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“Ready to Work” initiatives and The Pharmacy Technician

The practice of pharmacy grows by leaps and bounds each and everyday.

The education of Student Pharmacists to take on both current & emerging roles in providing pharmaceutical care has occurred and continues to evolve. I have a firm belief that this education will satisfactorily meet and exceed the needs of both current and future patients.

While the Pharmacists education is well defined in that Boards of Pharmacy and National Associations have criteria that you must meet prior to entry into the profession. The Pharmacy Technician’s education is not as well defined. Currently technicians are educated by for-profit institutions, some but not all Community Colleges, and there are some online programs.

Question??

How can Pharmacists fully utilize their education and knowledge in both current and emerging markets – if there is not an appropriate and affordable education model to satisfactorily keep pace with pharmacy technician demand in the market?

It’s my opinion that the greatest demand for the Pharmacy Technician will be in the retail sector. There is a high turnover rate in this market and typically this is the space where an organization can take on registered pharmacy technicians that have no pharmacy experience. With an increase in mergers and acquisitions between chain pharmacy, benefit managers, and health insurers – the demand for registered pharmacy technicians will continue to increase.

Current state laws will also need to keep pace with changes in how both Pharmacists and Pharmacy Technicians are utilized in the Pharmacy.

  1. Telemedicine
  2. Pharmacy Technician verification via Barcode technology (http://www.ajhp.org/content/73/2/69?sso-checked=true)
  3. Medication therapy management
  4. Pharmacist Practitioners
  5. Collaborative practice models
  6. The increased market-share of “specialty pharmacy”
  7. Compounding pharmacies regulated by federal guidelines USP 795, 797, and 800

These are all topics to consider when considering the job market and demand for both the practicing Pharmacist and Pharmacy Technician.

What can fill the education gap?

I had never heard of the “Ready to Work” initiatives taking place in Birmingham, AL. But after meeting Ms. Dorothy Henry and leadership at Lawson State Community College — I stumbled upon an institution that is at the forefront of this community based initiative.

Ready to Work programs can offer job seekers foundational knowledge to take on entry level job positions. “Ready to Work” educational healthcare tracks include medical assistant, patient care assistant, and pharmacy technician. These programs help folks learn how to become registered and/or certified to take on entry level positions in the workforce.

Having a job that you care about and enjoy is good for the individual because it increases self-worth. It’s good for the family because it provides a stable source of income. It’s great for both the community and local economy because the money can be recycled into tangible purchases of goods, services, and long term assets.

I’ve had the pleasure of working with folks interested in becoming registered Pharmacy Technicians through this program. And I really believe that this could be an opportunity where more Pharmacists can serve and become involved in helping young people find a career in their local community. Programs like this help to ensure that there are affordable avenues for people to learn and become aware of professions that can be a source for both a rewarding career and steady income. I have posted my lecture materials online at www.samblakemore.com . Feel free to follow along and give back any comments and/or positive feedback.

Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

 

 

 

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The increasing use of DAW 9 and it’s potential impact on pharmaceutical care…

The Dispense As Written Codes that I use regularly in my practice are:

DAW 0 = NO PRODUCT SELECTION INDICATED

DAW 1 = SUBSTITUTION NOT ALLOWED BY PRESCRIBER

DAW 9 = SUBSTITUTION ALLOWED PLAN REQUESTS BRAND

Why is this important?

Dispense as written codes are important in billing/filing claims correctly to a patient’s insurance plan. Claims must be billed/filed correctly so that patients receive the appropriate drug products at the correct price.

For me… DAW 0 is used most of the time (this holds true for most pharmacists), while DAW 1 is used sparingly; a drug example for those who are not Pharmacists as to when a Pharmacist uses DAW 1 is seen in the case of  prescribing Brand Name Synthroid. Prescribers often write for Brand name Synthroid instead of Levothyroxine because this drug has a Narrow Therapeutic Index (NTI). Due to the NTI, formularies often include both the Brand and Generic products on their formularies so that patients receive appropriate pharmaceutical treatment for their thyroid conditions.

If you’re interested in reading more about NTI, please visit the FDA’s website and review the powerpoint “Quality and Bioequivalence Standards for Narrow Therapeutic Index Drugs.

