35
Speaker 4: transaction rather than they don't realize what's going on behind
13:38
Speaker 4: the scenes, that pharmacists are checking everything and making sure
13:41
Speaker 4: that that patient's going to stay safe. All they see
13:44
Speaker 4: is what they get when they get to the.
13:45
Speaker 5: Counter, Right, you counted pills and handed me a bottle.
13:48
Speaker 4: Like that's so that's the perception and it's unfortunate, but
13:52
Speaker 4: realistically they're doing so much more and it's just not seen.
13:57
Speaker 4: So that patient provider relationship, at least from a patient perspective,
14:02
Speaker 4: grows whenever they get more FaceTime with that pharmacist, and
14:05
Speaker 4: that can come through clinical services. So once they're there,
14:09
Speaker 4: they're you know, that relationship is just only flourishing more
14:13
Speaker 4: generally what we've seen, Like, it was so much fun
14:16
Speaker 4: watching the clinical trials and getting feedback from everybody but
14:19
Speaker 4: the pharmacists as well as the patients through those surveys.
14:23
Speaker 4: It was really it was really enjoyable to get to
14:25
Speaker 4: see what everybody, yeah, add in their experience.
14:28
Speaker 6: So all of that is free, right, Like everything we
14:30
Speaker 6: just talked about costs zero dollars, which is awesome.
14:33
Speaker 2: You know.
14:33
Speaker 6: Then let's say you want to you know, grow even further,
14:36
Speaker 6: then you can start paying for you know, hyperlocal digital
14:39
Speaker 6: marketing campaigns and things like that if you really want
14:41
Speaker 6: to scale. But really the truth is, like I like
14:44
Speaker 6: that the analogy. You know, building a campfire is hard, right, Like,
14:49
Speaker 6: it takes time. You need to have the right wood
14:51
Speaker 6: and kindling and you know, the right fire starting equipment whatever,
14:54
Speaker 6: and it's kind of like hard to get started sometimes.
14:56
Speaker 6: But once it's started and you have logs and it's
14:59
Speaker 6: very you just kind of keep the fire going by
15:01
Speaker 6: throwing a log in. And that's the same thing as
15:03
Speaker 6: building clinical services in a pharmacy. It's it's harder, a
15:06
Speaker 6: little bit harder to get started, but once it's started,
15:09
Speaker 6: you just you just keep it alive and it can
15:12
Speaker 6: continue to grow. And if you want to add two
15:14
Speaker 6: logs instead of one, you can make the fire bigger, right,
15:17
Speaker 6: And that that happens because of word of mouth, right Like,
15:19
Speaker 6: once the patients get the service, they like it, they
15:22
Speaker 6: tell their friends and it becomes exponential.
15:25
Speaker 5: And the other thing is you need a you need.
15:27
Speaker 6: A way to intake the patients digitally, and that's something
15:30
Speaker 6: that really has been lacking.
15:32
Speaker 5: You know, any ad needs a call to action. Anytime
15:35
Speaker 5: a patient is in the store.
15:36
Speaker 6: You need to have an easy way for them to
15:38
Speaker 6: get started scanning a QR code and PRISM makes that
15:42
Speaker 6: kind of digital front door very easy.
15:44
Speaker 3: That's awesome implementation finding our patients. And now someone's listening
15:49
Speaker 3: to this podcast and they're like, time out. I've done
15:53
Speaker 3: programs before. I have so much confusion around billing. So
15:59
Speaker 3: let's talk about act getting paid. Why is getting paid
16:02
Speaker 3: for clinical services so difficult for our pharmacies today.
16:07
Speaker 4: Because the federal government needs to do something. Now I'm
16:09
Speaker 4: just well, I mean, I'm not going but that's part
16:13
Speaker 4: of the problem part of it. Pharmacist lack federal provider status,
16:16
Speaker 4: so it makes it really challenging from a billing standpoint
16:19
Speaker 4: across the board. So it's kind of like rolling the
16:22
Speaker 4: dice anytime they're going to provide a clinical service if
16:25
Speaker 4: it's actually going to get accepted. And then there's different
16:28
Speaker 4: rules in every single state of how it needs to
16:31
Speaker 4: be conducted, and it gets really, really kind of messy.
