Pharmacy in the Home (PIH) – Designing Your Future Direction

This is a project that has finally gained traction with community pharmacy leadership.
As a reference exercise, i2P plans to condense its knowledge of PIH projects and deliver this content to readers, spread over a number of articles.
The necessity of the project is self evident when you consider age demographics of the Australian population.
A young age demographic is a more mobile metric while an ageing population is a less agile demographic.
With the former, patients tend to travel to your location, while with the latter, you have to outreach and service the patient in their home.

Reducing the demographics to marketing opportunities you would quickly realise that the young demographic is strongly attached to the 0-5 age group (baby care and maternity needs market) while the ageing demographic has a strong association with chronic illness with a more intense use of medications concentrated in the last decade of lifespan.
Medication delivery can be utilised to access other products and services that reflect the needs of a longer-living patient, enabling them to receive aged care in the comfort of their own home.
Both of these demographics have long been important markets for community pharmacies, so it is extremely important for the needs of these two groups to be attended to, because they are the key to long-term business survival through maintenance of market share.
Building on what already exists in the pharmacy is the direction to take.

The young demographic now has an increased need for an outreach service, given the fact that people have restrictions placed on their working day, compared say, to their parents or grandparents era (transport to distant work locations, long or inconvenient working hours, childcare management) have converted a significant segment of this younger demographic to a time-poor lifestyle.

Thus, a service to the home is fast becoming a valued one for a wide and expanding group of consumers.

Community pharmacy has long had a minimal outreach service in the form of medicine delivery services, prescription alerts by SMS messaging, consultant pharmacist medication management services, and telephone consultations).
The logical process to establish a PIH system would be simply identify those community pharmacies providing some or all of the outreach services noted and identify best practice for each service segment.

Then identify how additional services can be value-added to the basic offering in a cost-efficient manner. The most obvious choices are the delivery of health literacy consultations, the remote delivery of health seminars and the remote delivery of clinical programs built around chronic illness or public health issues.
And there is also room for a time-poor or housebound consumer to access retail consumer products that can be integrated into a convenient system format, online or by personal telephone contact, email or even snail mail.

The basic segments of a PIH program include:

1. an efficient communications system;

2. an efficient logistics system;

3. a quality clinical services system;

4. a sophisticated marketing system;

5. a metrics system that measures output quality and patient satisfaction;

6. a research system that continually investigates all aspects of development and design of new and existing products and services, including testing by pilot study;

7. planned appropriate infrastructure investment reviewed and updated every three years (or a different cycle appropriate to needs, if necessary).

For this article, points 7 and 2 will be discussed.

Because a PIH program has a large percentage of its workflows external to the pharmacy, it needs to be structured as a separate business.
And because the investment that will ultimately be required may impact on the pharmacy budget, consideration should be given to whether this service entity should be a shared one, even between competing pharmacies.
Ideally, the service structure should be shared by all pharmacies in a clearly defined region.
While a private company structure might suit a small number of participating pharmacies, a cooperative corporate structure has proven in the past as being a more ideal structure for the long-term protection of pharmacist shareholder aspirations.

We have examples in recent history of major cooperative wholesalers providing a strong and appropriate service over a long period of time.
Then we saw them demutualise and customer focus diminished, in some instances with decisions adverse to the majority of their customer’s wishes.
There is a lesson here, in that perhaps the cooperative structure needs to be retained for a PIH service, despite any shortfalls that might arise within that style of infrastructure.

That will not prevent other independently owned companies from setting up with a service that might be economical for some of the capital-intensive types of investment.
The DHL logistics service, already a disruptive force in pharmaceutical products distribution, could be a contender, as you will see illustrated further along this article.
So might the existing pharmaceutical wholesalers, utilising their franchised  marketing entities as their infrastructure format.
i2P believes that because PIH programs connect directly to your personal patients and customers, this channel needs strong protection.
Otherwise, if control devolves to an independent company there is a potential to disrupt your business.
Given that pharmacy ownership rules are going to be tested vigorously over the existing business-cycle of the pharmaceutical industry, tight control of infrastructure will avoid or oppose disruptive threats.
As capital is often involved in disruptive competition, a shared cooperative corporate structure owned by pharmacists, will maintain a stronger financial focus and stability.

Another consideration of a PIH program involves the actual location of the pharmacy “bricks and mortar premises.
Location of future pharmacy premises providing PIH services may not need to locate in expensive areas such as shopping malls and regional centres because these types of premises rely on attracting mobile consumers.
The market is rapidly changing direction where you must go to your own consumers directly.
Therefore, cheaper main street premises will become more appropriate for the PIH-type operators and with a lesser investment required to cover rental, this releases the capital required to develop the PIH program.
Note that this is the type of location that Chemist Warehouse already operates from and that they are already piloting drone services.
While their thinking may still be rooted in discounted products, it is a business model that can’t survive in that mode forever.
However with their current version of infrastructure development, it does give them the opportunity to become disruptive in the provision of clinical services, which I am sure they will consider as they seek ways to offset their investment into drone logistics.
It also increases their value for a potential global pharmacy conglomerate to pitch a takeover offer at some future time.