So…DAW 9?

DAW 9 is increasingly becoming popular and being put into place by Pharmacy Benefit Managers (PBM’s). Typically generics have been dispensed because the generic product is the cheaper alternative when compared to the brand name product. However, increasingly manufacturers have been offering PBM’s rebates for the monies that they pay the pharmacies on the drugs cost.

In short…even when prescribers write a prescription and sign Product Substitution Permitted — the pharmacist must dispense the brand name product for the product to be covered by the patient’s insurance. This is done by changing the computer DAW code from a 0 to a 9.

So you may be asking, “how is it more profitable for the PBM’s to have higher priced drugs on their drug formularies?” I found a great article published by NCPA entitled “PBM Revenue Streams and Lack of Transparency”. The article is a quick read and outlines why Brand Name products continue to be on formulary even when a generic competitor enters the market.

Examples of using DAW 9 in my practice (Generic Drug — Condition Treated)

Dexmethylphenidate ER — ADHD

Diazepam Rectal Gel — Seizures

Methylphenidate ER — ADHD

Budesonide Respules — Asthma

What’s the effect on people and the market?

In my practice this leads to a major consultation point…

  • You and/or your family member is on a drug that insurance is requiring that Brand Name be dispensed (DAW 9). I’m not sure if your local pharmacy carries the Brand Name or Generic product. Thus, it is imperative that you contact your pharmacy days in advance to ensure this product is in stock when you attempt to refill your medication. If you don’t call ahead of time, this could potentially delay when you receive your medication, which could lead you to become non-compliant with your medication(s).

The reason that this is so important…

  • Finding the medication for your patient is important…but ensuring that your patient has access to this medication is just as important. If they can’t obtain or access the medication, then you can’t ensure their compliance on the medicine. And non-compliance ultimately can lead to hospital readmission.
  • When patient’s transition from an inpatient admission to being discharged to the outpatient setting, prescribers are often unaware of what’s on or not on the patient’s drug formularies. This can lead to confusion and delay and/or impede discharge planning which can potentially lengthen their hospital admission.

DAW 0 versus DAW 9 seems like such a trivial issue, but the increased prevalence of this small change can impact our patient’s compliance and can drive up the cost for providing healthcare.

If you have Questions related to this topic? Please feel free to leave a comment.

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

 

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Writing in Plain English…

Learning how to write in plain English has been one of the most useful concepts I have learned. Effective written communication is a business litmus test. If done well, it can help the business professional build their personal brand.

Plain English is defined in Wikipedia as being…

A style of communication that uses easy to understand, plain language, with an emphasis on clarity, and avoidance of complex vocabulary.

Personally, this has been extremely important to me in the following areas:

  1. Writing business emails to convey a message the reader can easily understand.
  2. Writing incident reports to convey a message that anyone could understand.
  3. Designing business correspondence to customers regarding new services.
  4. Designing operations & workflow management forms to ensure quality employee performance that leads to better customer service.

Thus, out of respect to the the art of writing in Plain English this is the conclusion of this blog post.

For further information click this. And if you really get bored and want to read a book — I would suggest the following, Writing & Speaking at Work by Edward P. Bailey.

Regards, Sam

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

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How to approach meeting someone for the first time…

So…what do you do for a living?

We all have our canned answers to describe ourselves to the strangers that ask us this question. So…I suppose for a moment, pause and reflect upon the answers you have given throughout the years.

Think of those times you were hesitant to state your job title; and also think of those times you were proud to state your job title. Consider the times you were either happy, sad, or indifferent when someone asked you “what do you do for a living.”   One thing is for certain; professional competence, college diplomas, jobs, and socio-economic status do not correlate to happiness, fulfillment, and satisfaction.

We are all on a wave but each person’s wave has different lengths. Being self aware and cognizant of this fact provides each of us with small boosts to our emotional intelligence score.

The dreaded “first impression” can certainly have different outcomes when you’re able to live in the moment of a conversation instead of replaying canned questions and answers.

If we agree that human beings are much more than job descriptors and titles; consider your own life story…

If someone had to introduce you in front of an audience; would you expect them to come to the microphone and blurt out your job title and degrees… then walk away from the microphone and sit back down?