16:35
Speaker 4: Even within each state, there's different regions that request different
16:39
Speaker 4: things and how it's submitted. So the confusion from a
16:44
Speaker 4: pharmacist perspective is very valid. And the patient has no idea,
16:49
Speaker 4: They're just all they know is is it accepted? Or not, right,
16:52
Speaker 4: So that's the difficulty of some of those transactions.
16:55
Speaker 6: As well, definitely, And so you know ECAPS Act, you know,
16:58
Speaker 6: if that passes, that would give pharmacists federal provider status,
17:02
Speaker 6: which wuld be huge, right because that would open up Medicare,
17:06
Speaker 6: which currently can't be built by a pharmacist at all.
17:09
Speaker 6: And also then once you know Medicare does some when
17:12
Speaker 6: CMS does stuff, the private pairs tend to follow. So
17:14
Speaker 6: right now, you know, if a private pair decides they
17:17
Speaker 6: want to pay for pharmacist service, it's kind of like
17:20
Speaker 6: an exception, not the rule, and it's treated as such.
17:24
Speaker 5: And sometimes there even needs to be like more of
17:26
Speaker 5: a value based care.
17:28
Speaker 6: It's not really fee for service, which is much easier
17:30
Speaker 6: for smaller businesses to do. So that that hopefully will
17:35
Speaker 6: all change right now. You know, Medicaid is kind of
17:39
Speaker 6: the is a great starting point in many states, but
17:43
Speaker 6: even that gets a little bit tricky because you know,
17:47
Speaker 6: a lot of states allow the pharmacists to build Medicaid directly,
17:50
Speaker 6: but if there's a managed care organization for the beneficiary,
17:54
Speaker 6: So if it's not like a direct Medicaid plan it's
17:56
Speaker 6: run through a managed care organization, you need to do
18:00
Speaker 6: contract negotiation because every third payer, like private insurance or
18:04
Speaker 6: MCO or even for medicare if even once he caps
18:08
Speaker 6: passes Medicare advantage, right like, that has a third party.
18:12
Speaker 6: So anytime that there's a third party that needs to
18:14
Speaker 6: be contracting and that gets a little bit tricky just
18:16
Speaker 6: because it's mainly designed for large healthcare systems, not necessarily
18:21
Speaker 6: independent pharmacies. You know, CPESN and you know is a
18:25
Speaker 6: great organization that helps with that side of things. You know,
18:29
Speaker 6: so if you're either part of that organization or you
18:32
Speaker 6: know other pharmacy owners that are, I would definitely reach
18:35
Speaker 6: out to them to get to know your local payer ecosystem.
18:39
Speaker 6: But there is there is a way to get started
18:41
Speaker 6: submitting claims, but the easiest way to get started is cash.
18:46
Speaker 6: Cash is king from a starting perspective. It makes it
18:50
Speaker 6: so much easier. You know, not all pharmacies have a
18:53
Speaker 6: pair mix that can support that, but many do. And
18:58
Speaker 6: you have to remember that privately insured patients pay a
19:00
Speaker 6: copay of usually like thirty five to I don't know,
19:04
Speaker 6: one hundred dollars.
19:05
Speaker 4: Really twenty five to fifty dollars for a lot of
19:08
Speaker 4: these general appointments.
19:09
Speaker 6: Right so thirty five dollars cash pay to walk in
19:12
Speaker 6: a pharmacy today, get expert service, and walk out with
19:15
Speaker 6: a prescription for a year or like with you know,
19:18
Speaker 6: maybe three months of the prescription and refills for up
19:20
Speaker 6: two a year, or contraception or whatever else it may be.
19:24
Speaker 5: It's kind of attractive.
19:26
Speaker 7: Well, and you know understand and get doing all of
19:31
Speaker 7: the paperwork and jumping through all the hoops for insurance
19:34
Speaker 7: and everything else like that.
