Pharmacy Technology Report
Pharmacy Technology Report
Investment, M&A activity heats up HIT
BY ALARIC DEARMENT
By most accounts, the U.S. economy embarked
on a slow but measurable recovery in
2011, but one area that saw a lot of activity was
investment in healthcare information technology,
according to a new report.
The report, conducted by Austin, Texasbased
public relations, investor relations and
market research fi rm Mercom Capital Group,
called 2011 an “extremely good year” for healthcare
IT companies in terms of fi nancial activity.
The funding in 2011 compared with $211 billion
in 22 deals in 2010, with the average venture capital
deal round coming out to $9.8 million per deal.
The top health IT venture capital investors in
2011 were HLM Venture Partners, based in Boston
with offi ces in San Francisco, which had four
deals. Meanwhile, Princeton, N.J.-based Cardinal
Partners; Louisville, Ky.-based Chrysalis Ventures;
San Francisco-based Founders Fund; Palo
Alto, Calif.-based Innovation Endeavors; and
Menlo Park, Calif.-based Kleiner Perkins Caulfi
eld & Byers each had three deals. The number
of venture capital investors also saw large-scale
expansion, from 62 in 2010 to 104 in 2011.
Most of the disclosed VC funding in 2011
went to health IT companies, according to the
report, for a total of $480 million in 49 deals.
Thirty of those deals, accounting for $336 mil-
U.S. $ in millions
lion, were disclosed, while $83.3 million went
to personal health record companies in 12 deals
— in the remaining undisclosed deals, certain
variables, such as names of investors and the
type of funding, were not made public. Other
deals included $27 million each raised by realtime
location systems provider Awarepoint and
Web-based healthcare network Ability, while
clin ical informatics company Humedica raised
$23 million, and Web-based electronic medical
records company Practise Fusion raised another
Healthcare IT venture capital funding (by quarter)
Disclosed amount (in millions)
Number of deals
Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
Source: Mercom Capital Group
Source: Mercom Capital Group
CONTINUED ON PAGE 4
Healthcare IT venture capital funding 2010-11
2 • FEBRUARY 2012 DRUGSTORENEWS.COM
Number of deals
Pharmacy Technology Report
CONTINUED FROM PAGE 2
$29 million. In the biggest deal, online doctor
appointment startup ZocDoc got $75 million
from DST Global and Goldman Sachs.
Of the 30 disclosed deals, 23 received their
funding in the early stages, which the Mercom
report called a “very positive sign showing investor
confi dence in early stage technologies and
companies.” Of the 18 deals that received funding
in the fourth quarter, six were early-stage.
Mergers and acquisitions also saw signifi -
cant activity in 2011, which the report called
“robust.” There were 104 transactions in the
health IT space with a total value of $6 billion,
compared with 85 transactions in 2010 with a
total value of $4 billion. The report attributed
the increase to a number of different factors, including
strategic acquisitions, consolidation and
increasing market share through acquisition.
The bulk of mergers and acquisitions involved
health information management companies,
CONTINUED ON PAGE 6
U.S. $ in millions
U.S. $ in millions
Total number of deals
Healthcare IT venture capital funding 2011 (by technology)
Source: Mercom Capital Group
Healthcare IT venture capital funding Q4 2011 (by technology)
Amount (in millions)
Number of deals
Source: Mercom Capital Group
4 • FEBRUARY 2012 DRUGSTORENEWS.COM
Number of deals
Total number of deals
Pharmacy Technology Report
CONTINUED FROM PAGE 4
among which there were 61 deals with a total
value of $1.9 billion. The runners-up were revenue
cycle management companies, which had
19 deals worth a total of $3.9 billion, and service
providers, which had 16 deals.
Blackstone Capital Partners’ acquisition of
Emdeon, a company that contracts with pharmacies
and their service providers to simplify
and improve end-to-end prescription processes,
for $3 billion was the largest deal of the year. In
June 2011, Emdeon entered a deal with Armada
Health Care to support prior authorization
management for Armada member pharmacies
through Armada’s ReachRx suite of services.
Other large-scale mergers and acquisitions
included General Dynamics’ acquisition of
Vangent Holding Corp. for $960 million. HMS
Holdings spent $400 million to acquire Health-
DataInsights, a company that identifi es and recoups
claim overpayments, while Vista Equity
Partners bought business management software
provider Sage Healthcare for $320 million.
Toshiba Medical Systems bought medical
visualization and analysis software maker
Vital Images for $273 million.
These were followed by such deals as the
$202 million acquisition by Aetna of PayFlex, a
company that provides Web-based proprietary
benefi t administration services for companies offering
such consumer-based products as health
savings accounts. Experian bought Medical
U.S. $ in millions
Source: Mercom Capital Group
Healthcare IT M&A 2010-2011
Present Value for $185 million, acquiring a company
that markets revenue cycle management
software. Harris Corp. spent $155 million to buy
Carefx, which sells interoperability workfl ow
software that uses its proprietary Fusionfx platform,
while McKesson bought British hospital
software developer System C for $141.5 million.
MedQuist Holdings bought speech recognition
technology developer M*Modal for $130 million.
Since then, MedQuist has adopted the M*Modal
CONTINUED ON PAGE 8
Disclosed amount (in millions)
4,500 Number of deals
Healthcare IT M&A (by quarter)
618 2,185 326 860 306 35 703 4,688 407
Q1 2010 Q2 2010 Q3 2010 Q4 2010 Q1 2011 Q2 2011 Q3 2011 Q4 2011
Source: Mercom Capital Group
6 • FEBRUARY 2012 DRUGSTORENEWS.COM
Number of deals
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Pharmacy Technology Report
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name, and on Jan. 27, the company announced
that Allscripts would adopt M*Modal’s Speech
Understanding technology and add it to its electronic
health records, saying that it would allow
for the creation of “content-rich, voice-driven
narrative patient documentation.”
But in addition to these large deals, there also
were many noteworthy deals that didn’t make
the Mercom report. For example, in December
2011, Medbox acquired Prescription Vending
Machines. Founded in 2008, Prescription
Vending Machines makes a biometric medicine
dispensing system that can dispense drugs
available from pharmacies, doctors’ offi ces, hospitals,
urgent care centers and alternative medicine
clinics. Financial terms of the deal weren’t
disclosed, but Prescription Vending Machines
has installed more than 100 machines and point
of sale systems worldwide and has had more
than $6 million in sales since 2010. ●
U.S. $ in millions
U.S. $ in millions
$4,500 Q4 2011
Total number of deals
Healthcare IT M&A activity 2011 (by technology)
Source: Mercom Capital Group
Number of deals
Healthcare IT M&A activity Q4 2011 (by technology)
Source: Mercom Capital Group
Telemedicine Revenue Service
8 • FEBRUARY 2012 DRUGSTORENEWS.COM
Number of deals
Total number of deals
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CES highlights health tech
Visitors crowd around the health pavilion at the Consumer Electronics Show in Las Vegas. The
show brought together more than 100,000 visitors and exhibitors between Jan. 10 and 13.
BY ALARIC DEARMENT
Now in its 44th year, the Consumer Electronics Show received a record
153,000 attendees and more than 3,100 exhibitors from
around the world in its 1.861 million sq. ft. of exhibit
space between Jan. 10 and Jan. 13.
The people and companies visiting the show fell under
just about every defi nition of the term “consumer
electronics,” but in particular, it included a number
of companies making products related to health care.
But rather than just seeing the latest healthcare technologies
directed at consumers, attendees at the show
got a taste of the technology behind the technology
— the platforms that power and augment technology
like mobile apps.
Among the companies showcasing these technologies
was Wind River Software, based in Alameda, Calif.,
which unveiled Wind River Solution Accelerators
for Android, a series of software modules that the company
said would help developers jumpstart Android
development and rapidly integrate features and functionalities
into their devices. The series consists of three
modules, dubbed User Experience, Connectivity and
CONTINUED ON PAGE 12
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10 • FEBRUARY 2012 DRUGSTORENEWS.COM
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Medical. The Medical module supports the IEEE 11073
stack, which allows for information exchange between
such personal health devices as scales, blood pressure
monitors and blood oxygen modules, as well as a Bluetooth
Health Device Protocol.
At the same time, the Beaverton, Ore.-based nonprofi t
Continua Health Alliance announced it would make its
design guidelines publicly available for download free
of charge, following an eight-month interoperability
and pilot phase. The group said that public access to the
Continua Design Guidelines would help a larger number
of developers build end-to-end systems that provide
seamless connectivity between personal connected
health products and services, facilitating critical interoperability
among devices and applications to drive down
data collection and management costs to signifi cantly
streamline and simplify the development process for
technology companies. As part of its commitment to
support the 2011-2012 GSMA Mobile Health University
Challenge, Continua recently
made its 2011 design guidelines
available to university
students to aid
Group is partnering
with three companies
to develop mobile
products and services that it said are designed to improve
consumers’ health and well-being. The company’s new
business partners — CareSpeak Communications, Lose
It! and Fitbit — help simplify the consumer healthcare
experience by making relevant, practical information
easier to access by using such mobile devices as smartphones,
UnitedHealth said. These include CareSpeak’s
medication and disease management application, which
enables patients to report their medication intakes and
biometric data to a clinician or care provider. Fitbit offers
a wireless tracker that includes an accelerometer
that it said can more accurately count how many steps a
user takes and an altimeter to track stairs climbed, while
calculating the number of calories a person burns. The
data then can be uploaded to Fitbit’s website, allowing
people to analyze their physical activity. The company’s
services will be integrated with UnitedHealth Group’s
OptumizeMe mobile health app. Lose It!, created by Fit-
Now, is a mobile app and website that helps consumers
manage their weight and improve their health.
That kind of technology could come in handy for
companies developing a host of new technologies
designed to interact with mobile devices, including
Valencell, which unveiled enhanced V-Linc technology
that integrates mobile health and fi tness technology
into audio earbuds. Presenters from the company
were on hand to demonstrate V-Linc on multiple mobile
platforms, wearing earbud prototype units and
showing mobile applications to demonstrate how the
technology measures such body metrics as continuous
heart rate, calories burned and speed during use
on a treadmill, stationary bike and in other exercise
scenarios. Company founder and CEO Steven LeBoeuf
noted that according to studies, 70% of regular exercisers
wear audio headsets while exercising.
Meanwhile, BodyMedia and Avery Dennison Medical
Solutions have created a body-monitor patch that
they foresee being used to gather physiological data for
health-and-wellness initiatives over a period of seven
days or less. The patch combines Avery’s Metria wearable
sensor technology with BodyMedia’s proprietary algorithms.
The companies said the patch initially would
be used as an evaluation tool for weight management,
while future applications are expected to include corporate
wellness programs, remote elder care, and safety
and monitoring of vital signs for a variety of health conditions.
The patch will track lifestyle indicators — such
as calorie burn, steps taken, activity levels and sleep patterns
through multiple sensors that collect more than
5,000 data points per minute — enable the data to be uploaded
to a computer or mobile device, and can remain
on the back of the left tricep for up to seven days. ●
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Health, Wellness and Technology Roundtable
PANELISTS: Will Abbott, CVS Caremark • Mike Cantrell, Good Neighbor Pharmacy • Bob Dufour, Blue Ocean Innovative Solutions • Bart Foster,
SoloHealth • Aaron Kaufman, Kony Solutions • Ashton Maaraba, PharmaSmart International • Craig Norman, H-E-B • Darren O’Neill, Health Mart
• Dev Patel, Moonshado • Rick Sage, Emdeon • Erick Von Schweber, Surveyor Health • Jim Weeast, Walgreens • Alan Yates, Numera Social
WAYNE BENNETT, DRUG STORE NEWS: In talking with retailers, people
tell me how they want to own health and wellness, and at the end of the
day, we believe that technology is the driving force. ...
