As pharmacy evolves, advancing the profession to the next level will take creativity, initiative, and hard work. Kerr Drug is already on the front line by offering in-store primary care clinics, providing off-site health screenings, and conducting medication therapy management (MTM) reviews, among other programs.

A Smart Answer for Health Care

Kerr Drug's commitment to providing its customers with high-quality health care is unparalleled. Besides the excellent work done with the Asheville Project and its pharmacy counseling centers, Kerr Drug also has partnered with SmartCare Family Medical Centers to provide primary care clinics within its pharmacies in Raleigh, Hillsborough, and Franklinton, NC.

So far, this one-stop approach has proven to be economical and efficient for customers. Kerr Drug makes the customers' needs a top priority, and joining forces with SmartCare has made access to health care much easier.

The SmartCare Centers are standalone facilities staffed by family nurse practitioners (NPs)—registered nurses with master's degrees who can prescribe medications. Patients visiting a center can be treated for common ailments such as sore throats, ear infections, and seasonal allergies. Patients also can utilize SmartCare for basic health services, such as flu shots, immunizations, school and employment physicals, and cholesterol screenings.

According to Jeffery McNeil, DSN, FNP-C, a district manager for SmartCare, "Local family practices will send patients to us if they are not able to see them right away. Also, if a family practice center is closed and the patient needs an evaluation [right away]—for example, if a wound infection needs to be seen within 48 hours—the SmartCare center can take care of it and report back to the family physician.

"We provide care for general, more common household issues, [most] of the things people experience—colds, allergies, [urinary tract infections], rashes, bronchitis," McNeil continued. "For lacerations, we use staples or surgical glue, but we don't treat facial lacerations." The centers are cost-effective for Kerr and profitable for SmartCare.

An Ounce of Prevention

McNeil explained the benefit of having NPs on staff at the centers. "The NP model is to partner with?patients and to treat them from a teaching perspective," he said. "SmartCare Centers put NPs in the forefront and allow them to practice their profession. They practice health care from a theoretical model of nursing—preventive, holistic—whatever treats the whole individual.

"For so long, medicine has been disease-focused. We diagnose and prescribe. NPs diagnose, but they also look for the cause of symptoms, rather than treating symptoms only," McNeil stated.

To that end, the clinics also host various health screenings to help patients stay on top of their health care concerns. Screenings include total-cholesterol checks, bone-density analysis (via ultrasound instead of x-ray), and the use of Dermascan to check for sun damage and dehydration, which McNeil calls "a great service we offer. Once patients see the damaged area, it's very effective in turning them on to a serious problem with their skin. It's a real teaching moment," he said.

SmartCare Centers accept insurance from in-network insurers, and the patient pays the usual copay. The average charge is $65 per visit. An urgent care clinic visit usually costs twice as much, a family practice appointment costs more than $100, and a trip to the emergency room costs 6 times as much.

"SmartCare services are affordable for a large part of the population," McNeil asserted. "Eighty percent of people without health insurance work, and most have full-or part-time jobs. They will only seek health care when they are sick, and they're not likely to use preventive services. Our centers?focus on preventive health care."

The Pharmacist-NP Team

The partnership between the pharmacist and the NP is key to the success of the Kerr Drug- SmartCare arrangement. "The pharmacist's role is completely separate from the clinic—a completely different company—but it is a complementary, synergistic relationship," Smart-Care's McNeil pointed out. "NPs can do an examination, and pharmacists are the experts on drugs. If a drug is too expensive, for example, then a patient can go ask for a recommendation for a cheaper drug [from the pharmacist].

"In turn, if a patient is asking [the pharmacist] about a rash?then perhaps the pharmacist does not want to be pushed into the diagnosing role, and that's where we can step in," McNeil said. In the event that a patient presents a more serious case, a physician is on call and is immediately available.

Is the Kerr Drug-SmartCare setup the wave of the future? Possibly, said McNeil. "The government knows we have a [health care] crisis, and they are looking for cost containment. This clinic is past the trial stage.?‘The train has left the station.'I honestly believe these clinics will do for the health care industry what the [automated teller machine] did for banking—add convenience and reduce costs. At the same time, we're delivering a high quality of service."