Maya Angelou famously said, “At the end of the day people won’t remember what you said or did, they will remember how you made them feel.” Ultimately, that’s what this blog post is about.

When you meet people for the first time, please let the experience be organic. Leave the canned answers and questions in the pantry closet. I have learned from my own personal experiences that this is an important concept to apply in my life. By making this small decision, it has allowed me to not blindly box people into categories or groups—because everyone has their own story to tell.

When you meet a person for the first time, consider this… those diplomas, job titles, and trophies on the mantle are simply short highlights to the various chapters that fill a person’s unfinished book of life.

Take home statements…

  1. You do have a life outside of your career…reciprocate this truth when meeting people for the first time by not immediately going for the “what do you do for a living” question.
  2. Throw the canned questions and answers in the garbage. They will help your conversations be more refreshing and organic.
  3. Instead of asking people what they do for a living, ask instead, “can you please tell me about yourself?” This allows people to have a moment of reflection. They then have an opportunity to decide if they would like to tell you their personal story.

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Author, Sam Blakemore, August 4, 2017.

 

 

 

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Managing conflict…

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You don’t have to be a manager to run into circumstances that make you want to claw your hair out. Managing conflicts in the retail market space is like pouring a cold cup of water in a glass during the summertime. What I’m trying to get at folks, is that you’re going to have to learn how to deal with the emotions of your staff, your customers, and your family, and most importantly yourself.

First, I would like to come clean… I can be the worse at dealing with conflict. I’ve yelled and kicked many garbage cans.

Any person that is passionate about their craft strives for excellence; and if excellence is not achieved there will be frustration.

Before we get into managing conflict…Let’s consider the following:

  1. On a scale of 1 to 5; how do you manage stress?
  2. Who do you talk to about your stress?
  3. What is your outlet for your stress?
  4. When was your last vacation from your work?
  5. Do you actively take time to de-stress during your workday?
  6. Have you considered quitting your job due to stress?
  7. How often do you raise your voice in a day, a week, a month?
  8. How is your family life; do you spend enough time with friends and family?
  9. How is your sleep? Have you been getting enough rest?

I bring up those questions to lead into how conflict arises. Conflicts arise with much more earnest and ease in times of stress and exhaustion. To ensure you’re at your best; make sure you at least attempt to take care of your daily needs. Eat lunch at an appropriate time, step away for a 15 minute break to clear your mind, or take a brief walk to get away from the office.

Back to conflict! Haha…

When facing conflict with customers, employees, peers, or even family— the first thing you should do is pause. The second step should be to gather your thoughts. The third step should be to listen before speaking. Pause, gather, listen. 

What does it mean to pause you ask? The pause should be intentional. It helps you to refocus your energy into not speaking. Oftentimes I’ve found that immediately speaking, only pours fuel on a “gasoline conflict”.

Gather… To gather means to collect your emotions, your feelings, your worries, your fears, your anxieties. Conflict is an adrenaline rush. Having someone out the blue, just begin yelling or cursing can be a shock to your nervous system. Thus, gather yourself and consider why you’re standing presently in conflict. The pause allows you to actively choose to gather your thoughts and emotions.

Lastly, listen with intent. Your mind will without a doubt be racing toward the hills. This person did me wrong. This person is not right. This person is crazy. Be an active listener in the process towards solving the underlying issues of both your customers and staff. I’ve found that 9 times out of 10 a customer or staff member just needed a moment to be heard. It’s easy to underestimate the value of listening. It’s very easy to want to solve a problem; oftentimes the problems are simple problems that can be solved in 30 minutes or by the end of the business day. The big problems that can lead to conflict often are the problems that have been festering for months.

Conflict is around the corner. But…

  • Reflect and honestly evaluate your personal stressors

Next, when presented with conflict: 

  1. Pause and breathe
  2. Gather your thoughts and emotions
  3. Listen with the intent to understand

 

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

 

 

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Who is your customer

I got into a rather interesting discussion with a friend recently. He works in higher education and asked me the following question after reading my blog post Considering “workplace levers” in office politics

“At a university, who is your customer…the student or the parent of the student?”

My response was quick..

