KERR Drug Is Taking Pharmacy to the Next Level

As pharmacy evolves, advancingthe profession to the next levelwill take creativity, initiative,and hard work. Kerr Drug is already onthe front line by offering in-store primarycare clinics, providing off-site healthscreenings, and conducting medicationtherapy management (MTM) reviews,among other programs.

A Smart Answer for Health Care

Kerr Drug's commitment to providingits customers with high-quality healthcare is unparalleled. Besides the excellentwork done with the AshevilleProject and its pharmacy counselingcenters, Kerr Drug also has partneredwith SmartCare Family Medical Centersto provide primary care clinics within itspharmacies in Raleigh, Hillsborough, andFranklinton, NC.

So far, this one-stop approach hasproven to be economical and efficientfor customers. Kerr Drug makes the customers' needs a top priority, and joiningforces with SmartCare has made accessto health care much easier.

The SmartCare Centers are standalonefacilities staffed by family nursepractitioners (NPs)—registered nurseswith master's degrees who can prescribemedications. Patients visiting acenter can be treated for common ailmentssuch as sore throats, ear infections,and seasonal allergies. Patientsalso can utilize SmartCare for basichealth services, such as flu shots,immunizations, school and employmentphysicals, and cholesterolscreenings.

According to Jeffery McNeil, DSN,FNP-C, a district manager for SmartCare,"Local family practices will send patientsto us if they are not able to see themright away. Also, if a family practice centeris closed and the patient needs anevaluation [right away]—for example, if awound infection needs to be seen within48 hours—the SmartCare center cantake care of it and report back to thefamily physician.

"We provide care for general, morecommon household issues, [most] of thethings people experience—colds, allergies,[urinary tract infections], rashes,bronchitis," McNeil continued. "For lacerations,we use staples or surgical glue,but we don't treat facial lacerations."The centers are cost-effective for Kerrand profitable for SmartCare.

An Ounce of Prevention

McNeil explained the benefit of havingNPs on staff at the centers. "The NPmodel is to partner with?patients andto treat them from a teaching perspective,"he said. "SmartCare Centers putNPs in the forefront and allow them topractice their profession. They practicehealth care from a theoretical model ofnursing—preventive, holistic—whatevertreats the whole individual.

"For so long, medicine has been disease-focused. We diagnose and prescribe.NPs diagnose, but they also lookfor the cause of symptoms, rather thantreating symptoms only," McNeil stated.

To that end, the clinics also host varioushealth screenings to help patientsstay on top of their health care concerns.Screenings include total-cholesterolchecks, bone-density analysis (viaultrasound instead of x-ray), and the useof Dermascan to check for sun damageand dehydration, which McNeil calls "agreat service we offer. Once patients seethe damaged area, it's very effective inturning them on to a serious problemwith their skin. It's a real teachingmoment," he said.

SmartCare Centers accept insurancefrom in-network insurers, and thepatient pays the usual copay. The averagecharge is $65 per visit. An urgentcare clinic visit usually costs twice asmuch, a family practice appointmentcosts more than $100, and a trip to theemergency room costs 6 times as much.

"SmartCare services are affordable fora large part of the population," McNeilasserted. "Eighty percent of people withouthealth insurance work, and mosthave full-or part-time jobs. They will onlyseek health care when they are sick, andthey're not likely to use preventive services.Our centers?focus on preventivehealth care."

The Pharmacist-NP Team

The partnership betweenthe pharmacist andthe NP is key to the successof the Kerr Drug-SmartCare arrangement."The pharmacist's role iscompletely separate fromthe clinic—a completelydifferent company—but itis a complementary, synergisticrelationship," Smart-Care's McNeil pointed out."NPs can do an examination,and pharmacists arethe experts on drugs. If adrug is too expensive, forexample, then a patientcan go ask for a recommendationfor a cheaperdrug [from the pharmacist].

"In turn, if a patient isasking [the pharmacist]about a rash?then perhapsthe pharmacist doesnot want to be pushedinto the diagnosing role,and that's where we canstep in," McNeil said. In theevent that a patient presentsa more serious case,a physician is on call and is immediatelyavailable.

Is the Kerr Drug-SmartCare setup thewave of the future? Possibly, saidMcNeil. "The government knows wehave a [health care] crisis, and they arelooking for cost containment. This clinicis past the trial stage.?‘The train has leftthe station.'I honestly believe these clinicswill do for the health care industrywhat the [automated teller machine] didfor banking—add convenience andreduce costs. At the same time, we'redelivering a high quality of service."

