The Australian College of Pharmacy recently held a conference in Hobart.
Within the conference structure was a panel of Pharmacy Guild personalities who fielded questions on the future of HMR’s and RMMR’s and what restrictions may be in place within the 6CPA.
The general consensus appeared to be that:
“It was highly likely that the government would insist on keeping caps on professional services such as HMRs and RMMRs.”
Disappointment is the only word that can be used to describe the potential demise of one of the more useful professional services to emerge from community pharmacy over the last decade, but understandable because of the conflict of interest position the PGA has taken since the inception of consultant pharmacy.
On the one hand it set out to control the consultant pharmacists as a group and on the other, competing to concentrate every dollar of HMR income in the hands of pharmacies over that of the consultants.
The PGA position can only be described as deliberate, dishonest and devious in the extreme.
Some years earlier when the concept of consultant pharmacists was being developed, the PGA did everything it could to destabilise any attempt to have a truly representative consultant governing body by using its sole negotiator powers with government to form an organisation that would never deliver for consultant pharmacists.
By definition a consultant is an independent person who can act on behalf of a client and in their best interests.
They have identified clients and take ownership of them.
They form up into representative groups that deliver services with economies of scale to their members and represent their interests politically.
The hijacking of a consultant pharmacist governing body by the PGA (plus a token partner in the PSA), the PGA has been in a position to influence ownership of the income generated by consultant pharmacists.
A blatant conflict of interest position indeed!
The best thing that could happen is for the PGA to back out of the consultant political structure while simultaneously agreeing to a separate negotiating process with government for consultants that has no PGA component (unless by invitation), and to do this immediately with goodwill, and no political tricks.
By not properly being in support of consultant pharmacists, the PGA has stunted growth.
There has been no proper investment or development in clinical services (particularly primary health care services) and specialist staff (clinical pharmacists and clinical assistants) because again of the PGA.
After more than a decade consultant pharmacists have basically one service on offer, and that is being competed against by another PGA initiative – the Medscheck!
Medschecks are in no way a quality equivalent to HMR’s, but they do divert government payments away from HMR’s.
Income, and the future income that could have happened with an unfettered consultancy initiative, is not being realised and has little chance of reaching any sort of a potential because it relies basically on employee pharmacists to implement.
The pressure and “churn” applied by the “factory-pharm” assembly line mentality means that these types of services will only flourish for a short period of time.
i2P has pointed out earlier that OTC pharmacy markets will be at risk as supermarkets begin to provide the “information factor” – the missing link to create consumer confidence in medicinal sales from supermarkets.
Instead of investing in an appropriate workforce and encouraging a diversity of specialist contractors, we are seeing declining inputs into suitable training.
Suitable means an emphasis on evidence-based wellness.
But there is a real down-side for the PGA and community pharmacies.
From this point onwards, pharmacies will begin to disappear because of their inabilty to compete professionally and as a result, PGA membership will also go into sharp decline.
Because consultant/clinical pharmacists have been unable to provide alliance relationships with pharmacies, those that succeed in forming up into a business structure will not be contenders for PGA membership and their skills will be on the open market for what the market will bear.
The following discusses a US large pharmacy (supermarket style) paralelled by food supermarkets (owning pharmacies).
Competition will shortly be arriving in the following format:
“Have a Rite Aid in your neighbourhood? Exciting news: you may now be able to find a Health Coach next to the prescription drop-off!
People today are alarmingly dependent on prescription drugs to maintain their baseline health. Some new initiatives to combat this issue come from the unlikeliest of places: the very pharmacies where people go to fill their prescriptions!
With the healthcare system in crisis, a shortage of primary care physicians, insurance companies looking to cut costs, and a nation riddled with health issues, big retail pharmacies are adapting the model they use to help patients. The core of the new model relies on employing teams of highly-trained health professionals who can provide ongoing assistance, personalized care, and preventative wellness counselling for patients.
If the description above sounds like a Health Coach to you, you’re not alone. Rite Aid has begun hiring Health Coaches to employ in stores, while Walgreens is looking for what it calls “health guides” and CVS has begun to employ nurse practitioners. It’s all part of a larger shift that signals the healthcare industry recognizing that there’s a massive gap in the current doctor-patient dynamic.
