Yost Pharmacy: Past and present meet
Dave Yost and Sarah McClain have community pharmacy in their blood. Their grandfather opened Yost Pharmacy — which they now own and operate — on Main Street in Mason, Ohio, in 1945. In the ensuing 71 years, the pharmacy has become a pillar of the community in ways that go beyond the doors of the pharmacy. Drug Store News spoke with Yost and McClain about their family’s dedication to community pharmacy and how they protect Yost Pharmacy’s legacy while meeting patient needs in the 21st century.
DSN: Why did you take up pharmacy and continue the family business?
Sarah McClain: I think a lot of it revolves around seeing the community involvement and being part of what at that time was a very small town — seeing it grow and be able to continue to have those local connections and that community feeling — and to see the business make a real impact on people’s lives.
DSN: What position would you say Yost Pharmacy occupies in your community, and what sorts of impact are you able to have as a result of that position?
Dave Yost: You kind of become a community staple when you’re around for three generations and when you’re in one place for over 70 years. We haven’t changed locations, and there’ve been a few remodels over the years. But the building stays basically the same — and you just become a fixture of the community, so you support the other things that go in the community like the sports teams and the theater. Your relationships with physicians become entrenched. When they have a question, they pick up the phone and call you as opposed to the new store that pops in or the CVS around the corner that maybe hasn’t been around as long.
As far as our place in the community, it’s that feeling that you become a fixture in the community and you touch everything just a bit. Obviously, we have a big role in the medical piece, but you just kind of become part of the everyday landscape of people’s lives. So when you grow up in it, you’re a part of that. It kind of just becomes a part of you, and it’s something that makes you want to keep it going.
DSN: What services have you introduced recently to help meet your community’s needs?
McClain: We have a number of services. We offer a delivery service, and that’s not a new service. It’s something we’ve always done, but it certainly has grown significantly as the demand for that increases. I think as the demographics have changed, there are more people who have challenges getting to the pharmacy and need that delivery. We provide a lot of medical equipment that’s not readily available from other pharmacies in the area, as well as vaccination services and compliance packaging. We also work with a number of the local assisted living and nursing facilities to meet some of the needs of their patients.
DSN: You mentioned that you’ve offered delivery for some time — what other sorts of legacy services are still in use today?
Yost: One of the biggest services is compounding. It’s definitely something that was standard practice for pharmacy when our grandfather started, and then it sort of became less popular. We kept doing it through that decline in popularity, and now it’s made a nice comeback. Being able to compound individual dosage forms to meet specific patient needs is increasing in demand as the drug pipeline is slowing down. Just today, I had two prescriptions faxed from chain pharmacies that either couldn’t do it or didn’t want to mess with it.
Delivery also is certainly something that, again, was on a much smaller scale throughout the three generations — and we do more of it now than we ever did — but it’s something we’ve done throughout our tenure. And just as with general pharmacy — the over the counter items, the bandaging, the specialty devices — those kinds of things have always been a niche for our business. They’ve waxed and waned depending on the needs of the community, but it’s something we’ve always done.
DSN: What Cardinal Health solutions do you use to run your pharmacy?
Yost: We use the Cardinal Health Inventory Manager (CIM). That piece has really helped control our inventory, which helps our cash flow and allows us to reinvest in the business so we can hire people we need to deliver these extra services or get new technology that we need to execute the increased volume demand. It frees up cash in case we need another delivery car or something — it’s some money in the bank because you’ve got a graduate-level type of inventory management working on your behalf. It’s something we couldn’t put together on our own, for sure.
We also take advantage of the RCS dashboard, which helps monitor our claims that are underwater and losing money. It helps monitor patients who aren’t adherent. When it comes to Star ratings, we can identify the patients a little easier through the dashboard, and we can reach out to them and try to get their compliance up. It helps us make sure we’re maximizing our insurance reimbursement. We also use the Reconciliation Complete to monitor our payments and make sure we’re collecting all the billables we have out to third parties. The other piece is the level of service we get from our local sales representatives. They’re ultra-attentive to our needs and responsive, which is a contrast to what we were getting with the supplier we used before Cardinal Health.
DSN: What is the most important feature of a community pharmacy?
Yost: It’s genuine relationships and personalized service. We try to accommodate, as best we can, all the individual needs of our patients, which can be a challenge as your patient population grows. But people respond to that, and your business grows — you just have to meet the challenge of meeting everyone’s needs. That’s how community pharmacies survive. They are creative, and they find a way to make it work. So whether it’s our store or other community pharmacies, the thing that’s important is the personalized service and the relationships you build with your patients. You can identify your patients by name. When they walk through the door, and you know they’re eligible for some extra service, you can ask them right there. You don’t have to drag them in for an appointment with someone they’ve never met before, and they tend to be a lot more honest and forthright with you. It just means you can take better care of them because it’s a much healthier atmosphere.
Fuse’s innovation process, adaptive nature on display at Cardinal Health RBC 2016
As expectations from regulators, patients and payers change, community pharmacists are forced to be adaptive. Rolling with the changes can be difficult to do alone, but one division of Cardinal Health is working to adapt to customer needs as they are trying to navigate the changing healthcare landscape.
At Cardinal Health RBC 2016, the innovation lab Fuse — which opened in 2014 near the company’s Dublin, Ohio, main campus — was showing attendees how it operates, how it responds to customers’ needs and how it is looking to disrupt the healthcare landscape.