19:36
Speaker 4: That's only part of it. It's still all the claim
19:39
Speaker 4: reimbursement aspects that are cycle management, revenue, cycle management, all
19:43
Speaker 4: of that comes into play and gets really difficult, especially
19:46
Speaker 4: for small businesses, right, like having to try to track
19:50
Speaker 4: that full element. We're watching endless doctors, surgeons, everybody else
19:58
Speaker 4: in healthcare fighting to the nail to even get anything
20:01
Speaker 4: approved for their patients. Right, so we know that a
20:07
Speaker 4: lot of doctors are going to and direct primary care
20:13
Speaker 4: models and all of these other things because insurance is
20:16
Speaker 4: just not as feasible, both from a business standpoint or
20:21
Speaker 4: from a patient actually getting what they need standpoints. So
20:24
Speaker 4: not to pooh pooh completely on insurance, but like it's
20:28
Speaker 4: not something that should hold you back in the journey
20:31
Speaker 4: of starting clinical services and creating that new line of
20:36
Speaker 4: business for your small business. Right, it should just be
20:40
Speaker 4: kind of a cherry on top that once everything gets
20:43
Speaker 4: passed through legislation and pharmacists finally get the provider status
20:46
Speaker 4: federally recognized, now we can really just like crank it up.
20:51
Speaker 4: And to Devin's point of the fire earlier, you're tossing
20:55
Speaker 4: in like all of the logs at that point. But
20:57
Speaker 4: it's right, but you already had to have that fire started.
21:01
Speaker 4: Otherwise it's a bunch of noise.
21:03
Speaker 6: So starting otherwise everyone's trying to start the fire at
21:05
Speaker 6: the same time, there's not enough wood to put like exactly.
21:09
Speaker 1: You want to start sooner, so and just grow it,
21:13
Speaker 1: grow it in a way that's going to be feasible
21:15
Speaker 1: both for your business as well as for the patients
21:18
Speaker 1: so they're not inundated.
21:19
Speaker 4: At all at once with pharmacies can do doctor well now,
21:23
Speaker 4: you know.
21:23
Speaker 6: Also, even just from a competitive perspective, like having already started,
21:28
Speaker 6: it's like she said, a lot easier to scale quickly,
21:31
Speaker 6: and you're gonna want to scale when when when those
21:33
Speaker 6: floodgates open, like you're going to want to take advantage
21:35
Speaker 6: of that, but you want that running start. You want
21:38
Speaker 6: the patients to already know that you do this so
21:40
Speaker 6: that you don't have to start from scratch on that
21:42
Speaker 6: You need your staff to be optimized and ready to scale.
21:46
Speaker 6: You don't want to go from zero clinical services to
21:48
Speaker 6: ten a day like that would completely disrupt everything else.
21:52
Speaker 5: Like you can go from.
21:53
Speaker 6: Zero to three and three to ten over the course
21:55
Speaker 6: of a year and it won't disrupt anything because you're
21:57
Speaker 6: going to get your reps in, you're going to get efficient.
22:00
Speaker 6: But you need to you need to be realistic about
22:02
Speaker 6: kind of getting started now in a way that's feasible
22:05
Speaker 6: so that when you know the macroeconomics change, and I
22:10
Speaker 6: believe they will, they kind of have to.
22:13
Speaker 5: The question is.
22:13
Speaker 6: When then you're ready to like make the big bucks,
22:17
Speaker 6: Like you can make some money now and then you'll
22:19
Speaker 6: be ready to make the big books.
22:20
Speaker 4: Ye small incremental changes, yep.
22:23
Speaker 3: I like that. I like that process. But just still
22:28
Speaker 3: thinking this through because I can imagine once again, pharmacy
22:31
Speaker 3: owners and operators are are already thinking about this and
22:34
Speaker 3: that is like simplifying billing. So what role is prism
22:39
Speaker 3: going to play in my business? My pharmacy business for simplifying,
22:43
Speaker 3: simplifying billing and reimbursement for our pharmacist lead services.
22:49
Speaker 4: So currently we're working on building out a fully integrated
22:53
Speaker 4: eligibility check and claim submission within the software within our platform, PRISM,
23:00
Speaker 4: and we're doing it through a partnership with a clearinghouse
23:03
Speaker 4: because we did not want to We did not want
23:06
Speaker 4: to do our try to do our own clearinghouse. We
23:08
Speaker 4: didn't want to have to try to negotiate things on
23:10
Speaker 4: behalf of pharmacists. All of that seems way out of
23:15
Speaker 4: the scope of practice of it enablement to us anyway,
23:20
Speaker 4: So we wanted the you know, the pharmacy to handle
23:23
Speaker 4: all of that. So imagine we're just your carrier pigeon
23:28
Speaker 4: to check the eligibility of that patient as well as
23:32
Speaker 4: to submit that claim. And so a lot of that
23:37
Speaker 4: data that's already in the system can automate most of
23:42
Speaker 4: the form. So your insurance form is already or your
23:46
Speaker 4: insurance claim is already eighty five to ninety percent complete,
23:49
Speaker 4: and you just have a few fields to complete and
23:53
Speaker 4: then click the box to say you know that you're
23:55
Speaker 4: submitting a claim. Like that, it makes it, It makes
23:58
Speaker 4: it from thirty men process down to a two to
24:03
Speaker 4: four minute process, just depending on what you're you know,
24:06
Speaker 4: what type of services you're submitting for exactly.
