Reinventing community pharmacy

A vast army of some 70,000 Walgreens pharmacists, technicians, nurses and nurse practitioners, and other clinicians is poised to plug some of the gaps in the nation’s overstretched healthcare system with expanded services, greater access for patients and new solutions for providers and payers in desperate need of quality, cost-effective solutions.


“For us, the product is no longer the pill. The product is the health outcome associated with that pill,” said Kermit Crawford, president of pharmacy, health and wellness. “We are deliberately transforming the way we practice pharmacy, going from what was a transaction-based environment to one that is more about patient relationships. So, for example, we’re moving our pharmacists from behind the counter out to where … they’re able to talk with our patients. And we’re enhancing those conversations through the use of technology.”


That transformation in pharmacy extends across Walgreens’ traditional retail prescription business, as well as its Take Care retail clinics and Employer Solutions Group, and its specialty pharmacy and home infusion businesses — all of which report into Crawford.


Crawford says Walgreens is on a quest to enable its clinicians to “practice at the top of their license.” And among the steps the company has taken “to transform the way our healthcare professionals operate today,” said the company’s top pharmacy and health decision-maker, are retail health services like patient adherence programs, a growing menu of health tests and collaborative disease management efforts with hospitals and physicians.


Not to be overlooked is the company’s vast immunization capability. Walgreens is the nation’s leading flu shot provider after the U.S. government. Its pharmacists and Take Care Clinic nurse practitioners and physician assistants administered 6.4 million flu vaccinations in 2011, nearly a third of them on nights, weekends and holidays. “No other provider can offer that convenient access,” Crawford asserted.


The massive vaccination program underscores Walgreens’ national reach and its claim as the nation’s most accessible and convenient provider of pharmacy, health and wellness services, with roughly 8,000 retail, clinic, hospital, employer and specialty pharmacies spread like a blanket across all 50 states. “We’re within three miles of two-thirds of the U.S. population,” Crawford said. 


What’s more, he added, “About 40% of our stores are located in medically underserved areas. And giving people convenient access to quality, affordable care improves the patient experience and … helps lower overall health costs.”


On the clinic side, “We’re evolving to a chronic-care model,” said Crawford, expanding the role of the nurse practitioners that staff its 350-plus Take Care Clinics beyond episodic care. And to be sure, it will be building a lot more clinics in the years to come.


“As we continue opening more Well Experience stores, that provides more opportunity to expand our Take Care Clinics,” he added. 


The need is clear. “Fifty percent of the people who visit our clinics don’t have a primary care physician. And with so many of our stores in medically underserved areas, there’s a real opportunity to grow our clinics,” Crawford noted.


Like its more than 27,000 pharmacists, the Take Care nurse practitioners are increasingly positioned as a vital adjunct to the care provided by the nation’s shrinking and overtaxed pool of primary care physicians. “In our clinics,” he noted, “we’re working collaboratively with a physician to manage a patient’s disease state. That care doesn’t have to be done in a physician’s office.”


“Walgreens can connect the dots in American health care,” Crawford added. “With health reform and rising health costs, we have a real opportunity here. The goal is to leverage our assets, our footprint of over 8,000 points of care, our presence in the community, our hospital and employer-
based pharmacies and health centers and our clinics … to help manage total population health.”


Clearly, one area in which payers need help managing costs is in specialty pharmacy, where Walgreens is able to leverage and bundle its many assets and channels to deliver multiple options for patients and payers to choose the mode of care that works best for them. 


One prime example of how Walgreens is able to accomplish this in specialty is through a program it calls “Well Transitioned,” which utilizes pharmacists in its more than 100 pharmacies based in hospitals and specialty clinics across the country, to provide pre- and post-discharge medication reconciliation for patients on complex specialty medications, such as organ transplant patients. “We call it the ‘front door’ of specialty pharmacy,” Crawford told DSN. 