Beyond the Usual

In addition to their traditional dispensing responsibilities, Kerr Drug pharmacists are educating patients on proper management of their disease states, providing health screenings for large corporations, conducting MTM reviews, and taking part in various research projects. All these tasks demonstrate the importance of the pharmacist's role in the health care system—and also generate sources of revenue that allow the profession to thrive.

As a clinical coordinator for Kerr Drug, Joe Heidrick, PharmD, is actively taking part in the changes to pharmacy practice. "PharmDs are equipped with a lot of clinical knowledge," he said. "These opportunities allow us to put our skills to work outside of the traditional dispensing process and outside of typical prescription counseling."

Generating Revenue

One of Kerr Drug's initiatives is putting together health fairs for corporate clients. At these fairs, pharmacists screen large groups of employees for various disease states, including high cholesterol, cardiovascular disease, obesity, and diabetes—anything associated with a chronic disease state. The company's insurer reimburses the pharmacists for every person screened. Kerr Drug entered into these types of contracts with large employers by contacting their insurance providers and demonstrating how important it is from a cost perspective to make sure that their employees are as healthy as possible.

In addition, diabetes education and flu shots are major revenue generators. We administer 50,000 flu shots a year," Dr. Heidrick noted. As pharmacists are getting paid for cognitive services, their interventions are decreasing medical costs. " Catching disease states early is an enormous health benefit," he pointed out.

Besides early intervention, Kerr's health screenings are improving access to health care. "Consider the medical population. They're 30 to 40 years old, male and female, workingclass. They may not go to their physicians [for these screenings], but they can be screened at our clinic." The cost to the employers and insurance companies is less.

On the Road

Dr. Heidrick's home base is a Kerr Drug community pharmacy, but he spends a fair amount of time traveling to health events. Ideally, he said, the company would conduct all screenings on-site. "But we're not at that point yet, so we have off-site events," he said.

"We recently had a health event for a company on Bald Head Island. We had another health event where we did screenings for the state highway patrol for North Carolina, and we had to go to the different posts,"Dr. Heidrick reported.

Diabetes education programs, however, are conducted on-site. Patients are referred to these education programs by their physicians.

These are major initiatives for Kerr Drug because Medicare pays Kerr pharmacists for them, making them a considerable source of revenue.

Another revenue source is providing MTM services for patients with Medicare Part D. Through that program, Medicare pays pharmacists for their knowledge and for their assistance to Medicare recipients. "It's building," said Dr. Heidrick. "It's the future of pharmacy."

He stressed clinical skills but also noted that "we don't want to alienate ourselves by saying we're not dispensing pharmacists, because that's not true." Business skills, however, are vital for pharmacists and will become increasingly important as the profession takes a new shape. "It is every bit if not more important to have a business sense for the future of pharmacy.We're constantly developing business opportunities. We do a lot of our own marketing and our own pricing of services," Dr. Heidrick said.

"These are all new concepts for pharmacy," he added. "You can't look it up in a book, because it hasn't been done in the past. For every project that works,we have 3 times as many that don't work."

As for the work schedule of a Kerr Drug clinical pharmacist, every day is different. One week for Dr. Heidrick began by administering flu shots and working on a research project (another source of revenue for Kerr is serving as a test site for clinical trials). Tuesday's schedule included diabetes education classes and working in the pharmacy. On Wednesday, he was on his way to a corporate health event that included screening for cardiovascular disease.

Thursday saw Dr. Heidrick working for North Carolina Medicaid as an auditor, conducting chart reviews to make sure that the state's Medicaid patients are receiving the standard of care they should. Friday he was back in the pharmacy, catching up on paperwork and getting ready for a flu shot clinic over the weekend.

This varied schedule includes a little bit of everything a clinical pharmacist needs to accomplish to maintain traditional responsibilities, as well as to incorporate the activities that will lead the profession to where it needs to go in order to thrive. Kerr Drug maximizes its patient care services by using its clinical pharmacists in challenging roles. In order to keep up with the changing profession, Dr. Heidrick advised, "You have to be a self-starter and have a good imagination [about what] you want a pharmacy to be."

Ms. Farley is a freelance medical writer based in Wakefield, RI.