Today’s event would not be possible without the guidance, insight,
commitment and passion of Bob Dufour. I’ve known Bob for about 12
or 15 years, and we had the pleasure of working together while he was
at Walmart. Many of you know that Bob had 24 years of experience at
Walmart, and in that time Bob provided leadership and direction that
was integral to Walmart’s growth in pharmacy from $100 million to
more than $20 billion in sales. He’s worked over the years with numerous
branded pharmaceutical manufacturers to execute programs in
compliance and persistence, and he also has worked on professional
education programs and pharmacy marketing programs for consumers.
Bob’s distinguished background includes stints as the past presi-
dent of the Arkansas State Pharmacy and 2007 chairman of the NACDS
Pharmacy & Technology Conference. He’s a [board] member for four
different schools of pharmacy, and he also is a frequent speaker at many
industry events throughout the year.
BOB DUFOUR, BLUE OCEAN INNOVATIVE SOLUTIONS: Thank you, Wayne.
[When] Wayne and I started talking last spring about [the topic for a
roundtable], I told him that the most interesting thing I could think of
is if we could bring together some key retailers with some leading and
emerging technology vendors who are working on projects for pharmacy
and have a very open discussion about the industry. ...
Our objective today is: No. 1, this is an opportunity for the retailers.
... Craig [Norman], if you think [about] how [sometimes] a vendor
shows up with a product and it’s a great idea that they’ve put a lot of
14 • FEBRUARY 2012 DRUGSTORENEWS.COM
In November 2011, The Drug Store News Group hosted in New York an exclusive executive round-table discussion of leading pharmacy retailers
and executives from leading and emerging healthcare technology companies. Guest moderator and veteran pharmacy executive Bob Dufour and
the panel examined a range of topics, including opportunities to use such new technologies as mobile and social media platforms to improve
patient compliance, how kiosks are helping to redefi ne the self-care experience at retail pharmacy and new clinical technologies that are helping
to improve pharmacist-patient interactions.
work into, and you love it, but you think, ‘Boy, if they just really understood
H-E-B a little bit better, would they have done it a little bit differently?’
So, it’s an opportunity for retailers to see what the suppliers are
working on, what they’re thinking and to give them feedback on what’s
relevant for the retailer.
So that is the objective of this meeting: to give you a chance to talk
about what you’re working on and give a chance to the retailers to give
you feedback on how relevant it is to their businesses.
So I guess to start ... where we see the big opportunities for the industry
is three-fold: One is how do we make health care more affordable for
the consumer? That’s a big issue that we’re facing in our country. Second,
how do we drive compliance and persistence? [Compliance and
persistence] will lower the cost of health care; it will improve health.
And third is, when you look at what I call “drug events,” how do we
do a better job? That’s more than clinical information; whether it’s the
adverse drug effects that we see, or if it’s the misfi lls from the pharmacist
— how do we use that clinical knowledge to get better at our craft?
So I guess to start with today ... if we can go around the table and just
quickly state who you are, the company you’re with and maybe two or
three sentences about what makes your company different.
“ Where we see the
big opportunities for
the industry is threefold:
One is how do we
make health care more
affordable for the consumer?
... Second, how
do we drive compliance
... And third is, ... how do we use that clinical
knowledge to get better at our craft?”
Bob Dufour, Blue Ocean Innovative Solutions
DRUGSTORENEWS.COM FEBRUARY 2012 • 15
MIKE CANTRELL, GOOD NEIGHBOR PHARMACY: I’m Mike Cantrell. I’m the
president of Good Neighbor Pharmacy. Good Neighbor Pharmacy is a
franchise banner that represents about 3,700 independently owned pharmacies
across the country. The parent company is AmerisourceBergen,
which is one of the top three drug distribution companies in the country.
“ It’s incumbent on
[us as] providers to
the technology is
going and then
respond to that progress
vehicles that facilitate
improved patient outcomes through
Mike Cantrell, Good Neighbor Pharmacy
ERICK VON SCHWEBER, SURVEYOR HEALTH: Erick Von Schweber, executive
co-chair of Surveyor Health. I’m going to suggest here that there is a
concept that unifi es and unites adverse drug events, compliance, adherence
and even sales and revenue. That concept is trade-off management,
as opposed to looking at the patient or consumer in stovepipes — they’re
a diabetic, they’re a congestive heart failure patient, they spend this much
— what if we could look at them in total? Well, that’s a pretty radical idea.
Consider this: For every patient, your typical senior, average 65-yearold
in the United States is on eight to 10 prescription [medications]. Lets
ask ourselves a question that’s never asked: For that one regimen that
they’re on, how many other regimens are possibly indicated for them?
And let’s be conservative — rather than nine or 10, let’s just look at eight
meds. ... The answer is an astonishing 39 trillion regimens, which as a
search space outnumbers Google when you search the Web by about
1,000 to one in terms of scale. And where there’s only one Web to search
— we’ve got 40 million-plus seniors in this country, each with this very
astronomical, complex space with these regimens differing substantially
in terms of adverse events, costs, effectiveness, etc. And the fact is, [often]
the regimen that people are on is not necessarily the one best suited
to them. So when we’re looking at reducing adverse events, when we’re
looking at getting that patient to be not just a reluctant medication taker
but actually someone who’s a consumer who loves what their regimen
does for them, what we need to do is fi gure out how to identify and
manage these trade-offs — the trade-offs for their concerns, the tradeoffs
for the concerns of the pharmacy system and the healthcare system.
Now that sounds like an impossible thing to do.
That’s where we come in. So we come out of a background in DOD and
DARPA, the Defense Advanced Research Projects Agency. What we have
is a technology that can look through those enormous spaces in seconds
and help a physician or a pharmacist manage those trade-offs for the patient.
So my hypothesis here today, which is what I’d like to talk about, is
how can we take these next two — not just one, but two — generations of
clinical decision support to better manage trade-offs for the patient and
the healthcare system, and therefore actually create a win-win-win for all
of us involved? That’s what I’d like to talk about.
DARREN O’NEILL, HEALTH MART: I’m Darren O’Neill, senior director of
retail technology innovation at McKesson, and more specifi cally with
Health Mart, which is a franchise banner of about 3,000 independently
owned pharmacies. I work specifi cally with retail technology and innovations,
where we affect patient care services delivered at retail through
our network of pharmacies and supporting technologies.
DEV PATEL, MOONSHADO: My name is Dev Patel from Moonshado.
We’re a mobile technology company that specializes in SMS, MMS, QR
codes, augmented reality and branded applications.
CRAIG NORMAN, H-E-B: Good morning, my name’s Craig Norman. I’m
SVP pharmacy with H-E-B. H-E-B is a grocery and general merchandise
retailer based in San Antonio. We operate roughly 230 pharmacies
in the state, fi lling a lot of prescriptions, typically more than your
traditional chain pharmacy. We also offer a broad array of professional
services that we administer right at our pharmacy.
ALAN YATES, NUMERA SOCIAL: I’m Alan Yates from Numera and
Numera Social. There are two sides to our business: one, we support an
array of home healthcare devices, and we provide an information service
— a data service — to a variety of electronic medical record and personal
medical record systems; the second piece of our business that I’m here to
talk more about is Numera Social, which is a Facebook and mobile application
to help people improve their health — so for self-management.
ASHTON MAARABA, PHARMASMART INTERNATIONAL: I’m Ashton Maaraba,
with PharmaSmart. We actually have two segments to our business
model as well. We manufacture and distribute blood pressure equipment
and kiosks, and we also have a health IT solutions segment of our business
that’s engaged with the whole [medication therapy management]
process, which we’re going to discuss today. We’re also in the data management
part of the business as a result of the blood pressure results that
we’re bringing in [from our] kiosk usage. We’re in just under 6,000 pharmacies
in the United States and Canada, and growing aggressively.
JIM WEEAST, WALGREENS: Jim Weeast with Walgreens. I’m the rookie
here — I’ve been in pharmacy retail technology for just seven months
now. [My] career [prior to that had been] in fi nancial services. At Walgreens
I’m responsible for developing technology integration plans for
various M&A activity that we have going on. I also have responsibility
for technology for our specialty and infusion business units. Finally, I
also have responsibility for the overall execution of technology projects
16 • FEBRUARY 2012 DRUGSTORENEWS.COM
within pharmacy, health and wellness, including linking our more strategic
projects into our legacy applications.
BART FOSTER, SOLOHEALTH: I’m Bart Foster. I’m CEO and founder
of SoloHealth. We’re based out of Atlanta, and we’re focused on selfservice
health care and empowering consumers to take charge of their
heath. We’ve developed the SoloHealth Station, which measures blood
pressure, body mass index and vision screenings. Because they’re all Internet
connected, we’re then able to put people in touch with local providers
in their community. We’re going to be scaling across the country.
I’m excited to be here, and one of the things I want to make sure we
cover and talk about is how we can empower consumers to better take
care of themselves. We feel that we don’t necessarily need the government
to take care of everyone; we need people to be educated, and we
need to make them aware of certain conditions they may have and get
them to take action. We feel that through an ecosystem of health and
wellness ... [we think] what we’re doing at SoloHealth — [a self-service
station] — can be the entry point or the on-ramp, ... but it’s bigger than
that. It’s an ecosystem around Web and mobile, and what we’re doing
in store that I think will be the big difference. But empowering the consumer
is what we’re most excited about.
WILL ABBOTT, CVS CAREMARK: I’m Will Abbott with CVS Caremark. We
also have two sides of our business, [retail and PBM]. I’m on the traditional
retail side. As the senior director of pharmacy operations, I have
responsibility for the policy, procedure, training and workfl ow development
for all staff behind the bench. Along with those responsibilities
comes a lot of our in-store technology, including vendor relationships
around kiosks, as well as our automation solutions and relationships
with industry partners like Surescripts. I also work closely with our
product development group, which has responsibility for adherence
programs and health-related programs.
AARON KAUFMAN, KONY SOLUTIONS: I’m Aaron Kaufman with Kony Solutions.
As the GM and VP of the healthcare division, which covers healthcare
life sciences, we work with some of the largest payers, pharmaceutical
companies, distribution companies and providers out there in the healthcare
domain, and we also are starting to get into the retail independent
pharmacy and retail pharmacy large chain [environment] from an app development
[standpoint]. We actually have a global app development platform
that allows you to write your code once and deploy it on every single
platform that’s out there. So, many top blue chip [companies] leverage our
platform to write their mobile applications. They [write] their applications
once, they have one code base and it deploys daily across all seven operating
systems, as well as HTML 5 and HTML 4, kiosk and even desktop Web.