“So, before a patient is being discharged, [our pharmacist] will go visit the patient in their hospital room and educate them about the new medications their physician is putting them on. And then once they leave, we’ll call them at home to talk to them about the medications they’re taking, how to take them, what to expect in terms of side effects, what they’re used for, what they look like and then later, how do they [get] these medications,” he explained. “So, if they live outside of the trade area of that on-site pharmacy, how they connect to other Walgreens services” to keep them compliant on their therapy regimen.


It’s an important example of how Walgreens provides new solutions for payers and patients that help trim the upstream costs of poor compliance and adherence. While much focus is given to the 12 cents on the healthcare dollar that goes to pay for prescription drug costs, not enough is focused on the other 88 cents. For instance, as many as 30% of all hospital readmissions are due to poor medication reconciliation, Crawford said.


To keep discharged patients compliant with therapy, Walgreens is able to provide a number of options for how they can get their medications. If the patient lives near the on-site hospital/clinic pharmacy, they can come back there to get their medications, or they can choose to have it shipped to their homes via a Walgreens central fill facility or shipped to their local Walgreens store through its Specialty at Retail program. “Our model is to allow patients to choose what is the best experience for them, but then we support that through all of our different assets and channels,” Crawford said. “We believe better patient experiences drive better patient outcomes, and that drives lower costs.”


The chief engine driving Walgreens’ revenues — which topped $72 billion last year — will continue to be its prescription dispensing business, which last year churned out 819 million scripts, or 1-in-5 U.S. retail prescriptions. What is changing is the way those medicines are dispensed as the company takes a broader view of the continuum of care, automates more of the dispensing process and shifts more of its pharmacists’ attention to direct patient engagement.


“We’re still filling scripts; we’re just more efficient in how we do it,” said Crawford. “We looked at all the administrative tasks associated with filling prescriptions, and some we have moved centrally.”


In addition, the company has added automation, “About 40% of our qualified prescriptions today are filled through e-prescribing, which is … taking work out of the dispensing.”


Walgreens’ massive flu shot and immunization program has been key to its effort to transform to a full-spectrum retail pharmacy, health and wellness powerhouse. Launched at the suggestion of a Walgreens pharmacist in Colorado — “the majority of our ideas come from the field,” said Crawford — the flu shot effort began to open patients’ eyes to the types of health, wellness and disease prevention services that Walgreens pharmacists could provide.


“Five years ago, we had about 300 pharmacists certified to do flu shots,” said Crawford. “This past year, virtually all 27,000 of our pharmacists were trained [as] certified immunizers beyond flu shots. Today, all our stores are certified to give any of the 20-plus CDC-approved immunizations that are approved in their state.”


Immunizations became the gateway for a shift in the company’s health mission and business strategy. “We demonstrated that pharmacists interacting with patients by giving them flu shots led to great conversations,” Crawford told DSN. “It was loud and clear that it was acceptable.”


What’s more, he said, “flu shots were the beginning of patients looking at our pharmacists differently — giving our pharmacists permission to play a greater role on the healthcare team.”


One reason: Walgreens pharmacists were talking with patients “not only about flu shots, but about the disease states that required them to get a flu shot,” said Crawford. “It really enhanced that face-to-face interaction.”


In September, Walgreens will further strengthen that relationship with the launch of its first customer loyalty program. One key aspect of its new Balance Rewards program is that it rewards card holders for healthier behavior, for instance, accruing points for participating in programs like Walk with Walgreens. Among other benefits like building store-purchase baskets and return customer visits, said Crawford, the program provides another entry point into Walgreens’ pharmacy, health and wellness offerings. “This is a way for us to reward people for adhering to their medication therapy, or participating in [preventive health] programs,” said Crawford. “We can tie it into the overall goal of helping people to live well.


“We’ve actually begun to change the way health care is delivered in this country,” Crawford asserted. “With health reform, another 30 million people will get access to care, and there’s already a shortage of primary care physicians.”


“Someone’s going to have to fill that space, and we think Walgreens and our professional clinicians are uniquely positioned to do it,” he said.