The goal of these new programs is to help fill this gap by helping these pharmacy chains become a place where patients can go for chronic or minor health issues that might otherwise take them to the doctor’s office. As Rite Aid said in their official press release announcing the new Health Coaching services, their coaches will provide support to individuals with chronic conditions and “work with the physician and patient on an ongoing basis to improve the patient’s overall health and self-management abilities.”
For Health Coaches looking to find a way into the healthcare system and tackle a nationwide issue from the inside out, this could be a very interesting and promising path to explore.
While the above initiative is being developed by large pharmacy groups, the major food supermarkets are also developing similar initiatives.
The health coaches will not necessarily be pharmacists – but sales assistants completing certificate course training from educational facilities owned by supermarkets.
Nurses have already been employed for in–house clinics and this process will have an effect on the number of pharmacists employed as well as the payment per pharmacist, given that the largest number of health coaches will not be pharmacists (or nurses).
For example, were you aware that Woolworths is an accredited educator and can be self-sufficient in this activity?
But the big players will be health insurance providers such as BUPA who are already players in this space, and they will be driving costs downwards, particularly salaries and wages.
You can envisage the pressure that will begin to build from this point on in respect of Australian Pharmacy ownership.
While the Australian health system is performing moderately well compare to the rest of the world, there are still many gaps to be filled, particularly in primary health care.
If Australian health care costs continue to rise, they will reach a point where the major payment organisations (government, major insurers, health funds etc) will coalesce and override any existing health models (such as pharmacies owned only by pharmacists) and a new model put in place – no matter what was politically promised.
And we can thank the PGA for the disruption to consultant pharmacists that we will not have a competitive professional services structure in place that represents quality and diversity.
Their partner in crime, PSA, the other shareholder in the Australian Association of Consultant Pharmacists – when will they ever wake up and be proactive?
Just as we have seen the Australian PBS commoditised and stripped down so that it provides little incentive to value-add by pharmacists, so has the pathway been established for all of health to undergo similar stresses.
Commoditisation as seen by health professionals is expected by consumers. They simply see it as a means to reduce health costs in the 21st century. They want more convenience and less cost.
Pharmacies and pharmacists will be one of the first to feel these effects (it already has through the PBS), individual pharmacists through becoming specialists in delivering primary health care will have a unique advantage and be competitive to nurses.
The future employer of pharmacists may well be Colesworth here in Australia, as they may only pursue health that can be retailed.
PBS, to Colesworth, may already be deemed as unprofitable and may be left to those pharmacies who wish to pursue profitless prosperity.
So why will the future Colesworth’s want to own pharmacies?
Certainly not for the dispensing service.
And because a gap has opened up in health services created by greedy medical and pharmacy practitioners, we will now have to deal with health coaches in a broader sense.
It is my belief they will devalue health service provision through providing a lesser-trained workforce at a lower hourly rate.
And this market may be inflicted on any new graduate willing on one hand to work for experience, but work in a poorer quality environment. Colesworth may end up being the largest employer of pharmacists and the future value of pharmacies will decline rapidly under circumstances that may be a disadvantage.
Who will want to support location rules when your services component is concentrated with other shopping formats for customer convenience?
Maybe the rules should be let go now so that a modest adjustment can occur without too much financial damage.
What is a Health Coach?
A Health Coach is a wellness authority and supportive mentor who motivates individuals to cultivate positive health choices. Health Coaches educate and support clients to achieve their health goals through lifestyle and behavior adjustments. Proper health coach training programs and health coach certification ensure that Health Coaches know how to work with diverse groups of people and equips them with the tools necessary to best fit the needs of their clients.
“The primary objectives of health coaching are to educate the patient regarding self health management and to encourage patients in taking a more proactive role in staying healthy.”-Medical Economics, Nov 2010
As more and more awareness is given to preventative care, health coaching is seen as a vital aspect of creating healthy lifestyle changes. Health Coaches are becoming recognized as essential and integral parts of people’s health and wellbeing. Not only is there a shift to live healthier lives, people are finding that helping others become healthier makes their lives better too.
The above health coach definition is part of the job specification of both a pharmacist and a GP.
GP’s think they are the only health professionals that can head up primary care.
Yes, they are trained to do it, but their way is always at a maximum cost.
And pharmacists in primary health care – those invisible people never mentioned in any public health initiative or doctor led primary health care initiative – we don’t know what their costs could be because the model is not developed as yet.
I suspect they would be acceptable but not necessarily the lowest.