In the retail health space — especially in the retail pharmacy space
— we are building on top of this platform a starter application, a template,
that’s very similar to what Walgreens offers today in the marketplace
for their brand. And we’re trying to make that kind of technology
a commodity for ... the larger and the smaller chains that can’t afford
to do mobile development themselves. So we have a template, a starter
application, that they can basically rebrand, reskin and allow patients to
refi ll prescriptions from a bar code, QR code or [by] entering [it] in; fi nd
a pharmacy if multiple [ones] exists; [and obtain] patient-friendly drug
monograph information, ... those kinds of activities that drive the needle
for repeat, sticky and monetization of interactions with a pharmacy customer.
[I am] looking forward to our conversations to come.
“ Someone’s not just
going to go to an app to
look up a drug monograph.
It has to be part
of their workfl ow. Like,
‘I’m going to pick up a
drug, I’m going to
refi ll it,’ now show them
what a drug-friendly
monograph is. Don’t wait for them to go
search for it. Show it to them to their face.”
Aaron Kaufman, Kony Solutions
RICK SAGE, EMDEON: I’m Rick Sage with Emdeon. I lead our pharmacy
solutions, which are all of the products and services we offer to our
pharmacy customers. Emdeon is one of the largest healthcare technology
data management companies in the U.S. healthcare system.
The thing that interests me the most is engaging the patient between
interaction of the physician and the pharmacy. So taking a lot of what
we’ve already started talking about this morning, and bringing all that
together with an interaction between the encounter with [the patients’]
physician and the visit to the retail pharmacy to make sure that they
continue that cycle of care. ...
And to Bob’s point, instead of trying to build technology and get people
to use it, we want to look at the technology that’s being adopted already
and see how the healthcare environment can take advantage of it, such as
social networking, mobile technology, the Web, email ... all the technology
that already has been adopted, and looking to see how healthcare can take
advantage of this technology to encourage patient interaction. Because if
we can engage the patient in their own patient care, obviously we have a
much better opportunity for the persistency and the compliance of those
programs, and then we build — more easily, I believe — on top of those
programs once we’ve got that interaction with the patient established.
DUFOUR: Thanks Rick. And that’s a really good lead-in to our fi rst topic,
which is mobile technology. And as Rick said, one of the opportunities
we have today is we want to communicate and educate consumers; we
want to get them more compliant. The thing that they’re really attached
to now that wasn’t around 10 years ago is [the smartphone]. I was telling
this story last night — I have three grown boys and a 16-year-old
DRUGSTORENEWS.COM FEBRUARY 2012 • 17
daughter, and if I call them, they don’t answer the phone. But if I text
them and say ‘Call Dad,’ they call right away. And I can’t fi gure it out,
but it’s a new generation, so we have to adapt to that.
So, I want to ask Dev to start off just as a primer on this because a lot
of folks have heard of short code and MMS and VMS and QR and maybe
AR [codes], but if you could just briefl y go over each one of those acronyms
and what they are.
“ Populating data
and having augmented
your locations, available
QR codes that
are able to ping back
information on the
Web that’s constantly updated, and the ability
to send notifi cations — those are the factors
early adopters in the market are looking for.
They’re more interested than just fi nding out
about their conditions and the drugs and the
side effects, which can be done via SMS and
lower-tier technologies.” Dev Patel, Moonshado
PATEL: So SMS, or text messaging, is an innovative way for patients
and providers to communicate with one another. In addition to sending
texts like Bob would to his children, providers also can develop mobile
applications — SMS-centered interactive applications. SMS is the most
ubiquitous technology that’s out there on a mobile device right now;
you don’t see phones that don’t have SMS. Nearly all phones within
the United States have SMS technology. So SMS is kind of the fi rst leg.
MMS is the next step, where you have video, images and a little bit of
audio. The carriers are very limiting in terms of how much bandwidth that
you can use within this technology. So, what has come is the next step,
which is VMS. It’s an application that Moonshado has released that allows
for person-to-person video messaging service. We’re building solutions
that allow for retailers and brands to provide specifi c content — health
education, product specials, in-store savings, to name a few — through the
VMS application, which is delivered directly to the user’s handset.
QR codes, or Quick Response codes, are a standard of 2-D bar codes. ...
It’s a square with a specifi c pattern or code — I’m sure most of you have
seen it. The idea behind it is since smartphones have a camera directly on
the mobile phone, you can scan the QR code, and it will link to some content
on fi le. That content can be changed by the owner of the QR code at
any time with a dashboard. We have dashboards within Moonshado that
allow you to create QR codes and change the content on the fl y.
The next thing is augmented reality, or AR. With applications or smartphones
you have the ability to take GPS data that’s within your phone,
match it with metadata that’s GPS-specifi c and create a virtual reality for the
user. It’s almost [like] the user is looking through the viewfi nder of [his or
her] camera and can see what you have populated the metadata with. So, for
example, a patient that has diabetes and is in your store can pull up an AR
application on their phone and see the items that are related directly to them
within the GPS metadata that you populated. The viewfi nder of their phone
will display as if they are shopping the aisles of the store. The customization
and interactive abilities of AR make it an easy way to reach customers.
Now branded applications are almost like a combination of SMS, VMS
and QR codes. The most important thing about branded apps is the ability
to really connect with the user. In order to persuade a consumer to
download an application, you have to really make sure that the person is
interested in what you have to say. Otherwise you’re better off launching
an SMS application that’s more ubiquitous.
DUFOUR: Thanks Dev. And with the use of mobile technology, consumers
are becoming more and more educated. I know on the way up here
on the plane yesterday, the guy sitting next to me asked me what I did,
and I told him I was a pharmacist. And he starts telling me that he’s on
Coumadin, talking about his PT, and how he goes and gets it checked.
And he really understood this. I asked him, ‘How did you come to know
all this?’ He said, ‘Well, my brother-in-law’s a pharmacist and he’s always
talking about it. But then I got on the ’net and read about it.’
And with that, the consumer is now walking into the pharmacy, and
whatever they have — even if it’s something very rare — they can go on
the ’net. In fi ve minutes they know more than the pharmacist knows,
and maybe more than some of the GPs know. So with that, how do we
address these issues?
O’NEILL: I think that’s a great topic. I think our culture has become an online
culture right now, and it keeps going more and more in that direction.
Just about anyone you meet is going to pull out a smartphone these days.
I was just with my nieces and nephews over the weekend, and they’re 8
and 10 years old. Nobody taught them how to use a smartphone, they just
know how to use them. And if I look back 15 years ago, we were trained
on how to use a computer. Now it is ubiquitous — to use your word, Dev
— everybody just uses one; it’s second nature. It’s like air.
I think our culture is so focused on the instantaneous and data-ondemand
— I want what I need now. So how does pharmacy step up to
that? How do we actually tap into that and then serve consumers where
they want to be met? Whether it’s on the Internet from home on my
desktop computer, on a laptop, on a smart device, via SMS or mobile
app. But then couple that with consumer-directed health plans, now I
have to make decisions as a member of the health plan. Where does my
money get spent? Well I need data to make the best decision.
So when I look at pharmacies, I say, what is our responsibility to that
culture that we are [part of] right now? How do we provide the patient
18 • FEBRUARY 2012 DRUGSTORENEWS.COM
with enough information to make an educated choice about their health
care? To spend the money in the place that will be most benefi cial to
them. And how do we educate them to make that decision [correctly]?
As opposed to just a cost-saving measure, [is it] a balance of what is best
for me and what does it cost? And I think that’s something that I’d love
for us to really think about here today — what is our responsibility in
that? ... [There] are a lot of retailers at the table here, ... can we make that
happen for a patient, and what happens then with our relationship with
that patient? So I throw that out there for anybody to jump on. I don’t
think I answered your question, I think I just amped it up a little bit, Bob.
DUFOUR: That’s a good point. Any thoughts?
MAARABA: I was just going to say that ... the biggest thing that we fi nd
through the mobile technology aspect of the business is that ... if you fi lter
enough information to [patients] ... — let’s say the patient is suffering from
a chronic illness, whether it’s obesity or whatever — a way to support
MTM and free up the pharmacist’s time is to continue to encourage the
patient’s understanding [and to encourage them to] resource information
about [their] specifi c disease state so they learn more about it from the preventive
side. That patient will come to the pharmacy with a little bit more
knowledge, so when they get to the pharmacy, on the MTM side, the pharmacist
spends more time, or tries to spend more time, with the patient.
I think the issue is that 65% of the population doesn’t even use a smartphone
yet. So you’re really only targeting about 35% of that patient population.
And we’ll probably talk more about the culture of the pharmacist
later in the session, but targeting those [patients] that actually are in tune
to the smartphone and can access the intelligence within that technology
— that’s where you really have to start and kind of build around that. And
then fi nd a balance with the traditional methodology ... [because] you’re
targeting the 35% that uses technology, [so] you have to fi nd a balance
with the other 65% that doesn’t use that technology.
MAARABA: That happens. It’s part of, like you said, this ecosystem of
care — the pharmacy/patient/physician triangle, or the circle of care that
we’re all working within; family members are part of that. And it’s not
just the pharmacist who’s the chief consultant between visits. Or let’s say
if your pharmacy is connected to an EMR [at the] physician’s offi ce, you
have to rely on that caregiver. Personally I don’t have the percentages of
those households [where caregivers with smartphones] are actually assisting
[loved ones who don’t have access to smartphones]. But from what I
understand and other summits I’ve been involved with, there is greater
involvement by family members. I think there’s a statistic out there that
depending on the number of family members within a household, at least
one is in tune with mobile technology, or let’s say the iPad craze and everything
else. So you are seeing an emerging trend within that [group], so
more and more people are getting involved ... when there’s a hospice care
situation, whether it’s a signifi cant other or whatnot.
O’NEILL: I think you’re just looking at the idea that somebody’s representing
that patient, right? So it’s still in that triangle — it’s the patient, but
they may have an advocate at that point. I think we’ll probably see a lot
more of that going forward. I don’t think that changes the dynamic; I
think it just changes who that person is that’s going to act on behalf of the
patient. So if we look at that triangle — the prescriber, the pharmacy and
the patient — if we were to actually close that loop and have that threeway
conversation, who else wants to participate in that conversation?
That’s where I start thinking, where do we go to from there? For example,
how do manufacturers perceive value in that [scenario], or how do
payers perceive value in that, in a preventive method? And what is their
gain? How do we actually turn this around and say we can affect costsaving
efforts, and potentially generate some revenue for retail pharmacy
... through this process as well? Would it help decrease overall healthcare
costs? Because there’s the triangle and then there’s the circle around it, as
you’re saying. Who wants to be part of that, who’s got information and
who’s got incentive for patients to download the mobile app and to be
more involved because there’s something more for them there?
“ I think our culture is
so focused on the instantaneous
— I want
what I need now. So
how does pharmacy
step up to that? How
do we actually tap into
that and then serve
consumers where they want to be met?”
MAARABA: Or incentivize that caregiver.
O’NEILL: Everybody gets incentivized.
Darren O’Neill, Health Mart
SAGE: I think an important component, Darren, that you just hit on is
that larger circle. And to Bob’s point earlier, the consumers are yearning
for this information, and there’s so much information available. The
challenge that we have in health care is that they do come informed.
Are they well informed when they come in to talk to the physician or
the pharmacists? They have information; they’ve self-diagnosed themselves
or their elderly parent or their child correctly or not.