24:09
Speaker 6: And so essentially we're taking all of the encounter data,
24:12
Speaker 6: the patient data, like you mentioned, the payer data, all
24:14
Speaker 6: that stuff, and we're like plugging it into a CMS
24:16
Speaker 6: fifteen hundred form for you. You can edit it, but
24:19
Speaker 6: it's already in there. And then you're you're putting a
24:22
Speaker 6: diagnostic code and the procedure code and the amount that
24:25
Speaker 6: you're billing.
24:26
Speaker 5: For because we didn't want to do that on your.
24:28
Speaker 6: Behalf and you know, in an inadvertently created fraudulent scenario. Right,
24:33
Speaker 6: So that's that's really all all the pharmacists tests to
24:36
Speaker 6: put in so you don't have to be field.
24:38
Speaker 5: Yeah, it's pretty easy.
24:39
Speaker 6: And what we're going to build is is kind of
24:42
Speaker 6: a coach, like a billing coach that's on the page.
24:45
Speaker 6: Like I know many of us millennials and older remember
24:47
Speaker 6: Clippy from Microsoft word the little paper clip thing. Think
24:52
Speaker 6: of a clippy that that tells you, you know, hey,
24:55
Speaker 6: you're you're billing to medical a contraceptive service. Well, guess what,
25:00
Speaker 6: only these two CPT codes are acceptable. So I see
25:05
Speaker 6: that you've entered a code that's going to get rejected, Like,
25:09
Speaker 6: maybe choose one of the two that won't get rejected.
25:12
Speaker 5: Yeah, et cetera. That's awesome.
25:16
Speaker 4: It's a contrademarket clippy.
25:18
Speaker 6: Yes, we haven't decided what its name will be, but
25:21
Speaker 6: we want it to be like as like cheesy as clippy,
25:23
Speaker 6: or at least I do.
25:25
Speaker 5: I think you got to have fun sometimes too with
25:28
Speaker 5: this stuff. That's good.
25:30
Speaker 3: I like that, all right. So I'm thinking as a
25:33
Speaker 3: pharmacy operator. I talked to so many pharmacy owners at
25:38
Speaker 3: these conferences, and they do share staffing as a concern
25:43
Speaker 3: on multiple levels, sometimes the pharmacist level, sometimes the technician level.
25:48
Speaker 3: So talk to us how pharmacies can offer services without
25:51
Speaker 3: having to hire a whole bunch more people in the beginning.
25:54
Speaker 3: But like we've already talked about it, it can scale.
25:57
Speaker 5: But let's talk about.
26:00
Speaker 6: Well, I mean, the true magic of prism really is
26:02
Speaker 6: the fact that it solves the workflow kind of issues.
26:06
Speaker 6: It makes it team based approach by empowering you know,
26:10
Speaker 6: non pharmacist you know, like pharmacy technicians and stuff to
26:13
Speaker 6: do different tasks that are within their scope of practice
26:17
Speaker 6: to create like a team based approach to the care
26:19
Speaker 6: of the patient. So it makes it so efficient that
26:24
Speaker 6: you don't need to upscale or upstaff at all to
26:27
Speaker 6: get started like that. That should not be a barrier
26:31
Speaker 6: at all. If you get to a point where you
26:32
Speaker 6: have a demand for twenty appointments a day, that's an
26:36
Speaker 6: awesome problem to have. Then you can do upstaffing in
26:39
Speaker 6: a way that you're still making you know, you're still
26:41
Speaker 6: making money.
26:43
Speaker 5: Additional money.
26:43
Speaker 6: So you know, we wanted to make it decrease the
26:46
Speaker 6: barriers to entry by making sure that the efficiency of
26:49
Speaker 6: the system created a scenario where you did not need
26:52
Speaker 6: to upstaff.
26:53
Speaker 5: And so we've achieved that.
