Wellness Services in Community Pharmacies-What Will Drive Success?

Opportunities for pharmacists to contribute to the health and well-being of patients through “wellness” services have been a topic of discussion in the profession for several decades. In the mid-1970s, professional journals included papers that spoke of the role of pharmacists in preventive health care,¹ described nurse—pharmacist teams focused on hypertension screening,² and outlined a community pharmacist—sponsored diabetes screening program.³ Health education, medical screenings, preventive health programs, and chronic disease management programs are typically the types of services included under the broad category of “wellness services.”

In many cases, these discussions highlight offering wellness services as a strategy for pharmacists to move beyond largely technical roles and contribute to public health improvement. It has also been suggested that these services are an opportunity to diversify revenues of the pharmacy and lessen the impact of diminishing returns from medication-dispensing services.⁴ On the surface, offering wellness services looks like a potential win-win scenario: contributing to improved health while capturing a new revenue stream.

Immunization delivery is frequently held up as a prime example of success. The number of community pharmacies offering immunization services has increased dramatically over the past decade, providing millions of vaccinations to Americans each year. The development of this important disease-prevention service offering has been supported as a reasonable source of revenue for providers.

In evaluating current and future successes of immunization or other wellness-related services, however, we must consider what is driving the demand for these services and what factors are contributing to success in today’s environment. Then we must consider whether those drivers will continue to be as influential in the health care marketplace as the US health care system adopts changes in quality reporting and payment policies. One method to consider these issues is to apply a strengths, weaknesses, opportunities, and threats (SWOT) analysis framework.

The Strengths of Wellness Programs Offered by Pharmacists

With more than 67,000 pharmacies in the United States and over 250 million individuals visiting a pharmacy each week, it has long been promoted that pharmacies are the most accessible health care access point in the country. As a result, pharmacies are increasingly viewed as an important delivery point for public health initiatives, including wellness programs. In many cases, pharmacists in a community have developed strong relationships with patients, local health care providers, and the business community, establishing a level of familiarity and trust that can be useful in building demand for a new service.

In addition to the convenient access and established relationships across a community, pharmacists also have access to prescription data, which can potentially be leveraged to identify patients who would benefit from wellness-related services. Pharmacists also have the clinical knowledge required to effectively deliver wellness services to patients is likely already held by pharmacists, thus limiting the need for an investment in significant training and skill development. If a decision is made to offer wellness services, it is likely that the program could be up and running in a short period of time and without a significant financial investment.

Weaknesses in the Pharmacy-Based Model for Wellness Services

Cost of delivery must be considered when evaluating the opportunity to offer a new service. With the median salary of pharmacists currently at more than $120,000, personnel costs associated with wellness services can be substantial if the service will be delivered by pharmacists. It can also become challenging to justify service delivery by pharmacists when many of the services that are included in typical wellness programs can be provided by lower-cost providers (eg, registered nurses). Lack of integration with primary care providers, lack of access to primary care records, and lack of data connectivity are additional issues that present challenges to the effective and efficient delivery of wellness services in most pharmacies.

Opportunities on the Horizon for Wellness Services

As the country continues to implement the “pay for value, not volume” principle of the Affordable Care Act, significant shifts in the health care delivery landscape are emerging. Of note is the emergence of accountable care organizations (ACOs), which seek to convene and coordinate a breadth of health care services for the purpose of achieving improved health in a cost-effective manner. The expanding presence of ACOs and other pay-for-performance (PFP) strategies creates opportunities to create new service delivery models that demonstrate value to patients and payers. The convenience of access through pharmacies and opportunities for pharmacists to influence patient outcomes in a manner that impacts quality metrics being monitored by state, federal, and commercial payers is significant and may present new opportunities for the delivery of wellness services in pharmacies.

Threats to the Viability of Pharmacist-Delivered Wellness Services

In an environment that is shifting toward rewarding quality, there is greater awareness of the importance of preventive health services as a strategy to manage health care costs. With this increased focus on disease prevention and chronic health management, it is anticipated that many stakeholders in the health care arena will seek to establish business enterprises focused on patient health and wellness. Additionally, rapid changes in technology will no doubt heavily influence the ways in which patients engage wellness services. As a result, we can look for wellness programs to become more mobile, bringing services directly to patients and potentially trumping the access advantage currently associated with pharmacies.

For example, employer-based wellness programs will continue to expand onsite screenings and other health care services, moving programs well beyond the fitness and health coaching offerings that often frame these initiatives. Integrated health systems participating in PFP programs realizing the importance of actively supporting patient engagement will expand their community outreach activities, creating mobile clinics that offer wellness, prevention, and chronic health management services. With this growth, we will see expanded use of low-cost personnel, such as community health workers and community paramedics, specifically trained to support the health and wellness needs of communities.

Reviewing the issues raised by this brief SWOT analysis, 2 important themes. First, in today’s environment, the offering of wellness programs by pharmacies leverages their location and convenience and does not necessarily rely on the unique clinical knowledge and skills of pharmacists. Second, the manner in which health care is organized, delivered, and paid for is undergoing unprecedented change, creating unique opportunities for entrepreneurial activities, within pharmacy and beyond.

The intersection of these themes suggests that when the services defined within a wellness program are not explicitly tied to optimizing medication use (ie, traditional wellness programs focus on health education, health screenings, immunization programs, etc, and do not rely on the unique medication expertise pharmacists hold), the prospects for wellness services envisioned through a lens focused on traditional pharmacy operations (ie, services delivered as an extension of medication dispensing and based in a static location staffed by personnel that only includes pharmacists and pharmacy technicians) are potentially diminished.

“Value” is the buzzword in today’s health care dialogue, and it is defined as perceived benefits divided by costs. When considering wellness offerings as a component of pharmacy services, one must determine how patients and payers will recognize value. Traditionally, the services offered by pharmacists have only been offered by them. As the profession develops service offerings that are not tied to traditional medication distribution services, the process of establishing comparative value moves into a realm that will pit pharmacists and pharmacies against many other types of personnel and businesses. When considering the opportunities for offering wellness services, pharmacy leaders will need to consider the level of their investment in the context of the full landscape of health care and the policies and trends that are driving change.

Todd D. Sorensen, PharmD, is professor and associate head, Department of Pharmaceutical Care and Health Systems, at the College of Pharmacy, University of Minnesota. He also serves as the executive director of the Alliance for Integrated Medication Management, a nonprofit organization that engages health care institutions in practice-transformation activities that support improved medication use.

Dr. Sorensen’s work over his career has focused on leading practice change and the development of future pharmacy leaders. He has worked with numerous health care organizations focused on identifying ways in which pharmacists can better meet the needs of patients. His research and service activities, focused on identifying strategies and leadership activities, have led organizations to successfully integrate and sustain medication management services. This work has been greatly influenced by 7 years of experience participating in and leading a national quality improvement collaborative for health systems seeking to optimize medication use in outpatient settings.

References

• Zellmer WA. Preventive health care and pharmacy. Am J Hosp Pharm. 1975;32(8):791.
• Fleshman RP, Archer SE. Nurse-pharmacist teams screen for hypertension. Hosp Form. 1976;11(2):73,77,81.
• Solomon AC, Hoag SG, Kloesel WA. A community pharmacist-sponsored diabetes detection program. J Am Pharm Assoc. 1977;17(3):161-163.
• Wilson JB, Osterhaus MC, Farris KB, et al. Financial analysis of cardiovascular wellness program provided to self-insured company from pharmaceutical care provider's perspective. J Am Pharm Assoc (2003). 2005;45(5):588-592.