So one of the things that we have to deal with is how do we bring this
technology together and help gear the appropriate information to the
patients in that triangle? Because they will come informed, and there are
a lot of infl uences coming in every direction, whether there’s a mobile
app that they’ve downloaded from WebMD or they’ve done a Google
search off the Web to fi nd something that is matching with their ailment.
So I think a real challenge is how do we create that triangle? [How do
we] create the opportunities for revenue, along with the persistency in the
DRUGSTORENEWS.COM FEBRUARY 2012 • 19
care of the patient and deal with the information that’s coming at them? I
think the more that we can help engage patients in the information that’s
going to be most pertinent to the conversation between those three parties,
the better the outcome for the patient and the more interaction we’re
going to have between our retail pharmacies and providers of care.
PATEL: I think another point is [that] the percentage in the public of smartphone
usage is rising. However, there still are people that are not using
smartphones — they’re using non-smartphones. So for them, SMS technology
is a delivering mechanism. It’s delivering the content that’s related
to their illness. And 95% of U.S. mobile phones are SMS-enabled.
“ There is a concept
that unifi es and
unites adverse drug
adherence and even
sales and revenue.
That concept is tradeoff
opposed to looking
at the patient or consumer in stovepipes —
they’re a diabetic, they’re a congestive heart
failure patient, they spend this much —
what if we could look at them in total?”
Erick Von Schweber, Surveyor Health
VON SCHWEBER: I think it’s also important if we generalize that to identify
what’s the context. Part of that context is the capability of the device.
Is it SMS capable or is it more capable [than that]? But additionally,
where are they asking that question? Do they just want a short, quick
answer? Because they’re not going to read pages of information even
on a smartphone. So can we detect whether they want a short, quick
answer or they want a placeholder so that when they get back to their
PC or their laptop or whatever, they can then dig in deeper?
PATEL: Setting up those appropriate channels is important so that we
gather the right content. So that we know if they are walking into H-E-B,
for example, that they know that 75572 is the short code I need to text in
to fi nd additional information about this.
DUFOUR: When we talk about senior citizens and the elderly, [we talk
about] how important they are in our industry with the number of drugs
they take [and] all of the opportunities that we have to help them with their
health care, the misadventures, the drug events. ... I know back when Part
D was being rolled out, there was an effort by the government to get more
seniors to sign up for limited income subsidy, the LIS, and I had done some
work with Bob Dole and the folks down there doing some media events in
Walmart to raise awareness for LIS. And what they found afterward, when
Part D rolled out, was the number of senior citizens — Erick to your point
— who signed up online versus paper forms. And whether it was them or
the caregiver, [it] was shocking to the government. And Alan, I don’t know
if you have any statistics you can share with us, for instance the number
of seniors who are on Facebook or the amount of time they spend. But it
really surprises a lot of folks because they think of the elderly as not being
enabled with these technologies. The reality is I think some of them have
become enabled and they’re very faithful to those.
YATES: Yeah, I can just say that the fastest-growing population on Facebook
is women over 50 [years old]. And they’re typically the people that
are the caregivers in the home and ... across the expanse of their extended
family. And I think we all probably underestimate the baby boomer generation,
and then how much the baby boomer generation, as they get
older and as they get sicker, is going to be equipped with the technology,
whether it’s Facebook or smartphones. So in general, I think that we
should be careful to not underestimate the degree to which these tools
can help an increasingly growing number of the population.
CANTRELL: Community pharmacists are well-positioned to assume a
more prominent role in healthcare delivery, and that role contemplates
not only the dispensing and administration of medications and vaccines,
but extends to the provision of health screening and patient education.
Technology is a fundamental requirement for enabling those initiatives,
but such technology must have the capability to support an integrated
health information exchange so that all providers for a specifi c patient are
aware of the various elements of care for that patient.
The growing use of social media and mobile apps greatly expands the
potential to reach many more individuals much more rapidly than the
more traditional means. For pharmacists, these vehicles present opportunities
to provide patients with meaningful information for general consumption,
or tailored to specifi c patients. In either case, these evolving technologies
serve to increase pharmacists’ role in healthcare delivery.
DUFOUR: Aaron, you and Dev both work in this space: What are some
of the capabilities and some of the innovations that you guys are seeing
with mobile technology that the retailers ought to be thinking about?
KAUFMAN: I think some of the things I’m starting to see on the health
plan side, especially, is the closed loop adherence. Letting the physician
know, the pharmacy know — everybody know, basically, as part of the
caregiver circle — that the prescription was taken. And there are a lot of
things that can happen [from that], downfalls and upfalls. So things like
when users start using systems, you’ll be able to see if they’re taking
their drugs on time and stuff like that. There can be misinformation or
miscues, ill-reported data; whether it’s on mobile or whatever, there still
could be bad data in there, no matter what. And the closer you get your
care circle to that picture and to acknowledge it — having your wife or
20 • FEBRUARY 2012 DRUGSTORENEWS.COM
your husband saying that they actually took that drug or they actually
went to go workout that day, having someone else there to verify and
validate some of the use cases — that to me helps to prove that circle of
care, whether it’s taking drugs, working out or being healthy.
DUFOUR: What are some things that are working and what are some of
the key lessons you’ve learned about when these things did not work?
KAUFMAN: There are some very transactional things that we see that
are working, like being able to fi nd care, being able to see what drugs
you’re on, being able to see your claims, pay your bills — very transactional
things. But when the informational side of things comes into
play, like being able to see a patient-friendly drug monograph on demand.
Like, ‘I’m scheduling an appointment to go see a physician or
I’m going to a provider to pick up some drugs right now — what do I
need to expect? What kind of questions should I ask my physicians or
my pharmacists?’ Those kinds of things aren’t being really used very
well or implemented well. I think some of the use cases — and the
way those tie into having someone that’s either on mobile or on Web,
desktop Web, whatever the channel is to deliver that on — those use
cases still are not well thought through by the people that are involved
in the healthcare system.
We’re trying to do things to help improve that by taking other industry
parallels, for example. But there are some things, the way we look at it, that
can help close that gap, the more it’s connected to their life. Someone’s not
just going to go to an app to look up a drug monograph. It has to be part
of their workfl ow. Like, ‘I’m going to pick up a drug, I’m going to refi ll it,’
now show them what a drug-friendly monograph is. Don’t wait for them
to go search for it. Show it to them to their face. ... Those kinds of things.
PATEL: In addition to some of the recent innovations in the marketplace,
augmented reality is an emerging one. These are the early adopters that
you are going to target in specifi c areas in your markets, where you’re
going to start seeing younger people interested in their health, interested
in nutrition, health-related items. Populating data and having
augmented reality readily available within your locations, available QR
codes that are able to ping back information on the Web that’s constantly
updated, and the ability to send notifi cations — those are the factors
early adopters in the market are looking for. They’re more interested
than just fi nding out about their conditions and the drugs and the side
effects, which can be done via SMS and lower-tier technologies.
KAUFMAN: I think from a technology perspective, there’s a lot of
things that people do to kind of downgrade the value of their application
because they try to fi t. They force-fi t in this least common denominator
approach to develop an app: ‘I’m going to do what every
device can do today.’ SMS is defi nitely one channel, but developing
an app for the iPad can be a lot richer than developing an app for
an iPhone. So leverage those APIs and the things that you can do
from a technology perspective to make the experience more interactive,
more fun, more friendly; whether it’s augmented reality or using
GPS, using accelerometer features, those kinds of things. Leveraging
the things that are device-native that create an experience for a pa-
tient or for physicians or anyone that’s in the care circle to experience
the things they should experience with this device. They’re used to
experiencing other apps, right?
A lot of people take the HTML 4 approach or the HTML 5 approach,
and that’s not going to fully get you the user experience that you want
on all devices. You’ll have to write all these different code bases to actually
leverage in HTML 5 what the iPad can do and the iPhone can do.
Then it’s not really a tech conversation. I just think that a lot of use cases
fail because people try to force-fi t one solution for all the technologies
that are out there. I think things that you do for desktop Web should be
different — leverage the things that are good for you there. Being able
to develop a multichannel application that reaches your constituents
the best I think is a strategy that a lot of the providers, a lot of the care
teams, including the retail pharmacies, in my opinion are failing at.
“ You have to take a
step back and not only
think about how to fi t
MTM into workfl ow,
but rather how [to]
fi t it into the demand
model. There are ways
to do it — it can be
done — but it requires
thinking about MTM differently in terms of the
types of interactions. Maybe it’s not one interaction,
maybe it’s multiple interactions over the
course of therapy that are shorter interactions
more targeted toward certain behaviors.”
Will Abbott, CVS Caremark
ABBOTT: I had a question for the suppliers. ... Pharmacies — and the
pharmacy industry as a whole — have ways of dealing with nonadherence
and nonpersistence. I see mobile technology as an opportunity to
reduce the cost of those existing solutions, to improve effectiveness, to
improve access, to improve relevance. ... One of the areas where pharmacy
as a whole has struggled, however, is noncompliance between fi lls.
How can we understand what is happening in the home with the patient,
insuring pills are taken at the appropriate time? Mobile technology, I believe,
is the fi rst opportunity where you have a device that is with them
more than any [other] individual [item]. I’ve yet to see solutions that
solve for noncompliance, but are mobile solutions evolving in that way?
Do you see any mobile solutions evolving in that way? Is there anything
DRUGSTORENEWS.COM FEBRUARY 2012 • 21
out there that’s effective? Because appropriate use of the medication in
between fi lls is something that I would say the pharmacy industry as a
whole is blind to. And I think mobile offers a potential solution.
PATEL: I think from an overview standpoint, ... adding game-based
achievements to taking medication, and having check-in ability every
time they’re taking medication within the app, allows you to relay that
data back. Additional profi le scores and achievements can be shared
in a social manner to kind of drive behavior, ‘OK, I’m on this medication,
because it’s benefi cial to my health.’ And doing so in accordance
with HIPAA is possible; simply share the data that is related to progress
within your health profi le standpoint ... with the social networking application
of just looping in friends to modify behavior.
KAUFMAN: There’s defi nitely [also] a reach outside of mobile. There [are]
devices that are out there like the Jawbone Up app — I don’t know if anyone’s
seen that. The actuating wristband basically vibrates and tells you to
wake up or tells you to stand up and do some activities. We’re getting access
to that API, and we’re trying to put in adherence to that, like it vibrates
you when it’s time to take your meds. ... We’re looking at different ways of
leveraging devices, too. We’re also working with a company called Glow-
Caps. ... So, connecting all the different things that are out there that could
possibly help let a patient, or anyone in the care team, know that some
activity needs to happen. So it doesn’t just have to be mobile but having
mobile as a centerpoint because it’s always on is a good idea; whether it’s
smartphones, whether it’s SMS, whether it’s MMS. But all those other devices
that you can connect to your outside world also [are] a way to do that.
YATES: I was just going to say that there are very good summaries of the
research around behavior change that [are] available to us all at this point.
And there is kind of a formula for behavior change, if you will. It involves
individuals setting their own goals, and certainly being informed about
how to set their own goals, as a starting point — being motivated around
“ The fastestgrowing
on Facebook is
women over 50
[years old]. And
they’re typically the
people that are the
caregivers in the
home and ... across
the expanse of their extended family.”
