Pharmacy U

Get ready for “New Pharmacy”

NuRx_PBMayJune17_Bregman
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Get ready for disruptive innovation in healthcare!

 

By Roderick A. Slavcev, Ph.D., MBA, MRSB, C.Biol.

Illustration by Martin Bregman

 

New Pharmacy is a philosophy that is bounded only by the skills of a pharmacist – no walls, no tradition – and it non-competitively seeks to identify the gaps in healthcare that contribute to inefficiencies in our system, and to employ pharmacists’ skills to turn these pain points into lucrative opportunities. There is no one correct model of New Pharmacy as long as it is governed by the principle of providing value-driven access to health and focusing customized healthcare experiences (not just pharmacy) on the patient. While theories are lovely, it is their functional implementation that creates value, and having been challenged to demonstrate what New Pharmacy might look like in practice (although my students do and have repeatedly done a much better job each year) I hereby offer the NuRx model and describe the impact of this disruptive innovation in healthcare.

NuRx seeks to virtualize the provision of healthcare (HC) by employing existing community pharmacies as health access centres wherein the “front store” is applied purely toward clinical space and the “back-store” (dispensary) holds customized medication inventory. While buying milk during the wait for medication may be convenient, it does little to address our growing healthcare needs and costs and represents a cost-ineffective utilization of the pharmacist’s skills.

Using a consultation “virtualized” model for professional service provision, NuRx will employ a weekly rotating schedule for a carefully designed roster of HC professionals, customized to most effectively accommodate the health needs of the regional demographic. Virtualization has the potential to confer massive efficiency to a business’s cost structure, but (as management guru Peter Drucker purported) before an organization is efficient, it must first be effective – and effectiveness here is not transactional access to drugs, but rather patient-centred access to healthcare. Assess the following model, turning current supply push healthcare on its head and instead looking outward to the patient as the primary target for value creation – and measuring outcomes.

NuRx

The pharmacist/pharmacy under this model manages and facilitates HC services around the patient, thereby serving as the broker for each patient’s tour through a full cycle of care. As an example, rotating schedules may include a GP, a nurse practitioner, a dietician, an optometrist and a select specialist(s), with each scheduled as a recurring locum for day(s) (urban model; figure) or week(s) (rural model), as dictated by patient need and local demographics.

In short, a front line HC team rotates around a patient whose chronic HC needs are led by the pharmacy with the patient/customer as the focus. Under such a model a NuRx pharmacy would manage: 1) provider scheduling and evaluation; 2) patient health needs, scheduling and longitudinal outcomes, including referrals from providers; 3) physical space and equipment requirements for HC providers; 4) traditional (medication provision) and non-traditional pharmacy services (anticoagulation management, hypertension and heart failure clinics, etc.); 5) follow-ups to ensure patient well-being (app); 6) emergency contact for patients (app opportunity?).

NuRx is not competitive with, but rather facilitative for, HC providers, and poses no regulatory hurdles as all providers handle their own billing and simply pay “rent” to the pharmacy at a fraction of overhead imparted by the current models of HC provision. This patient-centred model of practice could offer superior chronic disease management for patients at 10,000+ sites across Canada and also encourage interdisciplinary communication and support for HC professionals without compromising dispensary revenue – actually increasing it. NuRx has the potential to revitalize universal healthcare to Canadians with pharmacists in the driver’s seat and pharmacies as the primary site for frontline healthcare access.

 

Roderick A. Slavcev, Ph.D., MBA, MRSB, C.Biol. is ‎Associate Professor, Pharmaceutical Sciences, & Professor of Business and Entrepreneurship, ‎University of Waterloo