- Condition Centers
As the elderly population in the United States has grown, so has the need for health care products. Simultaneously, efforts to control health care costs have resulted in shorter hospital stays, with patients going home sooner, sicker, and weaker. These forces have produced an unprecedented surge in the market for home health care products.
Defining Home Health Care Products
A home health care (HHC) product is best described as a health care product that may be used in home care, which can include anything from canes to commodes to syringes. Durable medical equipment (DME) refers specifically to nondisposable hard products such as canes and beds. These are loose definitions, however, and both HHC and DME represent a vast array of health-related products.
HHC Products and Pharmacy
Pharmacy and HHC are a natural fit. Pharmacists, as licensed clinicians with advanced educational skill, are ideal distributors of HHC products. Because pharmacists know both the patient and the equipment, they are?more than other medical experts?better equipped to serve their patients' HHC needs. The combination of simplified billing, convenience of location, one-stop shopping, and "a friendly face" create an atmosphere conducive to the sale of HHC and DME.
HHC: A Growing Market
At any given time, large numbers of people are experiencing varying degrees of disability. Currently, >6.2 million Americans are disabled.1 For these patients, many HHC products?such as reachers, stocking aids, button hooks, grasp aids, grab bars, tub chairs, and raised toilet seats?are useful in the home.
It is estimated that DME sales will grow from ~$18 billion to $21 billion by 2008.2 In 2002, the Centers for Medicare and Medicaid Services (CMS) spent $7.7 billion on DME, prosthetics, orthotics, and supplies. CMS reported that DME made up 1.3% of public health care expenditures. According to Bruce Vladeck at the Medtrade Spring Convention, the HHC market will double by 2020.3 Additionally, the scooter market grew by about 7% in 2002, bringing the total market to approximately $1 billion.4 Growth of this magnitude bolsters the production of new and better products, providing patients with increased innovation, comfort, convenience, and mobility.
Defining the Market
As an umbrella term, HHC products represent a wide variety of goods. According to Wallace Weeks of the Weeks Group, which conducted a study to make projections of HHC growth from 2004 to 2008, the US respiratory, diabetes, and infusion markets will grow from $4.5 billion to $4.9 billion, $1.3 billion to $1.5 billion, and $4.8 billion to $5 billion, respectively.2 In 2002, the orthopedic brace and support market was estimated to be $812 million.5 The market for first-aid products?including bandages, tape, and gauze?has been estimated to be $447 million.6 Within the sleep disorder market, the market for bilevel and continuous positive airway pressure devices is increasing, estimated at $339.8 million in 2004.7 The market for adult incontinence- related products is estimated to be ~$1.1 billion per year.8 The pediatric wheelchair market was estimated to reach $18.2 million in 1998.7 All components of the HHC market are increasing in value at extraordinary rates.
Based on a survey conducted by the Center for Pharmaceutical Health Services Research at Temple University (TU), in conjunction with the National Community Pharmacists Association (NCPA), it is estimated that the HHC market will rise to $10.5 billion per year. As part of the TU-NCPA survey, ~7000 pharmacists were sent a questionnaire regarding their HHC product sales by various categories and their total sales. The results indicated that 70% of all responding pharmacists thought that their HHC product sales were increasing, and 83% of all responding pharmacies carried some form of HHC product (Table).
According to projections based on the TU-NCPA survey, the average pharmacy sells $179,400 worth of HHC products a year. This figure represents 5.54% of the average $3.24 million annual sales per pharmacy reported by the 2004 NCPA-Pfizer Digest.
The survey results are consistent with conclusions in the current literature. According to HomeCare magazine's 2004 Forecast Survey of HHC Dealers, 9.3% of respondents worked for a pharmacy/chain with DME and HHC products, 83.6% for an HHC provider, 4.8% at a specialty home care company, and 2.3% at another site.11 Sheldon Prial, director of the VGM Group, estimated that 5% of all DME is sold in pharmacies, and at least half of all pharmacies carry some form of HHC product.12 According to the 2003 NCPA-Pfizer Digest, 69% of community pharmacies surveyed carry DME, and 9% have home infusion products.13 Jack Evans of Global Media Marketing, an HHC consultant, estimated that bath safety and diabetes product sales in pharmacies are ~$50 billion and $2.8 billion, respectively.14
Why Is the Market Growing?
The dramatic and widespread upsurge in the HHC market can be attributed to a variety of factors. A large contributor is the aging of the American population, coupled with vast increases in life expectancy. In 2000, the number of people =65 years was estimated to be 35 million (13% of the total population). This segment is expected to double during the next 30 years, reaching 70 million by 2030. The rapid and consistent rise in the elderly population will exert a major impact on the HHC market. Rising numbers of disabilities and diseases likewise will intensify the need for HHC products.15-18
Secondly, managed care companies, Medicaid/Medicare, and private insurers are attempting to cut costs by pursuing home care instead of hospital care. An average home care visit was estimated at $88 in 1996, while a hospital stay was $1872/day.19 According to Harvey Meyers of Hollister Inc, a major HHC product distributor, ~35% of ostomy supplies are used in hospitals, while the remaining are purchased in the retail setting.19 Clearly, the push toward decreasing health expenditures escalates the potential for HHC.
HHC and the Pharmacist
As the principal supplier of HHC products, the pharmacist can and should play a greater role in enabling patients to be cared for at home. For example, asthma, affecting both adults and children, is treatable with drugs and HHC products, to avoid hospital care. In order to properly manage asthma, however, access to devices such as nebulizers, spacers, holding chambers, and other delivery devices is essential.
In a study by Warman et al, accessibility to medical devices and Medicaid acceptance was examined in a low-income neighborhood. Only 17% of the pharmacies surveyed carried child-size peak-flow meters, and only 33% carried nebulizers.20 The difficulty encountered in obtaining these devices can severely impede the health of patients. By selling these devices, pharmacies allow low-income patients?who might otherwise be unable to travel to a DME dealer?the ability to receive essential medical equipment. According to Magee et al, only 64% of pharmacies accepting Medicaid for DME carry spacers and peak-flow meters.10 Improving the stock of essential devices is crucial for treating asthma and other chronic conditions.
Planning to Add HHC Products
When expanding into the HHC market, pharmacists must establish a strategic plan to create a complete center for their patients' home health needs. Providing new goods invariably involves retraining sales professionals. An educated sales force is essential. Manufacturers, distributors, and educational entities that specialize in comprehensive education and training, such as NCPA's National Institute for Pharmacist Care Outcomes, can be excellent sources of education. Adding HHC products to the pharmacy's inventory will provide additional services, bring in new business, build on the current customer base, and elevate the pharmacy's standing within the community.
From home infusion to incontinence supplies, pharmacists are adding to the home care services and products they provide to their patients. All over the country, pharmacists are attending more pharmacy DME trade shows, expanding their HHC product display spaces, and stocking more wheelchairs, while improving the health of their patients through accessibility and education. In an increasing national market, pharmacies are taking larger slices of the local HHC pie. Providing additional services to the community in the form of HHC gives the pharmacy a healthy competitive edge, multiplies its profits, and enhances its ability to help the community.
Dr. Wertheimer is a professor and director of the Temple University School of Pharmacy's Center for Pharmaceutical Health Services Research. Ms. Chaney is a pharmaceutical marketing associate for Cognet-x. Mr. Santella is the research coordinator for the Center for Pharmaceutical Health Services Research at Temple University. Mr. Popomaronis is the vice president of Long-term and Home Health Care Services at the National Community Pharmacists Association (NCPA). Dr. Mick is an executive resident at NCPA.
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