Alan Yates, NumeraSocial
your personal goal and having a real targeted goal. Secondly, people get
stuck with too much information. So giving them an action plan and get
them committed to that plan so that they believe it will result in them
achieving their goal is a huge step. And have that action plan be fairly
descriptive — saying on Day 1, you do this; on Day 2, you do this; on Day
3 you do this. And having the mobile companion as a reminder to that
action plan is huge. Being able to get notifi cations, notices and reminders
[saying], ‘Hey, you didn’t do this. Did you mean to skip it?’ etc.
Having real, objective data that informs the individual as well as the
caregivers about what’s going on is huge so that people can be accountable.
You know when that pill wasn’t taken; you know when you didn’t
do [x, y and z] steps; you know that your weight isn’t really changing. ...
And then, fi nally, the last piece is social reinforcement. It’s having the
people around you that you can trust to help you with your health condition
or join you in your quest, join you in your goal, to again help you
stay accountable and stay engaged. So it’s not just the sort of thing that
reminds you, it’s really having this complete continuum of behavior
change working for you. Because people do need that help, they need
the whole continuum of pieces in place for them to actually change their
behavior and stay engaged for more than a month.
MAARABA: There’s a technology out there today that I am reading a lot
about these days: Apple Siri. That’s the voice recognition side of the
technology discussion that’s been going on. I think part of what Alan
[was] saying about patients being engaged because they also have to
walk the walk, so to speak, the other element behind that is the percentage
of, let’s say, the sophisticated population that actually will use the
technology, or those maybe not as sophisticated in terms of technology
usage but sophisticated in other ways, they need that push.
And this probably will segue into the discussion later on when we
start talking about where the pharmacist comes into play. ... I recognize
that retailers these days are really reinvesting in technologies that used
to be out there but then kind of died out, and now they are back in. For
example, the call that I receive on my cell phone that tells me to remember
to go to my CVS/pharmacy and get my script refi lled. Now obviously
with HIPAA constraints, there’s only so much you can divulge
with those calls. But those are the things that I think of — when you
look at patients out there that won’t wear, for example, the wristband.
It’s a matter of preference; it’s a choice. That’s the day and age we’re in.
There has to be a way that you can [implement] that voice recognition
technology [so that] the patient with a chronic illness could be driven to [do
certain things] if [he or she] didn’t remain compliant. I call it the ‘fear factor.’
I think that there has to be a challenge without crossing that [HIPAA]
line where you actually disseminate information. ... You’re almost putting a
sense of fear in that patient with that reminder: ‘If you don’t take that next
pill, if you don’t follow your regimen, this is what could happen.’
You’re seeing the cigarette industry being forced to print warnings
on each pack of cigarettes. Canada has done it for years; now the United
States is doing it. If you’re a smoker and you buy a pack of cigarettes,
you’re seeing pretty graphic images on your cigarette packs. I think
there’s a link there that can be drawn with, ‘If you’re not compliant, this
is where you may be headed.’ Then Siri says, ‘If you are compliant, then
this is what may happen to you in terms of better health’ and so forth.
22 • FEBRUARY 2012 DRUGSTORENEWS.COM
VON SCHWEBER: Well I guess maybe Siri’s lovely voice might be enough
to motivate people to do it.
YATES: Actually, people have found that a reminder from your mobile
phone is much more effective than a nag from your mother. ... There’s
something about it that gives it a little bit [of] added power, objectivity
and companionship. It’s sort of your conscience talking to you instead
of your mother.
DUFOUR: I agree with that. We were talking about this [earlier] ... about
compliance and how if someone has a heart attack and they’re in the hospital
for three days, when they’re ready to be discharged, the doctor says,
‘I’m going to give you a pill to take once a day that reduces your chance
of a second heart attack by 65%.’ And I know in the drug stores if I saw
someone like that, I’d ask them, ‘Erick, how long are you going to stay on
that?’ The guy would say, ‘The rest of my life.’ But when you run the data,
... [in] 84 days [or less], more than half of people are off therapy. And you
would think that if it’s going to save their life, they would take it.
So you have to do something, whether it’s social media, like you were
saying Alan, or some innate object that you can’t argue with — you
can’t argue with your phone — that’s telling you to take your medicine.
Maybe that will change the behavior.
I want to make one more comment on mobile, I know we kind of
jumped around into social media, which is perfect, ... but on mobile,
one of the things that Dev was working with — because you were asking,
how do we do some of these things — is the concept of putting a
QR code on your prescription label. So ... your computer knows what
drug it is [you’re taking], and I think we’ll eventually get to where your
computer also will know what lot number [it is] if you’re scanning the
bottle, or what the expiration date is.
So imagine the QR code on the prescription bottle. ... What does it
mean? Well, it gives you the ability as CVS or H-E-B or Walgreens, for
it to be whatever you want it to be. I’ve got [this prescription in] my
medicine cabinet. It’s been sitting there for six months, and I forgot what
it is. It says take one a day, but what is it? So you scan the QR code and
up comes the monograph for the patient to read on his phone. That’s
pretty handy. Then you get up the next day, and you read in USAToday
that there’s a drug recall — God forbid, right? But those things happen
— and so you go, ‘Oh my gosh, is this drug under recall?’ Then you
go and you scan the QR code — and you can change that QR code and
the patient monograph in 15 minutes. Now it comes up and it tells you
whether it’s from Walgreens or CVS or wherever. And it says, this lot
number is not under recall. ... That could be a huge benefi t to the patient.
ABBOTT: And you can imagine taking that to the next level, where it’s
not just relevant to the drug, but it’s context-specifi c to the patient as
well. Scanning the QR code takes you to that drug, to that patient and
potentially combines in some of the work that Erick was talking about,
which speaks to their full regimen and how they should think about
those drugs working together. Providing them with additional information
about their overall health in the context specifi c to them. If they
want additional information, they will have it in hand every time they
pick up a prescription. I wouldn’t want to constrain the approach to the
prescription, but take it into the entire patient as well.
DUFOUR: Absolutely. And Will, I think that’s the key to these kind of discussions,
is that these things and the software that you can produce are
just tools. But how they’re used, ... your understanding of the consumer
because you were there, you serve those consumers, you understand
that getting that information over to people like Alan, and then Alan
giving that feedback on what you see working and what’s not working.
YATES: We feel that we’ve really come into a big idea, which is this massive
trend toward Facebook, where [more than] 800 million people are
using this thing — people spend more time on Facebook than any other
application on the Web today. They’re interacting with their social circle,
[who are] real human beings that they care about — their family, their
friends, as well as their extended network — and being able to do things
with people that they worked with 10 years ago that they may not have
otherwise been able to connect to very well [in the past]. That, plus the
billion-plus people that have smartphones today that have access to
those things as their personal companions over and over. We really believe
it’s the combination of those two things in particular that are very,
very powerful for this model of behavior change that I talked about.
So we’ve created a platform ... that is private labeled by any number
of different companies — we’re working with consumer companies, retail
companies [and] grocery stores, as well as health plans, certainly,
and health providers — to give people goals; to help people select their
goals; to help people latch on to action plans; to help people measure
their actual results, and then to involve their social circle in keeping
them accountable and engaged and happy and having fun while they’re
doing something that’s good for themselves.
So we believe that ... there is something really big here for selfmanagement/self-help
without giving people medical advice, but really
giving them an action plan: ‘Hey, on Monday I promised myself
I would walk 5,000 steps. So I’m going to walk those 5,000 steps, and
if not, I’m going to get a mobile reminder that I didn’t check that off.’
So again, we believe that it’s this confl uence of events that really offers
a new sort of opportunity for all of us in the room to help people do a
better job of achieving their goals.
FOSTER: I’d like to just expand on that, Alan. If we look at some trends
going on, and one of the trends that you mentioned was self-service and
consumer empowerment, it’s not that long ago that if you didn’t go to
the bank on a Friday, you didn’t have money on the weekend. The ATM
machine changed all of that, but it didn’t happen overnight. It took 12
years. It was consumer adoption that made it happen. But then if you
look at airline kiosks and what happened with the airline industry — it
took about three or four years, and all of a sudden we can’t even check
into an airline without using a kiosk. DVD rentals, photo kiosks ... it’s
really paved the way for consumer acceptance of some of the things that
we’re talking about today.
But there’s been a fundamental shift over the last fi ve to seven years
from a service perspective of what used to be, ‘what can you do for me?’
It was custom jeans at the Gap, and I want the burger ‘my way’ at Burger
King. It was all about, ‘what can you do for me, Mr. Retailer?’ I think
DRUGSTORENEWS.COM FEBRUARY 2012 • 23
that the shift has been, ‘what can I do for myself? I don’t want to wait in
line; I want self-checkout at the grocery store. I don’t want to wait at the
doctor’s offi ce. I want to be reminded. I want text messages.’ It’s about
self-service, and that’s where I think consumer empowerment comes in. I
think we need to give people the tools to take care of themselves. But it’s
the shift — and I think everybody’s talked about it a little bit — of mobile
technology, checking in for yourself and what can we do for ourselves?
“ It’s about selfservice,
where I think consumer
comes in. I think we
need to give people
the tools to take care
of themselves. But it’s
the shift — and I think
everybody’s talked about it a little bit — of
mobile technology, checking in for yourself
and what can we do for ourselves?”
Bart Foster, SoloHealth
VON SCHWEBER: It’s interesting to comment that physicians — who are notoriously
objecting to doing any kind of data entry, any EMRs — when they
go to him they [have to] self-register using terminals. Even they will do it.
DUFOUR: You know, it’s easy for us to look at other parts of the medical
profession, whether it’s the doctors or the hospitals, and say, ‘Boy, pharmacy’s
leading the way in technology.’ But Jim, when you look at what
pharmacy’s doing compared with banking; we were talking earlier this
morning, and you were saying you’re new to pharmacy. I was thinking,
this is exactly what we need because the things you were solving in
fi nancial services years ago are the things you’re fi nding in pharmacy,
and you’re going, ‘That’s really easy to fi x, I understand this.’
And I think that’s true. I know that when we talk about Redbox, and
my small town where I live in Bentonville, I drive past where the Blockbuster
used to be, you think about the impact that technology has. And
here was this great company, and I remember in this small town, it was
fi lled up every night with people going in there and getting their DVDs.
You go about a half-mile up on the right, and there’s a Walgreens with
a Redbox sitting out front. That little box took down that big store. And
I go home, turn on my TV, push a button and Netfl ix comes on, and I’m
saying that little button is going to replace that box. And Redbox, as you
know, they already said, ‘OK, we did well, we have to do something different
now, this technology’s going to change.’
So technology has the power to change our industries. I know with
the self-service industry, thinking about the fi rst time I went to work at
a Walmart, we had a stand-up blood pressure machine. [Let’s] talk a little
bit about the self-care industry and how these kiosks have changed.
CANTRELL: Self-service health care will become more prevalent as the
new healthcare paradigm matures. Consumers’ decisions primarily will
be infl uenced by clinical, fi nancial and convenience factors. Once again,
technology will play a key role in enabling this shift, and pharmacists will
have the opportunity to elevate their role in the delivery of health care.
FOSTER: I got to be friends with Gregg Kaplan, who’s the CEO of Redbox,
and he told me the story two or three years ago. They recognize their business
fundamentally: They have coin counting — Coinstar that owns their
business — and DVD rentals. He said both have a fi nite life. He knows
DVDs aren’t going to be around forever. But they’re looking across the landscape,
and they’re saying, ‘What are some of the trends going on in self-service
technology?’ They want to own retail automation. And they’ve looked
at the landscape and said self-service health care is really at its infancy.
