INNOVATORS IN PHARMACY Take Care Employer Solutions: Health Care Innovation at Work

Take Care Employer Solutions has made it its business to stir things up. “We need to have disruption in health care,” said Peter Hotz, president of Take Care Health Employer Solutions Group and divisional vice president of Walgreens Health and Wellness. “The current system isn’t working.” As the only company providing a single-source solution for integrated, on-site health, wellness, fitness, and pharmacy, it appears that the company is achieving its goal.

Companies across 45 states have brought in worksite health centers through Take Care Employer Solutions Group, which is designed to achieve cost savings for both employer and employees. The introduction early this year of the company’s Complete Care and Well-Being, touted as a holistic solution that is “not only good for the health of your company, but also good for the health of your company,” has built on that premise.

We focus on great clinical care, but we also focus on watching that spend for that employer, said Hotz. “From a cost standpoint, we’re a great solution right now.” According to Hotz, the company overall has grown at “a healthy, double-digit rate” this year. Such data is a clear anomaly in a climate that has so many businesses struggling to simply break even.

Changing the Workplace for Pharmacists

Perhaps representing another anomaly is the way in which Take Care Employer Solutions allows for pharmacists to not only regularly collaborate with other clinicians in patient care, but also to have unprecedented opportunities for patient counseling and followup on a daily basis. “Our pharmacists can actually engage people right at the workplace,” said Hotz. “Pharmacists love to work in workplace pharmacies because they are able to have an effect and an impact on patients. . .and at the end of the day, see the impact they’re having.”

A far cry from playing phone tag with physicians’ offices from behind a drug store counter, Take Care’s work place health centers foster an environment of collaboration between clinicians. Aside from the daily, informal discussions that take place between pharmacists and other health care providers through an open line of communication, the health centers are home to weekly clinical staff meetings. In these meetings, clinicians jointly review and make decisions on patient care, as well as identify larger patterns of conditions and illnesses cropping up within the population they have come to know.

In a typical pharmacy setting, pharmacists can only provide as much follow- up as is allowed by the patient’s in-store presence. In addition, although there seems to be a trend toward greater opportunities for counseling in pharmacies, most pharmacists are not afforded the time, or the private space, to flex their counseling muscles.

At Take Care’s workplace health center pharmacies, patient counseling rooms offer privacy for in-depth discussion— a feature Hotz counts as important. “Do you want to get counseled at a cash register in front of a million people? No.”

Reaching beyond the pharmacy walls, the health centers pave the way for more patient-pharmacist contact. At some locations, prescriptions can be delivered right to an employee’s desk, bringing adherence-raising convenience to a new level. If a patient does not come back to the pharmacy for their necessary refills, the pharmacist will make a phone call to the individual to encourage them to do so, said Hotz.

When that does not work, there is always the option of some friendly stalking. Hotz raised the example of a pharmacist running into a patient in the workplace cafeteria and using the chance meeting as an opportunity for follow-up. Patients are likely to appreciate the gesture, as it is easy to lose track of refills and when they are due. “There is a huge benefit in terms of access,” said Hotz. “Pharmacists have the opportunity to do more of what they’re trained to do.”

Some company clients of Take Care Employer Solutions sponsor tailormade programs aimed at improving the health of their employee populations. “The pharmacist can be really helpful in engaging and enrolling the individuals,” said Hotz. According to Hotz, one employer agreed to waive copays if patients enrolled in a cholesterollowering program and adhered to their health regimens. “Dramatic reductions” in cholesterol levels were observed in the patients over a 12-month period, Hotz said.

Take Care is not just tooting its own horn in terms of patient outcomes. Workplace-treated patients had overall adherence rates that were 9.72% higher than those of community-treated patients, according to a study published in the American Journal of Managed Care (July 2009). The improvement is an asset of which pharmacists are well aware. “Estimates reveal that poor adherence imposes $177 billion annually in direct and indirect costs, from preventable emergency room visits, [to] treatment of chronic conditions and lost productivity,” an official from the National Association of Chain Drug Stores stated.

Although clinical excellence is the hallmark of Take Care Employer Solutions, creating cost savings for both the employer and the employee comes in at a close second. As part of a move toward greater transparency, the company not only provides 100% visibility in regard to drug costs, but also allows employees and their families at client health centers to buy prescription medications at cost. Take Care is still able to profit by charging clients for the implementation and management of the on-site facilities.

Generic substitution wherever appropriate is a policy that reaps benefits for everyone involved. The same goes for OTC product substitutions, as well as pill splitting and disease management programs. “It’s really the savings that are driven by what the pharmacists do,” said Hotz. Prescribing of first-line antibiotics provides fewer side effects for patients while providing value. According to a report published in Benefits and Compensation Digest (September 2007), “. . . in a program where physicians and pharmacists collaborated at a workplace health center to meet evidence- based guidelines for value-based antibiotic prescribing goals, workplacetreated patients received a much higher prescription rate of first-line antibiotics than community-treated patients, resulting in more appropriate prescribing and considerable cost savings.

For clinicians, and especially pharmacists, the company provides its own version of health care reform, one that revolutionizes the way care is provided. It seems no wonder that Hotz brims over with enthusiasm when talking about it. “I get to work with some of the greatest clinicians in the world,” said Hotz. “We have a group of people that are passionate about what they do.” If Take Care Employer Solutions is truly a “microcosm of the health care system,” as Hotz says, it appears that things are moving in a positive direction.