26:54
Speaker 6: None of the pharmacies in our clinical trial thought there
26:58
Speaker 6: was any disruption of braiding the clinical services. And I
27:03
Speaker 6: can't speak about it too much because we're going to publish,
27:05
Speaker 6: but you know, we did look at pharmacy staff metrics
27:12
Speaker 6: such as satisfaction, job satisfaction, and burnout, et cetera, before
27:17
Speaker 6: and after initiating the services, and it looks like that
27:22
Speaker 6: is solid as well. So it doesn't it doesn't appear
27:26
Speaker 6: to decrease job satisfaction or increase burnout. It looks like
27:29
Speaker 6: quite possibly probably the opposite. So you know, you can
27:34
Speaker 6: get started with your current staff. It's very easy to
27:37
Speaker 6: train them because the system is so easy to use.
27:41
Speaker 6: And if you end up with the problem of having
27:44
Speaker 6: too many people wanting services, that's just an amazing problem
27:46
Speaker 6: to have, then you can talk about upstaffing.
27:50
Speaker 3: I love it. I absolutely love it. I see the scalability.
27:54
Speaker 3: I see the track that we're on from an operational standpoint.
27:58
Speaker 3: What does a typical clinical visit look like when everything
28:02
Speaker 3: is working well and as Yeah.
28:05
Speaker 4: So that the patients get a schedule an online appointment
28:08
Speaker 4: on myprisonhealth dot Com or they can just you know,
28:12
Speaker 4: scan that QR code that Devin was talking about earlier
28:16
Speaker 4: in that pharmacy. Then the patient's going to make their
28:20
Speaker 4: PRISM profile and you know, it's essentially like their basic
28:27
Speaker 4: demographic information, what type of service they're trying to book
28:31
Speaker 4: an appointment for, and then that appropriate intake form right like,
28:35
Speaker 4: because this is technology, everything is dynamic questionnaires. So if
28:40
Speaker 4: you're going in for diabetes management, we're not going to
28:42
Speaker 4: talk to you about contraception or you know, vice versa.
28:47
Speaker 4: We might ask, we might ask if you have diabetes
28:49
Speaker 4: on the contraceptive form, but you know, that's it but
28:54
Speaker 4: all of that information is then going from the patient
28:57
Speaker 4: portal into the pharmacy portal and it populates the pharmacist
29:03
Speaker 4: soap note automatically, So the pharmacist has yet to do
29:07
Speaker 4: any data entry in eighty percent of their soap note.
29:10
Speaker 4: At least eighty percent of it is already done. They
29:13
Speaker 4: just need to add their own notes from the encounter,
29:16
Speaker 4: which then occurs right there. Depending on the type of
29:21
Speaker 4: service that's being provided, pharmacist, can you know, use the
29:27
Speaker 4: clinical decision to support to use what type of prescription
29:33
Speaker 4: should be you know, prescribed to that patient and depending
29:39
Speaker 4: on the protocols of what's supposed to be occurring within
29:45
Speaker 4: that appointment, we make sure that there's adherence to both
29:50
Speaker 4: the protocols the prescriptions to all the different aspects, and
29:55
Speaker 4: then that prescription information is shipped on over to sure
29:58
Speaker 4: Scripts and to the pharmacy management system for dispensing. So
30:04
Speaker 4: while that prescription is getting filled, you had the opportunity
30:09
Speaker 4: to educate the patient, ask more questions, have more of
30:11
Speaker 4: a you know, counseling discussion if that's in the workflow
30:17
Speaker 4: for you, and the patient can get their prescription just
30:20
Speaker 4: like normal and walk out, so you know, most encounters
30:24
Speaker 4: are right around eight to ten minutes and pretty quick,
30:30
Speaker 4: pretty pretty easy. The patient themselves, after they create that
30:34
Speaker 4: profile upfront, that's their profile, so it's not like they
30:39
Speaker 4: have to redo it every single time. A lot of
30:43
Speaker 4: these other services that are out there, they didn't want
30:46
Speaker 4: to have to make a patient profile, and like patient
30:49
Speaker 4: Portal which has got so much hip a compliance and
30:52
Speaker 4: so much you know, you need sock two, you need
30:56
Speaker 4: all of these different things that just get really heavy
30:59
Speaker 4: and difficults to achieve. So a lot of these other
31:03
Speaker 4: competing solutions they just force a patient to submit all
31:07
Speaker 4: of the information over and over and over again. And
31:11
Speaker 4: we went ahead and ripped off the band aid and
31:14
Speaker 4: did all of the compliance pieces so that patient can
31:17
Speaker 4: once they have their profile, you are now their provider,
31:21
Speaker 4: just like their doctor is, and they are used to
31:24
Speaker 4: going into a portal and getting all of their medical records,
31:27
Speaker 4: seeing all of the education, seeing all of these different things,
31:31
Speaker 4: booking an appointment, taking their intake forms. You are now
31:34
Speaker 4: competing with all of these amazing healthcare systems that are
31:37
Speaker 4: out there that are charging a wild amount of money
31:41
Speaker 4: to these patients.