They made one bet in health care, and they made it with our company
SoloHealth. They believe that what we’re doing is very scaleable, and it’s
something that the consumer can latch onto. What we believe is if you
look at the trends going on, being able to self-diagnose, being able to learn
about yourself, being able to do it yourself in a retail environment using
touchscreen technology, answering a series of questions, having fullmotion
video. ... And in the future, as 4G technology becomes more and
more prevalent, SMS instant messaging, iPads, iPhones, it’s all connected.
It’s an exciting industry to be involved in, I think, for all of us.
DUFOUR: You think of the old kiosks, and they really were nothing more
than information devices. These things are much better at it now because
they’re always telling us that the kiosks of the future are going to
have to be things that can’t be done with a phone. And I found it very
interesting when Bart put in his kiosk, there was one in my hometown.
I went to the fi tness center, they had one in there and I sat down and
tried it. His kiosk, you sit down and if you need to wear glasses, it will
do the same thing an optometrist will. It will tell you what your prescription
should be. And I know there’s some things it can do that full
capability’s not rolled out yet, Bart, because of the legal system, but the
capabilities you have with your kiosk [are] tremendous. And I don’t
know if you want to comment where you think that’s going.
FOSTER: I’ll comment specifi cally to what you’re referring to. So vision
screening is one of the functions that the SoloHealth Station does. I’ll
bring it up as an example because I think fundamentally we’ll see examples
of this. So the kiosk today does blood pressure, body mass index,
vision screening and a basic health risk assessment, but the vision
screening part — it actually simulates a 20-ft. optical path, and you’re
comparing what you see in the distance with what you see near. It’s very
similar to what you would experience in an eye doctor’s offi ce. Well, you
could provide a prescription if you had what’s called an autorefractor. If
you’ve been to the eye doctor’s offi ce, [he’d say], ‘what’s better, one or
two?’ There’s not a lot of value in [a doctor doing] that. There’s a device
24 • FEBRUARY 2012 DRUGSTORENEWS.COM
that will do that; it’s called an autorefractor, and you could give someone
their prescription. That’s not done today because of legal regulations, and
there are 30,000 eye doctors that would fi ght you tooth and nail.
What we’ve instead done is we provide you a vision screening that
says, ‘Hey, your left eye is not optimal. Here’s a list of fi ve doctors within
a 3-mile radius that accept your insurance. Why don’t you schedule an
appointment today?’ And we allow them to schedule an appointment.
So it’s not as disruptive. We think that’s working very well. But in emerging
markets — in countries where there’s not an eye doctor for 50 miles
— this becomes a way to improve access to care that will come to the
United States. With the cost going sky high and the focus on wellness and
prevention, we believe that the consumer adoption will take shape. But
in the meantime, we think that facilitating that dialogue with the pharmacist
[and] with the eye doctors in the community, that’s the model in
the United States, and that’s what we’re focused on.
DUFOUR: I think that has great value when you think about the retail
clinics. ... This is like an adjunct to that, which [is] one more service you
can offer. You may not have a vision center in your stores, but this little
device really shows that you’re in the healthcare business.
SAGE: I think we have to look at [the evolution of technology] from a retail
pharmacy standpoint. We need to ensure that as technology is evolving
that the retail pharmacy doesn’t go the way of Blockbuster video, where
technology can take the place of what we do today. And it will take the
place of what we do today, but we have to be the next step ahead to say,
‘where do we fi t into that?’ Because if we step back and say, ‘we do the best
job of the lick, stick, count and pour that anybody can do,’ the evolution of
technology will take care of that. It is important to understand that’s there’s
a lot of other ways of distributing medication — for example, the self-service
kiosks that can do a lot of what we do in retail pharmacy today. It’s the
other things that cannot be done by technology alone that’s critical here.
So I think the conversations that we’re having today are really important
because whether it’s the kiosk, such as Bart is talking about, or it’s the
cell phone or social media that can enable that patient, if we let that continue
on its own, I think there’s some pretty devastating things that can
happen to our industry. So we need to make sure that we’re embracing
technology and looking at how our individual companies can support
that technology for our partners, which are the retail pharmacists.
YATES: I’d love to broaden that question, actually, to the pharmacists in
the room and ask you, what scares you about social technology? What
scares you about social media? What scares you about mobile? What
scares you about self-service? And then we can fl ip it around and talk
about what you would like to see. Because I’m building these things. ...
WEEAST: I look at where Walgreens is spending quite a bit of time, and
the mobile strategy that we’re working on pays more attention right now
to the pharmacist and the clinician or the nurse in one of our Take Care
Clinics. The focus is to put the right information in front of the pharmacist,
clinician, etc., while they are having conversations with patients. The next
stage probably will be how to leverage mobile technology to extend that
information directly to the patients so they can consume it at their lei-
sure. We also must consider the trade-offs; there are investments you need
to make to stay relevant, but you can’t invest in every single technology
that pops up. You’ve got to fi gure out which ones are meaningful, which
ones actually provide value to patients [and] to payers, and you do that
through pilots and other opportunities. First rolling some of this technology
out to the pharmacists and clinicians provides for quick feedback.
“ The focus is to put
the right information
in front of the pharmacist,
while they are having
conversations with patients.
The next stage
probably will be how
to leverage mobile
technology to extend that information directly
to the patients so they can consume
it at their leisure.”
Jim Weeast, Walgreens
MAARABA: Just before the next retailer speaks up, I’d like to [jump in] just
one second. I think as we have similar concepts in the kiosk world, you
need to really focus on the root issues. Fifty percent of the patient population
is noncompliant. And all of us who were at NACDS this year would
have heard Doug Long mention that today’s trend of why a patient visits a
pharmacy is because the pharmacist is better at consulting that patient. No.
3 reason was that patients today are looking for pharmacists that are more
connected to the physician — so that circle of care element that I brought
up earlier. So that’s the No. 1 reason and the No. 3 reason why patients go
back to a pharmacy. If you remember the statistics back in 2005, the No. 1
reason to go to a pharmacy was to go in there, get your script and run out
because [people were] in a hurry. Well we’ve got a lot of issues these days,
not just fi nancial issues, but we also have health issues that are far more
critical to our economy and our households than they’ve ever been.
So the angle with a program like what we do at PharmaSmart is that
we focus on pharmacy services. We target the disease state, and we don’t
complicate it for the pharmacy because we know a pharmacy is busy. The
average net gain, I think, per prescription fi ll at pharmacy today is $1.06.
And that hurts in one essence. The gain from a pharmacy service reimbursement
is huge. So what we do is we focus on the pharmacy services
element and the MTM aspect of the business with the connected kiosk
that transmits data. That targets hypertension cases and then transmits
that information back to the physician’s offi ce through an EMR and to the
pharmacist through a PHR, giving that pharmacist a meaningful oppor-
DRUGSTORENEWS.COM FEBRUARY 2012 • 25
“ There has to be a
way that you can
technology [so that]
the patient with a
chronic illness could
be driven to [do certain
things] if [he or
she] didn’t remain compliant. I call it the ‘fear
factor.’ I think that there has to be a challenge
without crossing that [HIPAA] line where you
actually disseminate information.”
Ashton Maaraba, PharmaSmart International
tunity to target a patient who suffers from the No. 1 killer in the world. Or
perhaps even intervene from a preventive standpoint.
So those are the key aspects in our opinion. ... We believe in how critical
the out-of-offi ce visit is — the average patient probably spends about
three minutes three times a year with [his or her] primary care physician.
That’s too [little time] to actually advance a case; monitor a case; detect a
case properly. We look at statistics in our industry, like 1-in-3 of us suffer
from high blood pressure, 60% of us don’t even know we have it and 15%
of those cases are misdiagnosed. That’s a problem — that’s a problem
that gets right to the root of the total issue.
So when we get more engaged in the discussion about where the
pharmacist comes in, ... I think it’s the technology today that plants indicators
and alert messaging that can target patients, which allow the
pharmacist, who may be somewhat passive, to target a series of those
chronic conditions to help them identify who those patients are so that
they don’t have to actually ask the question. The technology’s seamless,
it’s integrated with the pharmacy workfl ow. It tells them ‘call this patient,’
or ‘when this patient walks in, you must do this.’ And there are
some retailers in this room that have already done that, they have their
DNA profi ling systems intact.
So that’s our opinion, and that’s how we focus our technology.
VON SCHWEBER: So I’m wondering. I hear Rick saying on the one hand
that retail pharmacy wants to make sure they don’t become the next
Blockbuster. I’m also hearing Ashton say there’s a huge opportunity for
the pharmacist to be a clinical pharmacist and provide more value, in fact
have more customer relationship there than they have with the physician.
MAARABA: They have to more than ever today.
VON SCHWEBER: OK. So I want to bring up the question, or the elephant
in the room, and that’s MTM. Now we know it’s a hard course. It hasn’t
hit the hockey stick yet, but I’m reading that there’s bipartisan support
for legislation that would open up eligibility for MTM from what it is
now — from maybe about 8% to 12% of the population in Medicare that
have a Part D plan to all Medicare enrollees who have even just a single
chronic condition, which could now be 30, 35, 38 million people, which
would make that one whopping big elephant. So I’m curious, I’d also
like to know from the retail pharmacy perspective, is that something on
your plate as a way of making sure you don’t become obsolete?
NORMAN: Well, I’ll queue it up. It absolutely is. MTM is something that
at retail we’re all very passionate about. The issue, as Ashton mentioned,
is integrating that into our daily workfl ow in the pharmacy.
Right now the platforms and the programs that are available to us are
disparate. The information resides on a website. Then my information
on that patient resides within my system. Then I have to go back to a
website to complete the billing and all the necessary documentation for
that particular provider. So how can I take all of that [and] seamlessly
integrate it into my workfl ow system so that my pharmacist can execute
consistently with every patient that may be eligible for MTM? That’s
the great opportunity that’s in front of us and the challenge that we
have at retail to be able to hit MTM out of the ballpark.
We do a great job in some stores because we know the customers that are
eligible. We do a great job of reaching out to these folks through distance
programs via call centers. But what we don’t do a great job of is taking care
of everything that falls in between that isn’t right in front of us because we
don’t necessarily know. Or we know that person may be eligible, but it’s
so cumbersome to execute that we’re just not doing it on a regular basis.
We’ve got a tremendous opportunity ahead of us. I was just talking
with someone earlier this morning about retail clinics. Think about just
fi ve years ago, I don’t think there is anybody sitting around this table that
wouldn’t have said, ‘What’s this retail clinic thing? I don’t think it’s going
to take off.’ Now look where we are fi ve years later. They’re very much an
integrative part of health care and a great partner to us in the pharmacy.
So it’s the same with all of the technology offerings that are available to
us. I’ve got a very, very diverse group of customers that we serve. Ashton
said it’s probably 30% of the folks that have smartphones, I would say
it’s much less than that within my market on a general basis. So yeah, we
need to build that technology and make it available to those customers
that utilize it on a regular basis because I want to remain relevant to them.