The student is the customer… the college student is around 18 years of age, and thus  has the final decision to attend the institution. Yes, their parents have great influence in their college decisions; but it’s my opinion that colleges must treat the student as the customer because they’re the folks attending class, living on campus, and being active members of the student body.  Additionally, many student’s take on student loan debt even when parents do have the ability to make payments towards their children’s college education.

Ultimately, students graduate and become alumni. The alumni hopefully become donors to continue the advancement of the institution. If the university mistakenly treats parents as the customer throughout these formative four to five years the student is on campus—there is the potential that the graduates won’t become actively engaged in efforts to both donate and raise donations.

My friend’s response… 

You’re wrong! Parents are the customers because they’re paying the bills!

Who won this argument you might ask?

This round and round again debate got me thinking…

How often do managers ask themselves, “who is my customer and why?” In my scenario the university is the business and the customer(s) are the student and/or parent.

So the business owner and/or manager has a decision to make.

Three questions…  

  1. Who is my customer and why?
  2. What is the criteria in selecting a customer?
  3. When the customer has been selected; how do we market to this segment appropriately?

A short list of factors to consider when selecting and defining your customer: 

  1. Who is the buyer of goods?
  2. Who is the active shopper of goods?
  3. Who influences the purchase?
  4. Who makes the final decision?

Ultimately, the business has to understand who their customer is to effectively market their product. Effective marketing is tough; as marketing to the wrong audience can have a negative effect on the long term health and growth of the company.

For example…does a children’s toy company create an advertisement campaign geared toward the child or the parent? 

Who is your customer? And what decision trees did you employ to come to your conclusion?

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

 

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Considering “workplace levers” in managing office politics…

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Management can be difficult. As you have read from my previous posts the most important resource of any business is its employees. If a manager is unable to effectively communicate and utilize their employees, he or she will not be managing for very long.

Leverage is a principle often utilized to discuss financial debt in the world of business. Financial institutions and businesses can utilize debt to take on more risks in the hopes of increasing revenue and profit margin. In that same respect the employee and manager utilize forms of “workplace leverage” to ensure status and influence within the organization. Both the manager and employee use various levers to elicit a response.

The manager’s “work place levers” 

  1. Hire versus Fire to influence employee behavior and decisions
  2. Praise versus Write Ups to influence employee behavior and decisions
  3. The power to increase salary and dole out bonuses to influence employee behavior and decisions
  4. Positive evaluation versus Negative Evaluations of employees to influence employee behavior and decisions
  5. Internal politics with ownership and co-workers to maintain status and position while influencing employee behavior and decisions

The employee’s “work place levers”   

  1. Underutilization versus over-utilization of sick and paid days off to effect management behavior
  2. Gifts and Praise of management/co-workers to effect management behavior
  3. Positive versus Negative Evaluations of management/co-workers to effect management behavior and decisions
  4. Habitually early to work versus habitually tardy to work to effect management behavior and decisions
  5. Internal politics with ownership and co-workers to maintain status and position to effect management behavior and decisions

I won’t delve to deep into the details of how these actions can be utilized by both the manager and employee; but briefly review each point. Consider the names and or faces of the people that you can associate with each variable. In short, both the manager and employee utilize forms of leverage to elicit responses.

As I’ve mentioned previously, people are as important as financial capital in maintaining a functional organization. For those in management; please take the time to consider these 10 key points to ensure a functional work environment.

  1. Be upfront and honest about the role each person plays in maintaining a functional business.
  2. Value the opinion of every member of the team, and actively demonstrate this by listening to their opinions and actively considering these opinions when creating changes within the organization.
  3. Even in times of disagreement; work diligently to maintain a level of respect for that person
  4. Focus on the value created for the shareholders when trying to create a unified vision between management and employee.
  5. Focus on the quality of the product created for the consumption of your customer when trying to create a unified vision between management and employee.
  6. At a minimum evaluate employees biannually; when evaluating always have a third person involved to witness. This reduces the possibility of arguments and misunderstandings.
  7. Be respectful of the goals your employees have; most likely they do not want to be employees for life. And that is fine. Work with them on creating a 1 year, 5 year, and 10 year plan so that they don’t feel stuck in a rut.
  8. Create rubrics to grade yourself and employees; this shows thoughtfulness and reduces bias when grading employees on their abilities.
  9. During reviews, offer each employee a time to have a moment of reflection. Ask them, “do you have an issue with management, a co-worker, or the organization that needs to be resolved?”
  10. Practice being able to discipline without bias; this practice helps maintain uniformity in the organization, and builds a level of trust for the employee in relation to management.