Logistics involving the “last mile” of delivery might prove to be one of the more expensive inputs to the PIH program, in the form of:

* high performance drones;

* economical forms of road transport equipped with cold chain facilities;

* “Uber” style push bikes;

* Australia Post and external courier services.

It is possible that all of these delivery formats will be utilised with drone delivery beginning to look like a “front runner”, as various types of businesses begin to test their capability and logistics abilities
Chemist Warehouse has recently been involved in a pilot study titled “Project Wing”.
Project Wing is being developed by Google’s research arm titled Department X.

i2P will also be looking at the type of new markets that could assist in offsetting the investment and running costs of going down the drone pathway – which seems to be inevitable.

Image result for project wing australia

Based in Bonython in the ACT , Project Wing is testing the delivery of food and medication to homes through the use of drones, as part of an expansion of trials conducted in Royalla.
Drones have demonstrated they can deliver items to backyards in the suburb using winches, while hovering at five metres from the ground.

While Project Wing is only testing in Bonython at this stage, it’s set to expand into other Tuggeranong suburbs in the future.
Some concerns were expressed by local residents worried about the noise potential and their personal safety.
However, using a Project Wing drone, propelled by two horizontal and 12 vertical engines in a mish-mash of helicopter and aeroplane design, the tiny machines have successfully delivered food items and pharmaceuticals up to 10 kilometres away and cut delivery times by making a bee-line for their destinations.

As demand for commercial drone services continues to grow, Google has developed a software system  that will automate the support and management of drone flights.
Wing’s UTM platform is designed to support the growing drone industry by enabling a high volume of drones to share the skies and fly safely over people, around terrain and buildings, and near airports.
Google are working with the Federal Aviation Administration (FAA) on the Low Altitude Authorization and Notification Capability (LAANC) system in the United States and with the Civil Aviation Safety Authority (CASA) in Australia to develop federated, industry-led solutions to safely integrate and manage drones in low-altitude airspace. This collaboration is essential not only for drone operations but also for advancing safety protocols that can benefit those pursuing Private Pilot Jobs, like the ones at Biz Jet Jobs, by ensuring a well-regulated and orderly airspace. As airspace management improves, it opens up more opportunities for aspiring pilots to operate safely and efficiently within increasingly complex environments.
The UTM platform can safely manage complex flight paths of multiple drones.
This enables drone operators to perform different types of operations simultaneously, such as package delivery, aerial photography, and search and rescue operations.
The UTM platform also helps drone operators monitor flights by providing real-time alerts for unexpected behavior or hazards.
A “manage-by-exception” approach enables operators to safely handle larger scale and more complex operations.

There is another major contender entering into the Australian pharmacy logistics market.
In fact they are the well-known company DHL, who have already been involved in disrupting the Australian pharmaceutical wholesaling system.
They have been piloting a drone system over long distances in Africa.
They have called it Parcelcopter.
The pilot study was designed conceptually as a rapid response system from the air with medicines successfully delivered in a remote area of East Africa.

Revolutionising the delivery of medicines to remote areas using drones the pilot project proved that it’s not just science fiction.
Three experts in their respective fields made it happen: DHL, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH on behalf of the German Federal Ministry for Economic Cooperation and Development (BMZ) and the German drone manufacturer Wingcopter.
Over a six-month period, they successfully tested the delivery of medicines using a drone to an island in Lake Victoria.
During the trials, the autonomous DHL Parcelcopter 4.0 completed the 60 km flight from the mainland to the island in 40 minutes on average.
A total of 2,200 km were flown and roughly 2,000 flight minutes recorded during the pilot project.

The drone thus opens up new opportunities to address the logistic challenges in the public health sector in many parts of Africa, especially supplying hospitals and pharmacies.
Medical care for the roughly 400,000 residents of the Ukerewe island district of Lake Victoria, for instance, is severely limited.
This is partly due to the poor infrastructure and difficult terrain.
Six hours are needed to cover the overland route of 240 km.
That makes it nearly impossible to provide emergency medication or to quickly refill cool chain commodities that are out of stock.

A key feature is that the DHL Parcelcopter 4.0 barely needs any infrastructure as it takes off and lands vertically.
After delivering its cargo, it can easily be loaded with blood and laboratory samples to take back to the mainland.
In future, the Parcelcopter could therefore not only improve logistics in the public health sector: it has the potential to help prevent crises worldwide, for example allowing an early response to slow the spread of viral diseases like Ebola.

DHL is a global enterprise that provides logistics solutions.
Pharmacy logistics is a particular interest for them and while they are concentrating on heavier loads compared to Google, they are well positioned within Australia to compete for smaller, more frequent payloads for Pharmacy in the Home (PIH) business.
Their potential for disruption of the pharmaceutical wholesaler can be extended to the community pharmacy by creating a future pressure (with other global contenders) through partnering with major global pharmacy groups, or actually owning pharmacies in their own right, should Australian ownership rules buckle under pressure to disrupt and change.
Strong leaders who are prepared to fight for their constituents are needed more than ever.
Unfortunately, they are in short supply.

More on PIH operations in future editions of i2P will appear to assist those community pharmacists  wishing to develop a program before 2025.

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