But then how do I reach out to those folks that have a disposable cell
phone that they’ve purchased? Maybe it’s through SMS technology. But
how can I get information to them that’s relevant to their prescriptions —
be it a refi ll reminder, be it [a] ‘your prescription is ready’ message — and
then link them to my website or give them a phone number to call and
follow up with their pharmacist?
So back to the initial question: Is retail pharmacy afraid of technology?
Absolutely not. Do we feel that technology will replace us at any point
in the future? Absolutely not. The healthcare system in the United States
demands and will require that face-to-face interaction. That is by and far
the best means for compliance and persistence with any disease state.
Yes, we can do great things and great outreach with technology, and we
26 • FEBRUARY 2012 DRUGSTORENEWS.COM
should continue to really push the envelope to make that available, but
that is going to augment the pharmacist-patient-physician relationship.
I was reading [a pretty interesting] article [recently]. It was pointed
toward physician interactions and how physicians are using technology.
I jotted down a few statistics. It said 50% of doctors are using smartphones,
and they’re using them more than fi ve times a day. I would
agree that is probably a statistic that is valid with our pharmacists. I
would say half of our pharmacists have smartphones and are probably
using them numerous times per day to access information.
Seventy-eight percent of physicians are recommending websites to
patients. Let’s not forget about the Web and the availability of information.
I believe that still is primarily where the majority of folks are getting
their information. Yes a smaller percent are on the fl y, on demand,
traveling all the time like we do. They’re getting it on their smartphone
— and we’ve got to remain relevant in that space as well.
So the physician community is slowly adopting, and pharmacy is
slowly adopting. You [have] to continue on your side to develop the
technology that we can all integrate as seamlessly as possible. I’m not
an expert as far as QR codes are concerned, but how big do those things
have to be Bob? Remember, there’s limited real estate that we have on
a prescription label. So what link, what type of indicator can we put on
there that will allow that customer [to] grab that bottle out of [his or her]
cabinet and scan it? How can I integrate that into all the other data that I
have to put on a prescription label currently?
DUFOUR: Well right now I think [the QR codes are] too large; they probably
would fi t on top of the cap, is that right Dev?
PATEL: It’s 2x2.
NORMAN: That’s huge.
DUFOUR: But ... think of where cell phones were fi ve years ago or 10
years ago. So ... I know [QR codes are] going to where they will be
smaller, so we have to be thinking about those types of technologies.
The thing I like about QR codes versus a one-dimensional bar code is
that you, as a retailer, can control that message. You can change it on the
fl y, and [for] everyone who scans that code it’s different. In fact, I was
with Dev when we were down with a major database company, and he
was showing them these QR codes and how they work. He laid this one
QR code out and said, “Well it works this way.” There were three executives
who all scanned it, and they all got the same information. He did
another one, same thing; a third one he did, all three of them [scanned]
it and all three of them got different information. So he showed these
subscriptive abilities — that this subscription is a physician, so you get
this information; as a pharmacist you get this; as a patient you get that.
So there is a lot of things that people really haven’t thought about that
[are] really cool about those things. But I think that they really give us
a lot of opportunity.
But I think I want to switch the conversation because we have just a
few minutes left. ... I know Rick has done a lot of innovation over the
years, even before Emdeon. Can you talk about some of the clinical technologies
you’ve been working on and what you see coming?
“ The healthcare system
in the United States
demands and will require
interaction. That is by
and far the best means
for compliance and persistence
with any disease
state. Yes, we can
do great things and great outreach with technology,
and we should continue to really push
the envelope to make that available, but that
is going to augment the pharmacist-patientphysician
Craig Norman, H-E-B
SAGE: Yes, and I think that it speaks a lot to the technology that we were
talking about before. On the clinical side, again as I mentioned earlier, how
we can bridge the gap between what’s going on on the medical side and
what’s going on on the pharmacy side I think is critical to the long-term
success in the pharmacy and the improvement of patient care.
So as we’re looking within Emdeon at the signifi cant amount of information
that is fl owing through on behalf of our customers, [we are
looking at] how we can disseminate and make that information available
to all providers of care. There’s a lot of things going on from a patient
perspective, and we need to interact with that patient, but we have to
start with the information that’s available to the provider so that they can
make better-informed decisions and help support technology that ultimately
will be available to the patients as well.
The key is, as we were talking about the MTM information that [Erick]
brought up, I think that it is critical to understand what can be available
and used within the retail pharmacy. So [perhaps] it’s actually looking at
improving the persistency and looking at adverse impact, but also looking
at what retail pharmacy can do in addition to what they’re doing today.
So how can they expand upon the opportunities of having a professional
provider of care that has more interaction than the physician does?
As Ashton mentioned, a lot of us don’t spend nearly as much time
with our physicians as we do with our pharmacists. [We need to] engage
the pharmacist to do more, even if it’s outside of the plan-based structure
that’s in place today. I get my prescription card, and it says I can get prescriptions
at my pharmacy. But I have to go to my physician, which I very
rarely go to, to do all my other benefi ts with this other card. So as we can
start helping bridge that gap and make those benefi ts on the medical side
DRUGSTORENEWS.COM FEBRUARY 2012 • 27
“ I think we have to
look at [the evolution
of technology] from
a retail pharmacy
standpoint. We need
to ensure that as
technology is evolving
that the retail
pharmacy doesn’t go
the way of Blockbuster video, where technology
can take the place of what we do
today. And it will take the place of what we
do today, but we have to be the next step
ahead to say, ‘where do we fit into that?’”
Rick Sage, Emdeon
available to the retail pharmacy, that opens up a lot more opportunities
for that interaction with the patient, and obviously a lot more revenue
opportunities from a pharmacy’s perspective.
We go beyond that border of that prescription benefi ts card because
we know if we’re not getting paid, it cannot be sustainable to us long
term. So we must bridge that gap and move a medical information system
that is quite behind the times to more real-time decision processing
— pharmacy has a long way to go as well, but at least we have a way
of making sure that there’s payment before the patient leaves. [We’re]
looking at how we can bridge that gap and be able to perform more
information, more services, whether it’s MTM or basic prescription fi lling
services or specialty pharmacy within the retail environment that
may be covered under major medical; there’s a lot of technology that’s
allowing us to do that now.
It also will help push major medical into the environment that we’re
in in retail pharmacy; that’s the movement of going to real-time claiming.
But I think it is important within retail to look at the immediate opportunities,
whether it’s in a clinic environment or just our traditional
pharmacy, of making those types of interactions that we might walk
away from today because payers are saying it’s covered under a major
medical benefi t, not a pharmacy benefi t, and turning that around to allow
pharmacy to be reimbursed for those services as they interact with their
patients. And there is the line of, ‘OK, how do I bridge that gap? How do
I work with that?’ I know there [are] provider concerns from the physicians’
side. They’re saying, ‘you’re getting into my environment.’ But I
think what we have to look at from a patient perspective is a lot of those
patients are not going to the physician, so they’re not getting that care. So
it’s not that we’re taking away from physicians, we’re interacting better
with that patient to make sure they are persistent; to make sure that they
are getting the care that they need to get, and the pharmacies are getting
reimbursed for that. So I think that’s an important component as we look
at where the evolution of pharmacists goes.
And going again to what Erick said as far as more on the clinical side
and less on the production side of a retail pharmacy, technology’s going
to take care of the production, whether it’s a kiosk or all the other automation
that the pharmacies already have now. But we have to look at ...
the ability to take more on from a clinical standpoint in that pharmacy ...
within that workfl ow. And the key is, within the workfl ow — if they have
to go out to something outside of workfl ow, it’s going to be a challenge to
do the adoption within pharmacy, but if it’s going within the workfl ow
— the billing can be within workfl ow, and the interaction with the patient
will allow for some key opportunities for pharmacy.
MAARABA: I was just going to say that, to touch on what Rick said, how
simple it actually can be. Kerr Drug with their Asheville project proved it.
They launched that Asheville project, they piloted it — did a great pilot
— and kept it simple. The patients that they were getting reimbursed for
were not all on multiple drugs, ... they weren’t prescribed multiple drugs,
whereas a lot of the MTM reimbursement focuses on how many drugs —
between four and six. It was simple use of limited technology where they
improved the execution on the pharmacists’ side. So they focused on two
things. They focused on fi rst, get that pharmacist to execute. And then No.
2, follow a strict regimen. They set the reimbursement, they processed the
reimbursement and they were getting an average of $10 to $14 [for] just
basic [consultation]; [it] took them a few minutes to handle that process.
And you compare that [with] the average time it takes to fi ll a prescription,
talk to the insurer, all those things, you’re seeing where the profi tability
is in pharmacy, which is back to using the technology, combining it
with good, old-fashioned pharmacist execution and driving it, reinforcing
it. And we all know that on the retailer side, we have to keep doing that
more than ever ... and we have to keep simplifying the technology as entrepreneurs
and innovators on our end.
VON SCHWEBER: Craig, I have a follow-up question to what you said.
How important of a factor is it to be able to improve the productivity of
that clinical pharmacist so that it actually could be added to the workfl ow
so that they can provide that kind of clinical counseling [and] they can do
MTM in short periods of time so that they can actually be a profi t center
rather than a cost center?
NORMAN: That’s absolutely critical. We work every day on increasing our
productivity at the pharmacy so that we have the time to engage the patient
in all of the professional services that we offer within our business
model. That’s the focus for Walgreens, CVS, everybody. We’re all working
very, very hard to increase our productivity [and] take work out of the
pharmacy to an off-site facility where it can be back the next day so that
we can free up the pharmacists as much as possible to be able to execute
from that standpoint. So it’s absolutely critical.
VON SCHWEBER: So that’s a good place to focus.
28 • FEBRUARY 2012 DRUGSTORENEWS.COM
ABBOTT: We talk a lot about integrating these programs into workfl ow.
I would take a step back and ask how it fi ts into the entire pharmacy
productivity and demand model. ... Our pharmacists are central to our
core workfl ow in that they check every prescription. If you take a step
back, integrating MTM and other service into workfl ow is one way to
get to fi t them into our demand model. I would caution, however, that
fi tting into workfl ow is a very constrained way of thinking of how to fi t
the demand model.
I was talking about this at dinner last night, retail pharmacy is an interesting
blend of a retail-driven/consumer-demand model with the complexities
of a manufacturing process. If we think about manufacturing
plants, they have very scheduled demand; you fl ex up or down based on
demand, but you know when you start the day how many widgets you’re
making, when you’re going to make them and how many you should
have by 1 p.m., how many you should have by 2 p.m. In the retail environment,
you don’t know any of this. You don’t know when that patient’s
going to walk in; you don’t know when you’ll have an insurance issue to
resolve. As a result, you have a demand model that’s quite spiky — predictable
to some extent, but quite spiky in general. You have to think about
how you fi t these MTM or clinical programs into that model.
I don’t know what this group’s experience is, but what is the shortest
reasonable MTM transaction that’s been devised? Eight minutes? Five minutes?
It certainly is not on the order of a minute-and-a-half to two minutes.
If we are talking about fi ve- to eight-minute MTM transactions, then we’re
talking about doubling the average time to fi ll a prescription in most retail
pharmacies. This obviously would have serious impact on the productivity
and demand models, even if the programs were integrated into workfl ow.