You will never be able to keep people completely happy. And following this plan will not eliminate every employee’s discontent. I still implore each manager to have a plan, and  stick with that plan during both the good and bad times. Work with diligence to ensure the employees you manage have enough space to consider their place and role in the organization.

We work and work till we are tired. The days and months will pass us by, and before we realize it our most important employees are desiring to leave the organization and often we don’t even see it coming.

Please review my 10 key points; by reviewing these points I hope that you’re able to improve employee satisfaction. It is important that managers ensure that an employee’s concerns are heard. There should be open lines of communication in all phases of hierarchy; ownership–>management—>employee. Communication is paramount to ensuring business success.

A company can quickly collapse under the duress of organizational stress. To prevent this collapse managers must pride themselves on using “workplace levers” in an appropriate manner to maintain balanced scales of power in these “workplace courtrooms” that house office politics in every business and industry.

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

 

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Customer service — Alert Active Engagement vs. Distracted Passive Engagement…

A worker with voice low, eyes down, distracted by smartphone in their hand, “welcome to _______ how may we assist you?”

Distracted Passive Engagement is a buzz kill.

Customer service in it’s simplest form is an opportunity to tell the story of your business.

When a customer steps into your business, on the surface they’re looking for a product to purchase. However, consider that the shopper has an ability to purchase a given product in a variety of other ways besides coming to your business.

How many places can you buy coffee?
How many places can you rent cars?
How many pharmacies are there in a five mile radius? 

Managers should treat their customers as smart and knowledgable.  Typically at their disposal is a smartphone that can answer most of their general questions.

It’s easy to run a business as an accumulation of transactions; you sell and they buy. But if you manage a business in this manner you’re losing an opportunity to convey that theres meaning and substance in the what, why, and how you provide the product and/or service.

When a customer visits your business, visualize them screaming at the top of their lungs,  “Gimme a reason to shop here!”

Are you adequately providing the foundations of customer service?

Clean—there’s no bigger turnoff for the shopper than to walk into a business that’s unclean and unorganized.

Time—in providing your service you respect your customer’s time and if there’s a delay in providing the the service or product you apologize and/or inform the customer as to why there is a delay.

Care—the employees care about what they do. They’re engaged fully to the mission of the business and want to be of service to the customer.


The focus on the remaining sections of this article is to discuss how to find those that care. I often tell new applicants the following;

” I can teach them how to perform their job, but I can’t teach them how to care about their job.”

When an employee is simply going through the motions of performing his or her job this can be detrimental for both the customer and business.  Poor customer engagement will lead to a decline in generating revenue.

 In my own experience as a manager there are two options in how your employees provide customer service.  

  1. Distracted Passive Engagement (DPE) 
  2. Alert Active Engagement (AAE) 

Both AAE and DPE can induce the sell of a given product. However, only AAE can induce the sell of a product while also increasing the potential of retaining customers. This customer retention induces customer loyalty and creates the businesses “brand”. Think about it from this perspective…

How does a business create a brand from one-time shoppers of their service?

DPE equals going through the motions. The employee shows up to work on time, the employee says all the right things, and they make adequate sells of your product line. The manager should ask themselves the following regarding employees that may be distracted and passive in their engagement with customers:

  1.  Do they know the details of the products they sell?
  2. Do they know the attributes of your traditional shoppers?
  3. Are they able to quickly deduce what the buyers want and need?

Employees that perform AAE  don’t just go through the motions.  General statements about employees that are actively engaged with the needs of the customer are as follows:

  1.  Typically these employees are in tune with the needs of the customer.
  2. Employees that actively listen to the needs of the shopper and make appropriate recommendations to meet customer need and satisfaction.
  3. Employees that strive to find new ways to provide quality service.

Remember the difference between AAE and DPE lays in the foundation that active engagement with the customer leads to greater success in retaining customers over a lifetime as opposed to simply making a one time sell.