31:43
Speaker 6: Yeah, and just having the portal, like she mentioned when
31:47
Speaker 6: you sign the encounter if automates the outputs like the
31:51
Speaker 6: encounter note goes to the patient portal, the educational document,
31:54
Speaker 6: any sort of you know, physician notification to their primary
31:58
Speaker 6: care provider or referral, so.
32:00
Speaker 5: All that kind of care management stuff. Patients can see it.
32:04
Speaker 5: And that's important for a couple of reasons. A.
32:05
Speaker 6: We know it's important from a patient perspective, like they
32:07
Speaker 6: want to have access to that, but be it also
32:11
Speaker 6: is important from a compliance perspective because technically speaking, federal
32:15
Speaker 6: law prohibits information blocking. So if you know, if you
32:19
Speaker 6: do render a service to a patient and they want
32:21
Speaker 6: their medical record, you have to provide that to them,
32:23
Speaker 6: and a lot of those other systems like you can't
32:26
Speaker 6: really do that, so you're kind of an violation potentially
32:30
Speaker 6: with the federal law.
32:32
Speaker 4: Or it's you know, it's going to disrupt your workflow
32:34
Speaker 4: because as soon as they ask for all of it,
32:36
Speaker 4: you have a certain amount of time that you need
32:38
Speaker 4: to actually prove all that hab it and get it
32:41
Speaker 4: to them, not in their email, because you can't just
32:44
Speaker 4: email it right, it has to be in a hippo
32:46
Speaker 4: compliant way. So now what the patient's going to have
32:49
Speaker 4: to come back in for a not like paper copy
32:51
Speaker 4: or paper copy, so it just gets it gets messy.
32:55
Speaker 4: And I think every patient who's over the age of
32:59
Speaker 4: the essentially has had to deal with this at some
33:02
Speaker 4: point whenever they want their medical records. And there wasn't
33:05
Speaker 4: patient portals back in the day.
33:07
Speaker 6: So like nowadays, like you know, my parents are in
33:10
Speaker 6: their seventies and I mean they're all over the patient
33:11
Speaker 6: portals like people expect it now. Oh absolutely, And you
33:15
Speaker 6: can't like you're not going to look professionally like they're
33:19
Speaker 6: not going to look at you as a provider if
33:21
Speaker 6: you don't have electronic medical records. It just kind of
33:25
Speaker 6: is what it is, like that's how people are trained now.
33:27
Speaker 3: Yeah, that makes sense. Once again, the layout is really
33:32
Speaker 3: well thought out. And I'm also thinking about for pharmacists
33:37
Speaker 3: that aren't offering clinical services other than maybe vaccinations, how
33:42
Speaker 3: do you suggest they get they get started? Because we
33:45
Speaker 3: know that vaccines in the same context and in preparing
33:50
Speaker 3: your business to expand, pharmacists are doing well by providing that.
33:55
Speaker 3: So now it's time to add the next layer. So
33:59
Speaker 3: tell us about how do we get started.
34:02
Speaker 6: Yeah, I've talked to a lot of pharmacy owners who
34:04
Speaker 6: have been approached, let's say, by people who are like, hey,
34:07
Speaker 6: let's do this like pretty elaborate test to treat protocol
34:11
Speaker 6: with clear you know, cleo waiver and blah blah blah.
34:14
Speaker 6: It's like that's awesome, Like I'm all for pharmacists doing
34:18
Speaker 6: all of it. However, that's not the best place to
34:21
Speaker 6: get started necessarily. Like that, that's a complicated place to
34:25
Speaker 6: get started.