On the tradeshow floor, Fuse’s aptly named Innovation Taking Flight display was inspired by some of the earliest disruptors — the Wright brothers, who brought a game-changing steering process to aviation to build the first successful aircraft and change the transportation industry forever. One section served as a showroom for some of Fuse’s innovations, allowing attendees to offer feedback on some of the solutions still in development. In another section of the Fuse display, the Scout team, who focuses on innovation, was creating a prototype of a solution that helps pharmacists integrate clinical services into their workflow.
The prototype build began before the show with a customer survey asking what pharmacists’ biggest pain points are, with clinical services integration coming up most frequently. Over the course of the show, attendees helped narrow down what they were looking for in a solution. By the final day of RBC 2016, Marty Vian, Fuse user experience leader, and his team had built Nomi. The prototype’s name is a play on words, as it would help pharmacists identify their patients using facial recognition software that would also identify potential clinical interventions for which the patient is eligible.
“The main area that Fuse focuses on in innovation is working with the customer — understanding their problems and what works best for them,” Fuse communications business partner Jessie Slater told Drug Store News at Cardinal Health RBC 2016. “We're not developing things that work best for Cardinal Health or for Fuse — it's what works best for our customers. We involve them in every part of the process.”
One of the best-known innovations to emerge from Fuse is Cardinal Health MedSync Advantage. Vian told Drug Store News the platform — which helps community pharmacists identify patients who would benefit from medication synchronization, sync a patient’s medication and monitor adherence — was developed by the innovation lab in partnership the with Cardinal Health Retail Independent business, in response to an issue raised by a customer at a past Cardinal Health RBC, and it was done with constant consultation with customers.
“Instead of building the entire bike and then seeing if we can ride it, we start with a small piece of it,” Slater said. “So before we get too far along in the process, we get customer feedback and ask, ‘Up to this point is this working?’ Then how can we iterate on that, make it better and keep iterating until we get there?”
“We want to come out of this with a great idea and great insight on how well an idea will work, but it also highlights how we work," Vian said. "We're trying to demonstrate the speed at which we work and the involvement of the user, getting their feedback along the way as opposed to spending 18 months building a piece of software that nobody really wants.”
Cardinal Health RBC 2016 panel highlights impact, potential of pharmacy advocacy
Given that 51% of prescriptions in the average pharmacy are for Medicare or Medicaid beneficiaries, independent pharmacists know just how the business of pharmacy and public policy are inextricably linked. And at Cardinal Health RBC 2016, the ways pharmacists can have an impact on the legislative process were front and center.
During Cardinal Health RBC 2016’s Opening Session, host Eva Saha moderated a panel discussion about pharmacy advocacy, featuring Cardinal Health SVP Independent Sales Steve Lawrence, Healthcare Distribution Alliance SVP Kristen LaRose Freitas, National Community Pharmacists Association President and CEO Doug Hoey and Bronx-based independent pharmacist and President of the Pharmacists Society of the State of New York Roger Paganelli.
Paganelli kicked off the panel by discussing one of the tangible effects his involvement as a member of PSSNY has had on the profession, pointing to a New York law taking effect this year that focuses on multi-source generics pricing (MACs), creating a way for disputes to be appealed, investigated and resolved. The law requires pharmacy benefits managers to respond to pharmacy-filed appeals within seven days. If an appeal is deemed valid, all other pharmacies in the network will see the maximum allowable cost adjusted.
“When we are reimbursed less than what we pay for a prescription, we wanted the opportunity to go back to the PBMs and say, 'You paid us less than what we paid for this. It's not fair. We want it back,’” Paganelli said.
On the national level, HDA’s LaRose Freitas touted the speed with which pharmacy owners and other stakeholders came together to lobby Congress to pass a bill that worked to combat the prescription drug abuse epidemic, while ensuring legitimate patients could get access to their medication. The Ensuring Patient Access and Effective Drug Enforcement Act was signed by President Barack Obama in April. The law clarifies some Drug Enforcement Agency regulations, while allowing pharmacies to correct any identified issues with medication before corrective action is taken.
“I think sometimes people feel like their voice isn't heard, but this legislation is an example of how pharmacy groups and patient groups asked for some guidance and clarity in DEA regulations and were ultimately successful,” LaRose Freitas said. “This was legislation that moved extremely quickly. Congress heard there was a problem that needed to be addressed, and they did it in a bipartisan way.”
Alongside the legislative victories are ongoing efforts that Hoey discussed, including one of the most anticipated issues awaiting congressional action — giving pharmacists provider status under Medicare Part B. The legislation, which has 290 House members and 49 senators as co-sponsors, is currently awaiting action by the Congressional Budget Office.
In addition, the NCPA has had a big hand in asking the Centers for Medicare and Medicaid Services to issue a guidance that would address direct and indirect remuneration fees, which can be assessed by PBMs and plans months after a prescription is dispensed. The guidance NCPA is pushing for would require those fees to be disclosed at point of sale.
“It's not a cure all, but at least it's a step forward in being able to make some business decisions,” Hoey said.
Throughout the panel discussion, participants emphasized the impact that pharmacists who get involved in the process of lobbying lawmakers can have simply by reaching out to their representative. And Lawrence left RBC attendees with a call to action, highlighting the only pharmacist in Congress, Rep. Earl “Buddy” Carter, R-Ga.
“We need more pharmacists throughout state and national levels,” Lawrence said, adding that advocacy is equally important. “[Lawmakers] need to understand what you do every day so they can pass the right legislation and you can take care of your patients the way you want to. Doug said it best, and I’ve heard other people say it — you need to get into politics or get out of pharmacy — and you should take that to heart and get involved.”