Qualities…

In regards to a job applicant; reflect on the following questions regarding the person’s interview:

  1. Do they have a passion for the service your business provides?
  2. Are they equipped to serve the public in this capacity?
  3. If they’ve never been in customer service;  can they adapt to a service oriented work culture?
  4. Are they curious? Good questions during the interview process can mean that they will be equally active and engaged with customers.
  5. Problem solvers? Do they like to help folks solve their problems. This can be of value to both the customer and the business.

Educate…

Once they’ve become a member of your staff; harness the potential that you saw both in their application and during the interview process by educating employees on these key points:

  1. A focus on the long term instead of short term—be willing to lose a sell on a product if it’s in the best interest of the customer to get a given product elsewhere. In being up front and honest regarding the customer’s needs you will build trust. Trust will build customer retention.
  2. Awareness—be aware of customer body language. An awareness in how customers are feeling provides direction in how to engage with them to meet their needs. This awareness shows the customer that you understand what they want from the service or product that you provide.
  3. Listen—actively listen. Only by listening can your employees make appropriate recommendations.
  4. It’s okay—-it’s okay if you don’t know the answer. It’s better to state that you don’t know up front with customers. This builds trust with the customer. Be up front with customers and state, “I’m not sure, but I may be able to find the answer to your question if you give me a moment to research it.”
  5. Expert—your employees won’t know it all, but go over with them some key topics. Of those topics, find out which topic they feel most knowledgable about. Harness this knowledge and teach them to be experts in this area. Their expertise in a given area can be the difference in making the “sell”.

The goal…

Good customer service is one step in forming a relationship of trust. It demonstrates that your business can provide the customer with what they need. Once that relationship is built, continue to add layers of trust by maintaining outstanding customer service.

On the surface, customer service seems simple. Be nice, be courteous, and say thank you.

But it takes more to retain customers in this marketplace.  The owner/manager that doesn’t consider customer service to be a differentiator does not fully consider the threat of decreased  revenue from a decline in customer retention. In the retail space there’s an old saying…

“The customers you really like and want to keep don’t tell you they’re leaving…they just leave.”


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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

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A B-school essay from a Pharmacist’s perspective

My Operations Management (OM) Professor in B-school had one question for our final exam.

Explain if this course will or will not be relevant in your chosen profession or career path?

I revisited my short summary a few days ago and considered the role of the Pharmacist in relation to the current healthcare model. How can Pharmacists help create efficiency when we see inefficiency? How can individual Pharmacists help bring order to a process and fill in the gaps when we see an opportunity to help?

I believe the Pharmacist can fill in the “gaps” and find an opportunity to serve in new ways.  This will further our value to the healthcare team. Dispensing medications correctly should always be the foundation of our Profession, yet there are more bricks to be put in place to create the final framework in our bid to be seen as “healthcare providers”. With the broad knowledge base that Pharmacists have in their toolbox, there is an opportunity to be more than “retail or clinical.”


December 4th 2015 at 9:53PM I submitted the following.


Sam Blakemore, PharmD

Personal Operations Management

I have been a practicing Pharmacist for three years.  In that time period, Walgreens purchased Alliance Boots, CVS Caremark purchased Target’s in store pharmacies, and most recently Walgreens made another large investment in agreeing to purchase Rite Aid Pharmacies.

The number of patients that the healthcare system takes care of will continue to rise due to more people having access to healthcare with the implementation of the Affordable Care Act.  Yet, the reimbursements for these services has become more competitive due to increased demand for better pricing by federal and state funded programs.

The Affordable Care Act has made mergers the new norm. Hospitals, Pharmacies, and Home Health Care Agencies have decided that the key to survival is to become as “lean” as possible. In becoming “lean”, the merged companies streamline operations by initiating new workflow processes, retire outdated facilities, and layoff under-performing workers in the hopes of increasing productivity and profits.

