What's the Hurry, It's Only Been 35 Years?

Lowell J. Anderson

Originally published in the "Minnesota Pharmacist," the journal of the Minnesota Pharmacists Association

It was 1975. We first heard of a new idea called Pharmaceutical Care. Those of us in practice at that time were puzzled: neat name, but isn’t that what we had being doing all along, taking care of our patients and customers? As we heard more we discovered that it was more than what we had been doing. It was bigger! As this movement gained momentum it began to talk about pharmacists accepting responsibility for the manner in which our patients used their medicines.

As is usual with the prospect of change, it was frightening. Even though we were all quite comfortable doing what we did-- deep down we knew there must be more. It was also exciting as it promised an increased importance for pharmacists in the health care of our population. In a time of growing control of pharmacy practice and profitability by managed-care it offered hope for new opportunities.

All the elements of the profession of pharmacy saw this as a new strategic direction. Professional associations offered resolutions in support, encouragement to adopt, and continuing education to help in the transition. Boards of pharmacy, seeing that it could serve to improve health promulgated rules that supported the clinical activities of pharmacists. Colleges of pharmacy changed their curricula to incorporate it.

Fast-forward thirty-five years to 2010– virtually a professional lifetime. New pharmacists are trained in the clinical aspects of a pharmaceutical care practice with an officially recognized service called medication therapy management (MTM). All practicing pharmacists have used continuing education programs to improve their clinical skills. Some state Medicaid programs incorporated it as a benefit, and Medicare Part D included it. A growing number of practitioners are successfully embracing it. And employers are slowing seeing it as a benefit for their employees.

But we seem to be stuck at that often referred to crossroads – the light seems to be stuck on either red or yellow. It never changes to green! Why is that?

We are like the Swedish couple sitting in the porch swing on a beautiful spring evening. He turns to his wife of many years and says, “Dear, I love you so much I can hardly keep from telling you.”

We can hardly keep from telling our customers that we have something to offer that is important for their health. I think we need to look closely at the face that we as pharmacists present to the public. Those of us who practice are told daily that by our customers that they come to our pharmacy because they trust us, they get good advice and service from us, and they like us. Yet our pride is in how many prescriptions we fill and how quickly we can do it. We need to listen to our customers - rarely if ever will someone say that they come to our pharmacy because of our ability to fill a lot of prescriptions. Or, because of the price we charge for a prescription, since that is determined by their health plan.

We need to talk about what they are interested in! We need to begin to market to our strengths. The long-time metrics of “fast, cheap and accurate” are no longer valid. The new metric for medicines use is “did my medicine do for me what I wanted it to do.”

Most of us are not formally practicing pharmaceutical care or MTM in the sense that we interview a patient, document our findings and recommendations and create a care plan. I do believe the vast majority of pharmacist practitioners deliver valuable clinical services routinely in the course of their practices. I think that we underestimate and downplay the importance of the discussions that we have with our customers and patients “on the fly.” These are conversations that we have in response to a focused question or concern rather than being comprehensive. Over time these interventions significantly affect the medication therapy and the health of the consumer who comes to us. We should be proud of that. However, we also need to ramp it up to the next level by offering documented MTM with follow up when appropriate.

This is where marketing enters. The press and policy people are talking about MTM. Employer and government health plans are slowly putting the benefit in place. Our customers and patients hear these discussions but don’t connect it to the services that we are providing in our pharmacies. We must connect the valued services we provide in each of our pharmacies to the values of pharmaceutical care or MTM that our customers are hearing.

Our goals should be that the consumers think of their pharmacy first as the place that helps them use their medicines appropriately– second as the place they get their prescriptions! And, the practice model we adopt should be sustainable for both the pharmacist and the pharmacy

Pharmacy owners are very good at marketing the front end of the store - the card and gift department, the OTC section and seasonal merchandise. The professional part of the pharmacy is usually promoted as “hours 9Am – 8PM,” and “we take most health plans.” These are nice to know, but not concepts that instill fervor in our customers!

Marketing is based on thinking about the business in terms of customer needs and their satisfaction. We should all brush up on our marketing skills and apply them to our practice with the same amount of thought and resources we use to market the front end of our pharmacies.

In the end, I believe the most effective promotion of a service is face–to-face and builds on the trust that customers and patients have in the pharmacist. We can routinely connect the concepts of MTM that are being talked about in the press and by managed care with the services that we are providing in our pharmacy. Rather than talk about the services offered in the abstract, talk about them in the specific. “How are your glucose levels – do we need to consider a dose change?” Are you seeing improvement toward goals of your cholesterol – maybe another statin would give you better results?” That will get a more positive response than “Would you like some: counseling – or MTM – or pharmaceutical care – today?”

The faculty of the college of pharmacy recognizes the need for better marketing within the practice community and believes that it can help. The college will launch a new rotation next fall that will focus on marketing of pharmacist services. The student will investigate the pharmacy market area, competition and opportunities for practice development. At the end of the rotation they will provide the pharmacy with a report of the findings. The students will meet weekly to discuss their findings and also to meet with marketing experts to help them better understand the techniques of marketing.

One of the faculty members has received a grant from the Community Pharmacy Foundation to develop marketing tools for the community pharmacy. Additionally, a PhD candidate at the Duluth campus is devoting his dissertation to the study of MTM marketing. And, members of the UPlan MTM network will be offered a seminar in the spring that will be substantially about methods to market MTM services to UPlan members and others in the community.

There is a story about a guy who goes to a boxing match. Before the fight one of the boxers crosses himself. The guy turns to a priest who is sitting next to him and asks: “Father, do you think that by crossing himself the boxer will win the match.” The priest responds, “Only if he can box!”

Can pharmacists prevail in our desire to make MTM an important part of a sustainable practice? Yes, but only if we know how to manage, market and sell it!

Lowell J. Anderson, D.Sc., FAPhA, practiced in community pharmacy for most of his career. He is a former president of MPhA, Mn Board of Pharmacy and APhA. In addition he has held positions in the Accrediting Council on Pharmacy Education, National Association of Boards of Pharmacy and the United States Pharmacopeia. Currently he is Co-director of the Center for Leading Healthcare Change, University of Minnesota; Manager MTM Network, UPlan MN; and co-editor of the International Pharmacy Journal. He is a Remington Medalist.