34:25
Speaker 4: It's like wanting to start day trading rather than just
34:28
Speaker 4: doing it like a one or two stock trade, right,
34:30
Speaker 4: Like you're.
34:31
Speaker 6: Not going right, you don't start trading options from like
34:34
Speaker 6: minutes zero, right, like you get there? Like that could
34:37
Speaker 6: be the goal, and that should be the goal.
34:38
Speaker 5: I think everyone, Like in my mind, everyone should have
34:41
Speaker 5: that goal.
34:41
Speaker 6: But get started with something easier that maybe that requires
34:46
Speaker 6: less oversight and integration. So things like contraceptions are easy
34:53
Speaker 6: because there's no testing required.
34:55
Speaker 5: Right, there's a whole.
34:56
Speaker 4: Process and end yourself. It's not adding another third part.
35:00
Speaker 6: You don't have to create out or account and then
35:04
Speaker 6: like somehow get them electronic orders and receive results and
35:08
Speaker 6: et cetera.
35:09
Speaker 5: It's it's just easy.
35:10
Speaker 6: So, you know, starting with something like contraception tobacco cessation,
35:15
Speaker 6: et cetera, diabetes management, hypertension management.
35:20
Speaker 4: Yeah, if you're not ready yet to let's say you're
35:22
Speaker 4: not yet comfortable right away with prescribing, but you still
35:25
Speaker 4: want to be able to provide other services like diabetes
35:28
Speaker 4: management or hypertension management, and you know it's going to
35:31
Speaker 4: be impactful for your community by all means, like Devins saying,
35:36
Speaker 4: like start small, Start what you're comfortable with, preferably contraception,
35:41
Speaker 4: but just pick for the ladies. But you know, do
35:46
Speaker 4: what you feel is going to be most comfortable. But
35:48
Speaker 4: don't like start small and expand. I mean right back
35:53
Speaker 4: to that whole fire, like get get it burning first, yes, right,
35:58
Speaker 4: and once it catches, it's going to catch and then
36:02
Speaker 4: you can slowly start adding logs to it. But if
36:04
Speaker 4: you're just going to be like pouring gasoline, yeah the bonfire,
36:11
Speaker 4: then at that point right where.
36:12
Speaker 5: You kind of make the Coachella efy, like you.
36:16
Speaker 4: You poured gasoline on something and it can burn out
36:19
Speaker 4: really quick. Yeah, right, so.
36:22
Speaker 5: Or you can burn out really quick.
36:23
Speaker 4: That's the point that But like the whole thing is
36:28
Speaker 4: like do something that's going to be sustainable long term
36:32
Speaker 4: rather than just dump everything on it. Because it's the
36:36
Speaker 4: hotness this month or next month. Start small and slowly
36:42
Speaker 4: grow it and until you.
36:43
Speaker 6: Feel comfortable, and until your staff feels comfortable, because that's
36:46
Speaker 6: the other thing, right, Like it's not just you know,
36:48
Speaker 6: maybe there's a pharmacy pharmacist in charge who's going to
36:51
Speaker 6: oversee this, but like it's going to affect the entire staff,
36:54
Speaker 6: right and hopefully in a good way, but probably it'll
36:58
Speaker 6: go better if you start small.
37:00
Speaker 5: For that perspective as well, I love it.
37:03
Speaker 3: Yeah, And I like the fact that you are helping
37:06
Speaker 3: to build this model and we've gone through steps. You
37:11
Speaker 3: have something that we've really checked the boxes. And this
37:16
Speaker 3: will be in the show notes as well, so that
37:17
Speaker 3: you can go through what those boxes are. But let's
37:21
Speaker 3: talk about what success looks like and taking it in
37:24
Speaker 3: those stages because we want to get started, we want
37:26
Speaker 3: to get going. But what does success look like for
37:29
Speaker 3: stage say one, two, three?
37:32
Speaker 5: Yeah? I think you know.
37:34
Speaker 6: Success for stage one is like you get it up
37:36
Speaker 6: and going. Your staff is comfortable, you get a couple appointments,
37:40
Speaker 6: you get good feedback from the patients. Right, you start
37:42
Speaker 6: feeling confident, you have a system in place.
37:46
Speaker 5: You're thinking like okay, like, we can do this as
37:49
Speaker 5: a team.