Mergers within the pharmaceutical industry are creating shifts in the supply chain. This will impact the drug companies, wholesalers, and retail pharmacies both independent and chain. In the article Drug Partnership Could Trigger Major Supply-Chain Changes, the author states the following:

For now, drug manufacturers mostly use wholesalers like AmerisourceBergen to ship their product to pharmacies. But if manufacturers are squeezed too much by the arrangement, some could opt to bypass wholesalers altogether and peddle their drugs straight to the drug stores…1

Pharmacy mergers have increased for the purpose of survival in a market with a reimbursement structure that changes by the day. In the article, Reassessing the pharmacy supply chain for a healthier bottom line, the author states the following:

The unpredictable and shrinking reimbursement landscape requires these organizations to reassess expenses and processes –especially within the supply chain—across all facilities and departments to determine cost-effective operational strategies.2

Forecasting reimbursement and cost of drugs in pharmacy is key to success. As an example, Rite Aid Pharmacies earnings per share decreased due to a cut in Medicare reimbursement rates.

Rising generic drug prices are hurting drug store operators as insurers and pharmacy benefit managers have been slow in raising reimbursement rates for those drugs…reimbursement rates for Medicare Part D drug plans, which cover prescription drugs for senior citizens and the disabled, are falling due to growing competition to win these contracts.3

Appropriately forecasting revenues and expenses, using lean/six sigma principles to eliminate drug errors, and having a firm grasp of inventory management are the big three principles I will remember from this course. Having a firm grip on these concepts can be the difference between thriving and failure in this market. It is imperative that a pharmacist have a firm grasp of operations management to thrive in this market and differentiate one’s self against other pharmacists they’re competing against for a job.

I want my patients to have a good experience. I want them to receive the right drug, at the right dose, at the right time, and for the right price. With that in mind, this quote grabbed my attention when I first read it.

“With the country focused on controlling the escalating costs of healthcare, every entity in the healthcare system is under increased pressure to lower costs—while at the same time not jeopardizing the quality of care that patients receive.”4

It is my opinion that schools of medicine, nursing, pharmacy, public health and so forth should require or offer as an elective an operations management course. This course has challenged me to reconsider how I manage employees and myself. This operations management course offered me the information, vocabulary, and resources that I’ll be able to draw from in a healthcare environment that is rapidly undergoing change due both to increased competition and decreased net margins.

References

1.) Martin, Timothy W. Drug Partnership Could Trigger Major Supply-Chain Changes. 22 March 2013. http://www.wsj.com/articles/SB10001424127887324373204578374801163395308. Accessed 23 Nov. 2015.

2.) Piotrowski, Cary. Reassessing the pharmacy supply chain for a healthier bottom line. 17 July 2015. http://www.beckershospitalreview.com/finance/reassessing-the-pharmacy-supply-chain-for-a-healthier-bottom-line.html, Accessed 18 Nov.

3.) Ramakrishnan, Sruthi. Rite Aid cuts full year forecasts citing reimbursements. 17 Sept. 2015. http://www.reuters.com/article/2015/09/17/us-rite-aid-results-idUSKCN0RH1I920150917#BMoHOwRPdPZFJMVo.97. Accessed 18 Nov. 2015.

4.) Pharmacy Inventory Project: Improving Inventory Management at Genesis Healthcare System Pharmacies. 19 Nov. 2014. http://fisher.osu.edu/supplements/10/14252/white_paper_genesis_2014_2.pdf. Assessed 18 Nov. 2015.


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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn

Posted on

Rebaked PIE…Pharmacist Industry Engineer


It’s not always about how much money a business makes; oftentimes its more important to understand how much money the business can save.

I asked a Pharmacist the following question:

“Who is probably the most famous and richest industrial engineer? Your hint… he grew up in Mobile, AL?”

He paused and thought about it for a few moments…

Then he said, “I’m not sure…who?”

I said, “look at your smartphone… Tim Cook  ring a bell…”

Tim Cook…iPhone…ring a bell…”HAHA.” I know…I know…so funny, not really. Our discussion began when he asked me about my experiences in B-school (business graduate school).  I discussed various points in my journey as a manager, and how I sought some  answers to my many managerial questions. B-school helped fill some of those gaps.

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Quantitative Analysis for Managers I explained was an interesting but difficult course. I really had to work hard to put all the concepts together. It was business math on steroids.  A taste of algebra with a pinch of calculus and a dollop of excel spreadsheet.  One week we were discussing linear programming models; the next week we were discussing transportation models.