You have to take a step back and not only think about how to fi t MTM
into workfl ow, but rather how [to] fi t it into the demand model. There
are ways to do it — it can be done — but it requires thinking about MTM
differently in terms of the types of interactions. Maybe it’s not one interaction,
maybe it’s multiple interactions over the course of therapy that are
shorter interactions more targeted toward certain behaviors. Maybe it’s,
to Craig’s point, pulling it out of the retail pharmacy, or only having certain
elements there; but having the pharmacy companies or pharmacyrelated
companies do this through centralized approaches. But that’s the
crux of this, that as long as we are in retail pharmacy, our pharmacists are
within that core service offering, within that production process. You have
to manage around the demand model.
CANTRELL: Access to care and cost containment are two of the three fundamental
elements needed to support an evolving healthcare system. The
third is the advancement of the quality of care. Accountable Care Organizations
contemplate all three elements, and one focus is of particular
interest to me: ... patient readmissions due to nonadherence to medication
treatment plans. Here a collaborative drug therapy management model
presents pharmacists with an opportunity to elevate their role in health
care through more active participation in the delivery component, but
without the support of technology, the burden of program execution and
management would be impractical.
DUFOUR: Well, I think you’re spot on, and my closing comments, when
you think about what Will said and you think about Bart’s kiosk — and
the fact that it has the capability if you wanted it to do autorefraction —
and you think about MTM, can we make our technology to where just
because an optometrist can sit there and say, ‘One or two; better, worse,’
or pharmacist giving advice, can we do the same type of algorithms, the
same type of thinking to whether it’s captured only on electronic devices
and sent back and the pharmacist can do MTM, and they’re still adding
value? ... I think that’s what we’re talking about. And it’s huge. ...
But I’ll say to Craig, H-E-B has always been an innovator, even back in the
days. Bob Coupman was always doing crazy things, and I’ve always seen
H-E-B as a very agile retailer. But today, more than ever, I’ve seen a lot
of retailers getting out there saying, ‘How are we going to get valueadded
services? What are we going to do to be the next big deal,’ so that
when someone walks into CVS, that’s where they want to stay because
of what CVS did.
And I’ve had the opportunity in the past six or eight months to really
look at the technology industry. A lot of these companies I’ve delved into:
I went to Alan’s social network and joined it; I [checked out] Bart’s kiosk;
I [looked at] all these things. And there’s some amazing technology out
there, and I think Jim hit on it when he said we can pilot these things, but
we can’t go out and buy everything. But I would urge the retailers to really
get with these companies, at least see what they have, try it in a couple of
stores. Most companies, and I’m not trying to sell for them, but most companies
will let you have a pilot for free or very low cost; understand what
they have and give them that feedback because it is going to be important
that each one of us as retailers is saying what the next big thing [is that] we
can do to drive loyalty to our stores.
CANTRELL: I learned a tremendous amount today from the suppliers and
could have spent hours listening to where technology is evolving. To me,
it’s incumbent on [us as] providers to understand where the technology
is going and then respond to that progress by developing the appropriate
vehicles that facilitate improved patient outcomes through pharmacistsupported
O’NEILL: Bob, can I just make one comment? Because Alan asked the question
before, and I don’t think we got to talk about it, just really quickly. You
said, what are we afraid of with mobile, or social media? And I look at that
and say, the only thing I would be afraid of is that retail pharmacy doesn’t
step up and represent that doorway to the self-serve patient. The patient
wants to self-serve, and we talked about that a bit, where do they go? Right
now they go to Walgreens with your app, right? But do they go to Health
Mart? Where do they go? Does retail pharmacy represent that portal that
says, ‘Come here and I will help you with what you want?’ That’s the only
thing that I’m afraid of, that retail pharmacy will miss that opportunity to
say, ‘Come and knock on my door, and I will help you with the information
you want.’ So I just wanted to get that in; I think that’s big.
KAUFMAN: I wanted to refl ect on that question. My other fear on that is
not just representing that doorway, but NOT representing that doorway
well, and then somehow compromising the credibility of pharmacy as a
whole, the pharmacy practice as a whole, and potentially creating confusion
on what is the role of the pharmacist and how are they a participant
in your health care in helping you manage your health? ●
DRUGSTORENEWS.COM FEBRUARY 2012 • 29
Pharmacy Technology Report
Emdeon Pharmacy Services is a leading provider of electronic solutions to the pharmacy industry, offering
comprehensive and innovative solutions for claims management and analysis, e-prescribing clinical
services and simplifi cation of complex billing and processing issues, such as Medicare/Medicaid DME
billing and patient loyalty programs. Emdeon partners with pharmacies and their service partners to simplify and improve end-to-end prescription
processes through the company’s innovative solutions and exceptional service. Emdeon’s expansive service offerings provide customers with the
necessary tools to be competitive, improve patient care, and combat ineffi ciencies and errors that lead to low reimbursement rates.
Emdeon’s solutions, designed to improve pharmacies’ profi tability and effi ciency, include:
• Claims management and analysis
• Audit risk mitigation
• Specialized processing solutions
• Medicare and Medicaid DME billing services
• Electronic prescribing and clinical solutions
• Patient benefi t eligibility services
• Patient persistency, adherence and compliance programs
• Pharmaceutical brand programs
Emdeon’s transaction services, data center solutions and network infrastructure are designed to meet the evolving needs of a complex industry.
Mobilize, empower and connect the healthcare ecosystem. Kony offers feature-rich and future-proof
mobile applications in less time and at lower cost than any other solution to organizations that support and
deliver health care, according to the company. Pharmacies and drug store retailers rely upon Kony apps to help customers locate their store, refi ll
prescriptions, research medications and their costs, schedule a pharmacy consult, manage their health and well-being, investigate health plan
benefi ts, maintain a PHR and shop in an “endless aisle.” This functionality allows pharmacies to put their whole store in customers’ hands, discourages
trips to their competitors, and increases customer retention and loyalty. Kony is ideally positioned to help pharmacies defi ne and deploy an
effective and ROI-based mobile strategy through its comprehensive software and services offerings.
Moonshado is a global technology provider of mobile solutions and platform services, and is a CSCAapproved
connection aggregator for mobile messaging. Moonshado’s innovative cloud technology enables
mobile network providers, SMS resellers and marketing fi rms, as well as retail, health and pharmaceutical companies, to broaden their
reach and expand their services with industry-leading mobile-centric solutions, the company stated. Moonshado’s interactive messaging services
provide a cutting-edge approach to marketing, education and customer experience, enabling companies to align products and services with
mobile-centric interaction via SMS, MMS, QR codes and branded apps on Web and the mobile Web. B2C companies can easily integrate mobile
solutions into their existing plans to connect with consumers across all mobile channels, the company stated. Moonshado generates real-time
messaging to drive customers to action with mobile alerts for product specials, patient education, reward-club statements, seasonal announcements
and more. Moonshado has developed and executed successful mobile campaigns to increase customer loyalty and interaction for clients.
Build viral customer loyalty with your own Facebook and iPhone app. Take your social media strategies
far beyond a simple fan page. Now you can immerse customers in your own branded Facebook and iPhone health-and-wellness app. Numera
Social offers a new way to create deeper ongoing daily relationships with customers, helping them to improve their health while extending the
reach to their family and friends. Numera Social’s social and mobile platform provides merchandising options, compliance benefi ts and many other
opportunities to build health-and-wellness business along the way. Bring a brand to life by offering self-management resources, while enabling
support and motivation from peers and friends. Spark a chain reaction that fuels healthy behavior and customer loyalty.
With more than 20 years as a provider of in-store blood-pressure monitoring
equipment, PharmaSmart International knows how important it is for people to
monitor their circulatory system. The company has been preaching heart health for years, and now is ratcheting up its efforts in both education
and connectivity to meet the needs of a patient base that is more knowledgeable and tech-savvy than ever.
According to PharmaSmart, one-third of all Americans have hypertension; one-third of those who have it don’t know it; and only half of those
with hypertension take their medication as prescribed. When those statistics are coupled with the fact that some of the leading health issues today
stem from poor heart and circulatory health — including obesity, diabetes and stroke — it’s easy to understand why many feel that a commitment
to preventive health should include regular blood-pressure monitoring. It’s no coincidence that the current generation of PharmaSmart kiosks is
built around frequent monitoring and the dissemination of networked results data. Its newest model is the “PS-2000 With Connectivity,” a smallfootprint,
22-inch-by-25-inch kiosk with many of the same features of past models; only this time it has a renewed emphasis on tracking and
sharing results, a holistic approach to monitoring that the company calls its “hypertension management program.”
“As pharmacy looks to MTM reimbursement as a core ROI objective, our technology is designed to specifi cally meet the challenges of patient
recruitment, pharmacist workfl ow and payer reimbursement,” said CEO and president Fred Sarkis.
SoloHealth is a leading consumer-driven healthcare technology company that specializes in developing and
deploying interactive health screening kiosks to empower consumers about their health through awareness and
education, which leads to prevention and lower healthcare costs. Anchored by its award-winning SoloHealth
Station, this next-generation kiosk offers free vision, blood pressure, weight and body mass index screenings, as well as an overall health assessment
and access to a database of local doctors.
Currently in select U.S. test markets and retail locations, SoloHealth is launching a nationwide rollout beginning in early 2012, with thousands of
SoloHealth Stations estimated to be in retail locations by the end of the year. A cloud-based platform, the SoloHealth Station offers highly personalized,
targeted and interactive healthcare opportunities for consumers, advertisers and retailers by placing kiosks in high-traffi c retail locations and
offering access across a multiplatform ecosystem, including Internet, mobile, social and emerging platforms, as well as a digital signage network.
The multiple-platform approach gives advertisers, consumers and medical professionals the ease of interaction from many touch points, allowing
for greater effectiveness and effi ciencies.
The company recently was honored with Intel’s coveted IT healthcare award, the “Intel Innovation Award,” recognizing leading-edge technology
and exceptional innovation for healthcare delivery and processes.
Surveyor Health’s Med Risk Maps is a new generation of evidence-based Clinical Decision
Support (CDS) designed for clinical pharmacists. It enables pharmacists to perform more exhaustive clinical pharmacy and medication
therapy management reviews, yet requires far less time than the current standard of running interaction checkers and reading drug monographs
and inserts. The MTM Workfl ow provides all clinical functions needed, from medication reconciliation and compliance reports through tracking
concerns as they develop into incidents, which are identifi ed as ADEs. CMS reporting is eased as a Medication Action Plan is developed through
the use of Med Risk Maps, and is included with the reconciled Active Medications List in a Summary Report for the patient.
The greater depth and coverage looks at the entire regimen as a whole and includes instant analysis of additive toxicity side effects in addition
to drug interactions and contraindications, together forming a risk landscape that may be searched, sorted and analyzed to the level of detail
desired, reducing alert fatigue while improving insight. Patient complaints are correlated with risks, revealing those likely to be caused by the patient’s
meds and indicating the top risk factors — targets for alternate therapy. A simulation capability reveals alternate medications of lower risk
for patient problems and simulates the impact of prescription changes before trying them out on the patient. A trending function brings attention
to adverse drug events that may manifest with a change of prescription, enabling wise risk and cost trade-offs to be understood and managed.
Med Risk Maps is available as a fully managed cloud service and may be integrated with health information technology, such as dispensing
systems and EHRs.
30 • FEBRUARY 2012 DRUGSTORENEWS.COM DRUGSTORENEWS.COM FEBRUARY 2012 • 31