Beyond the Usual

In addition to their traditional dispensingresponsibilities, Kerr Drug pharmacistsare educating patients on propermanagement of their disease states,providing health screenings for largecorporations, conducting MTM reviews,and taking part in various research projects.All these tasks demonstrate theimportance of the pharmacist's role inthe health care system—and also generatesources of revenue that allow theprofession to thrive.

As a clinical coordinator for Kerr Drug,Joe Heidrick, PharmD, is actively takingpart in the changes to pharmacy practice."PharmDs are equipped with a lot ofclinical knowledge," he said. "Theseopportunities allow us to put our skills towork outside of the traditional dispensing process and outside of typical prescriptioncounseling."

Generating Revenue

One of Kerr Drug's initiatives is puttingtogether health fairs for corporateclients. At these fairs, pharmacistsscreen large groups of employees forvarious disease states, including highcholesterol, cardiovascular disease, obesity,and diabetes—anything associatedwith a chronic disease state. The company'sinsurer reimburses the pharmacistsfor every person screened. Kerr Drugentered into these types of contractswith large employers by contacting theirinsurance providers and demonstratinghow important it is from a cost perspectiveto make sure that their employeesare as healthy as possible.

In addition, diabetes education andflu shots are major revenue generators.We administer 50,000 flu shots a year,"Dr. Heidrick noted. As pharmacists aregetting paid for cognitive services, theirinterventions are decreasing medicalcosts. " Catching disease states early isan enormous health benefit,"he pointed out.

Besides early intervention,Kerr's health screeningsare improving accessto health care. "Considerthe medical population.They're 30 to 40 years old,male and female, workingclass.They may not go totheir physicians [for thesescreenings], but they canbe screened at our clinic."The cost to the employersand insurance companiesis less.

On the Road

Dr. Heidrick's home baseis a Kerr Drug communitypharmacy, but he spends afair amount of time travelingto health events.Ideally, he said, the companywould conduct allscreenings on-site. "Butwe're not at that pointyet, so we have off-siteevents," he said.

"We recently had ahealth event for a companyon Bald Head Island.We had another healthevent where we didscreenings for the statehighway patrol for NorthCarolina, and we had to goto the different posts,"Dr.Heidrick reported.

Diabetes education programs,however, are conductedon-site. Patientsare referred to these educationprograms by theirphysicians.

These are major initiativesfor Kerr Drug becauseMedicare pays Kerrpharmacists for them,making them a considerablesource of revenue.

Another revenue sourceis providing MTM servicesfor patients with MedicarePart D. Through that program, Medicarepays pharmacists for their knowledgeand for their assistance to Medicarerecipients. "It's building," said Dr.Heidrick. "It's the future of pharmacy."

He stressed clinical skills but alsonoted that "we don't want to alienateourselves by saying we're not dispensingpharmacists, because that's nottrue." Business skills, however, are vitalfor pharmacists and will becomeincreasingly important as the professiontakes a new shape. "It is every bit if notmore important to have a businesssense for the future of pharmacy.We'reconstantly developing business opportunities.We do a lot of our own marketingand our own pricing of services," Dr.Heidrick said.

"These are all new concepts for pharmacy,"he added. "You can't look it up ina book, because it hasn't been done inthe past. For every project that works,wehave 3 times as many that don't work."

As for the work schedule of a KerrDrug clinical pharmacist, every day is different.One week for Dr. Heidrick beganby administering flu shots and workingon a research project (another source ofrevenue for Kerr is serving as a test sitefor clinical trials). Tuesday's scheduleincluded diabetes education classes andworking in the pharmacy. On Wednesday,he was on his way to a corporate healthevent that included screening for cardiovasculardisease.

Thursday saw Dr. Heidrick working forNorth Carolina Medicaid as an auditor,conducting chart reviews to make surethat the state's Medicaid patients arereceiving the standard of care theyshould. Friday he was back in the pharmacy,catching up on paperwork and gettingready for a flu shot clinic over theweekend.

This varied schedule includes a little bitof everything a clinical pharmacist needsto accomplish to maintain traditionalresponsibilities, as well as to incorporatethe activities that will lead the professionto where it needs to go in order to thrive.Kerr Drug maximizes its patient careservices by using its clinical pharmacistsin challenging roles. In order to keep upwith the changing profession, Dr. Heidrickadvised, "You have to be a self-starterand have a good imagination [aboutwhat] you want a pharmacy to be."

Ms. Farley is a freelance medical writerbased in Wakefield, RI.