I felt like I could study all week for the tests, and still not feel good about my prospects of passing. The Professor would allow us to have a formula cheat sheet, but that was of little  value.  The course took time and was intense. The tests were tough. He ended up curving our final grades that semester.

It was tedious work. It took time to wrap your mind around some of the concepts; but studying those concepts gave me satisfaction. My mind was being pushed and thats what I wanted as a student. It made me appreciate the skill and art it takes to make complex business processes less complex. I began trying to understand the formulas behind business principles. I enjoy learning about a Professor’s educational background. It always explains why some concepts just feel so natural to the teacher/lecturer. Turns out our Professor that semester was an expert in the field of industrial engineering. I had heard about civil engineering, chemical engineering, electrical engineering, etc.. But I had never heard of industrial engineering.

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Pharmacist in general have an appreciation for math and science.  So I decided to show my Pharmacist “buddy” an old video on linear programming that the Professor had uploaded on the web. The Pharmacist became “giddy” with anticipation on how to setup the correct mathematical equation to reach an appropriate business decision based on profitability.

We then lightly touched on transportation models

I said, “driving a 18-wheeler seems simple enough…but then imagine all the routes and paths those trucks can take to get to their destination.”

He said, “yea…that’s right…isn’t that why some mail couriers only take right hand turns? That’s why they have people doing that research…think of all the money they save on gas, and all the time they save by making routes more efficient…”

I said, “you know where most of these principles fall under? Industrial engineering…”

Industrial engineers bring science to our everyday lives by engineering efficiency; they use math to bring order to a process. Pharmacists practice the same methods with medications. We ensure patient safety by being the medication experts of the healthcare team. We bring order and create efficiency in the dispensing and consumption of medications.

So what’s stopping Pharmacists from reaching our full potential as the “industrial engineers” of drug management? Gaining status as “healthcare providers” will go a long way in creating a structure for the reimbursement of our services. But until that “provider status” reaches all 50 states; what can our Profession do to show the “system” our value?

Currently the market is focused on volume to magnify shrinking profit margins. However, the market will gradually shift to a focus on reducing costs. In part because rising costs will lead to skyrocketing debt in our current healthcare model. The market is at risk of collapse due in part to rising medication costs.  While we can’t control how Pharma prices new drug regimens.. Pharmacists can be on the front lines of change by initiating the following principles:

  1. Limit “defects”–use “lean” principles to ensure patient safety and accurate dispensing of medications with appropriate operations management principles
  2. Improve discharge planning—ensure patients receive the appropriate medications upon discharge.
  3.  Improve access—ensure that upon discharge from hospitals or clinics; patients have access in the community to the appropriate medications from local pharmacies, mail-orders, and patient assistance programs.
  4. Engage in dialogue with prescribers—regarding the prior authorization process, formulary additions and deletions, an analysis on patterns seen at the pharmacy in the local community.
  5. Build an alliance—with social workers, churches, community organizers so that when patients need help the Pharmacist can give guidance.
  6. Data mine–effectively gather data about medication usage and prescriber patters; then turn data into usable information to enhance quality of care.
  7. Reduce expense—have an active engagement in knowing the costs of medications, and the copay tiers of pharmacy benefit managers. Have an active discussion with patient’s and their families regarding their ability to manage these expenses.

There are more PharmD’s graduating with dual degrees; Pubic Health, Business, and Law. There are more PharmD’s entering pharmacy school having already obtained a bachelors degree. The “Millenial PharmD” has the potential to step outside the box to meet the changing demands of the market.

My version of the Pharmacist Industry Engineer (PIE) does not epitomize  the traditional meaning of Pharmaceutical Industrial Engineering   in that traditionally the framework of the definition was focused on manufacturing for “Big Pharma”.  I simply seek to use this term to reframe how we are defined as agents of change in the current marketplace.

A PIE as defined by me—both optimizes and individualizes pharmaceutical care, creates new processes to improve pharmacy access, improves operations to ensure patient safety, and builds communication channels with both prescribers and patients to reduce waste and expense for the individual and healthcare system.

Efficiency. Accuracy. Reduced Defects. Reduced Costs. 

 

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Sam Blakemore is the Pharmacy Manager of Peds Rx Pharmacy Solutions. Connect with him via: LinkedIn