37:50
Speaker 6: And then you know, stage two is you've built up
37:53
Speaker 6: some patient demands. Your community knows that this exists. You know,
37:57
Speaker 6: you start seeing patients coming in requesting it spontaneously. You
38:02
Speaker 6: start noticing that you're making some new sustainable revenue stream
38:06
Speaker 6: that has better margins than dispensing that is, you know,
38:12
Speaker 6: has nothing to do with the PBM. So you're kind
38:14
Speaker 6: of like gaining some like financial independence from you know,
38:18
Speaker 6: from the oppressors, right. And then stage three is, you know,
38:23
Speaker 6: you start expanding services. Your community starts thinking of your
38:27
Speaker 6: pharmacy as their first stop and their healthcare journey for
38:32
Speaker 6: non emergent you know, either cute or chronic issues. They're
38:38
Speaker 6: coming to you first. You know, you are now not
38:42
Speaker 6: just a place of transactions. You're you're the provider, and
38:47
Speaker 6: they're looking to you as they're looking at you as
38:49
Speaker 6: a provider. And there's a fundamental shift in how your
38:52
Speaker 6: community views your pharmacy and your staff.
38:55
Speaker 3: All right, So pharmacy owners listening out there, pharmacy operators,
39:00
Speaker 3: technicians who have now been given more responsibility to help
39:04
Speaker 3: grow the business of your pharmacy, and there's so many
39:07
Speaker 3: of them out there. If a pharmacy owner is listening,
39:10
Speaker 3: you're thinking about this. This sounds great, but I'm still hesitant.
39:14
Speaker 3: What are you going to say to those people?
39:17
Speaker 4: Well, the pharmacists that are going to adopt and adapt
39:21
Speaker 4: early are going to define the future of the profession.
39:27
Speaker 4: And you, you know, like we've been saying, you don't
39:30
Speaker 4: have to have everything perfect at once, you don't have
39:32
Speaker 4: to do everything at once. It's okay to do incremental
39:36
Speaker 4: improvements and incremental services. Start small and at them. On
39:42
Speaker 4: every single pharmacy that we've teamed with, and as you know,
39:47
Speaker 4: we're fortunate enough to fortunate enough to work with They're
39:49
Speaker 4: all unique and they all have different needs. They all
39:52
Speaker 4: have different patient needs. So you know, we're happy to
39:57
Speaker 4: talk with you at any point about your unique challenges
40:02
Speaker 4: that you are facing. Your patients are FAE saying. So
40:06
Speaker 4: if you reach out to us, we always are interested
40:08
Speaker 4: in learning more about you guys, and we hope that
40:10
Speaker 4: you want to learn more about us. But you know,
40:13
Speaker 4: the future of pharmacy is bright when we all get
40:16
Speaker 4: on the same page and we all fight for the
40:18
Speaker 4: same exact cause, which is always going to be affordable
40:23
Speaker 4: access to care for patients and making sure that all
40:26
Speaker 4: of us are treated equitably. That doesn't matter if it's
40:30
Speaker 4: the patient or the pharmacist or the pharmacy tech. Everybody
40:33
Speaker 4: deserves their access and deserves their recognition. So if we're
40:38
Speaker 4: just here to be a support tool.
40:39
Speaker 6: Yeah, So if this sounds interesting to you, you know,
40:42
Speaker 6: reach out to us. Schedule a demo. I think that's
40:45
Speaker 6: probably the best way to get started. See what we've built,
40:48
Speaker 6: see if it makes sense for you. No pressure, but
40:51
Speaker 6: to do that, you just go to get prismarx dot
40:53
Speaker 6: com and we'll get in touch and we'll make it happen.
40:56
Speaker 3: You heard it, Get prismarx dot com. You can listen
41:00
Speaker 3: to the other podcast in if you go to the
41:03
Speaker 3: about section you'll be able to hear a discussion with
41:07
Speaker 3: a fellow podcaster on our network, doctor Daniel Plumber, a
41:12
Speaker 3: Torks episode, and also parts one and two Get Ready
41:18
Speaker 3: for more revenue in twenty twenty six and doing something
41:22
Speaker 3: that you're for your community that they desperately want in need.
41:27
Speaker 3: Thank you so much for listening to this series and
41:31
Speaker 3: give us a call, give us a chat, reach out
41:33
Speaker 3: to get prismarx dot com.
42:00
Speaker 6: The Big Think