No mere dispenser

As the Patient Protection and Affordable Care Act begins to be implemented, and a new Republican majority in the House discusses potential changes to the law, it is clear that much work remains to be done to reform the nation's healthcare system. As we all know, a debate still continues to be waged on how to best improve quality while also reducing healthcare costs.

As executive vice president and CEO of the National Community Pharmacists Association, I would strongly suggest that one way to address this debate is really quite simple: Turn to independent community pharmacists. This group of respected, clinically trained healthcare professionals has a proven track record of improving health outcomes while reducing system costs. They are in a prime position to help the public and private sector at a time when patient demand for primary-care services is expected to grow exponentially.

Currently, the marketplace is saturated with mega-chain, mail-order and mass-merchant pharmacies whose main focus is on the volume of prescription drugs sold. Independent pharmacists attract and retain patients by focusing on providing excellent patient counseling, while offering niche medication and health services that are broadening the traditional role of the pharmacist. In other words, their primary focus is on quality of patient care, not on quantity of goods sold.

The 2010 NCPA Digest is a comprehensive financial analysis of independents. It provides substantial evidence that, in contrast to its competitors, independents' focus on patient care, especially in underserved and rural communities, is working and is sustainable even during challenging economic times. In fact, 51% of independents are in markets of 20,000 people or less, where they are often one of the only healthcare provider options available.

The digest also reveals the continued proliferation of niche services offered by independent pharmacies that are attracting patients in search of more personalized care. For example, 69% of these pharmacies now offer diabetes education and training programs, while other disease state management programs for smoking cessation, weight management, asthma management and HIV/AIDS are also becoming increasingly common. In addition, 76% offer immunizations such as influenza shots, 71% sell durable medical equipment such as diabetes testing supplies, 67% provide specially tailored compounding drugs such as hormone replacement therapy, and 76% of independents make personalized home delivery (often free of charge).

These services not only meet critical patient needs, they also help pharmacists offset losses from prescription drug reimbursement rates, which have been declining for decades. Independents also are becoming more efficient, which frees up pharmacists to spend more time with patients: 43% of independents report using at least one kind of automated dispensing technology—technology that can help independent pharmacists be efficient about dispensing while more effective in providing care.

Additional studies delineate the critical role community pharmacists can play in improving health outcomes and providing the vaunted bending of the healthcare cost curve. According to the New England Healthcare Institute, the improper use of prescription drugs costs a staggering $290 billion annually. Pharmacists can significantly reduce that number, if the model employed in places such as Asheville, N.C., and Spartanburg, S.C., were replicated at the national level. 

For example, in Asheville, officials tried a new approach to help city employees, dependents and retirees combat chronic problems such as diabetes, asthma, hypertension and high cholesterol. After an initial education session, patients relied on independent pharmacists to keep them on the right health track and adhering to their medication therapy. After one year, the diabetes patients experienced lower costs (down from $7,042 a patient to $4,000) and fewer sick days (down from 12.6 a year to six). Treatments for cardiovascular issues and asthma also proved to be less expensive.

The experience of Smith Drug Co. in Spartanburg tells a similar story. Struggling with soaring diabetes treatment costs, the company shifted its focus to prevention and medication adherence. Patients joining the new program were given free supplies and other incentives. In just one year, treatment costs were slashed from $11,637 to $5,406 per patient, while the costs incurred by patients enrolled in the more traditional regimen went up $1,500. The true benefits of programmatic efforts such as this are abundantly clear in the short term, but it is the long-term effect that will truly tell the whole story. Healthier patients will undoubtedly save the nation's healthcare system substantial sums by avoiding expensive visits to emergency rooms, doctor's offices and hospitals associated with reactionary medicine.

In sum, there must be more attention in public and private programs, as well as private-public partnership initiatives (such as accountable care organizations and medical homes), to the true value of community independent pharmacists—individuals who can play a critical role in providing quality care while reducing overall costs to the system.

As our nation continues to solve the healthcare reform puzzle, independent community pharmacists may truly be one of the missing pieces.

Kathleen Jaeger is executive vice president and CEO of the National Community Pharmacists Association.