Rick Gates: The ECAPS Potential for Walgreens

WEBVTT
00:00:05.040 --> 00:00:08.480
Hey everyone, welcome back to the ECAPSWatch podcast.
00:00:08.560 --> 00:00:11.119
I'm Kevin Hoolihan, the CEO at Workflow Services.
00:00:11.279 --> 00:00:14.160
Today, I'm very excited to have Rick Gates join me.
00:00:14.400 --> 00:00:18.960
Rick is the chief pharmacy officer at Walgreens and chairman of the board at NACDS.
00:00:19.120 --> 00:00:23.920
He's been with Walgreens for nearly 31 years, beginning his career as a community pharmacist.
00:00:24.239 --> 00:00:31.920
In his role, Rick focuses on enterprise clinical strategy and expanding payer reimbursed clinical services across the Walgreens pharmacy network.
00:00:32.079 --> 00:00:35.520
And he's passionate about enabling pharmacists to practice at the top of their education.
00:00:37.200 --> 00:00:40.000
Improve outcomes and patient engagement nationwide.
00:00:40.719 --> 00:00:42.240
Rick, thanks so much for joining me today.
00:00:42.399 --> 00:00:43.359
Excited for the conversation.
00:00:46.880 --> 00:00:51.520
And Rick, we really appreciate your partnership and leadership at a high level.
00:00:51.679 --> 00:00:59.039
I'd love to start off with your perspective on where the industry is heading regarding additional clinical services in the pharmacy.
00:00:59.359 --> 00:01:07.200
Yeah, you know, and I think that's a great question because, you know, as you look at where we sit today, a lot of what we're still tied to is really product in stores.
00:01:07.359 --> 00:01:12.159
And I think what we really need to do as a profession is start to fill in the healthcare gaps that we're seeing.
00:01:12.239 --> 00:01:18.879
And that can be in rural markets, that can be with primary care shortages and everything else that we're starting to see across all the communities that we're in.
00:01:19.120 --> 00:01:26.959
There's such an opportunity for us to really let pharmacists step into what they're educated to really serve patients for and serve a bigger need.
00:01:27.120 --> 00:01:30.640
The challenges that we have, though, it comes down to reimbursement and other types of things.
00:01:30.799 --> 00:01:34.239
And I think that's where we'll probably wait into a lot of our conversation, Kevin, today.
00:01:34.319 --> 00:01:37.040
But, you know, I think we're starting to see that uh pan out.
00:01:37.120 --> 00:01:44.239
You know, rural health transformation and what's been announced by the government recently, the administration is a step into really starting to solve for it.
00:01:44.400 --> 00:01:54.480
But we've really got to solve for both state and federal ways that we can get reimbursement for the services that pharmacists can actually provide and the outcomes that they ultimately will get for their patients as well.
00:01:54.959 --> 00:02:07.200
Yeah, so a theme that we've had with a lot of guests on the podcast is although eCAPS passing will open up, you know, arguably the largest payer for a category of services, there are still opportunities today.
00:02:07.280 --> 00:02:11.759
And so one of the things that a lot of our guests have talked about is ECAPS is great.
00:02:11.840 --> 00:02:13.120
You should keep your eye on it.
00:02:13.199 --> 00:02:16.639
Um, we're all optimistic that it's going to happen, but don't wait around.
00:02:17.039 --> 00:02:22.879
Can you talk a little bit about how you're thinking about services today and your sentiment around that?
00:02:23.280 --> 00:02:26.960
How do you think about what to do today versus what to keep your eye on for the future?
00:02:27.360 --> 00:02:39.680
Yeah, you know, what's interesting about it, and I think, you know, we we play the role as a large national player, you know, and so we look at ourselves as a large uh network of independent pharmacies because we are in communities all across America.
00:02:39.919 --> 00:02:44.719
That that's that's a good thing, and it's a challenge when it comes to the services and service expansion.
00:02:44.800 --> 00:02:53.680
And let me explain that because, you know, uh we are in states, and I can actually spin up services based off of state scope of practice or whatever it looks like in that state.
00:02:53.759 --> 00:02:55.360
And I think those are all great things.
00:02:55.520 --> 00:02:59.199
But a lot of times what we have challenges with is our payers that we have are national.
00:02:59.439 --> 00:03:09.039
And so when you look at a payer that's national, I think like in I Healthcare or others, they're trying to look at consistent services for their members as they go state to state.
00:03:09.120 --> 00:03:17.280
And so sometimes it may seem like it makes a lot of sense in a state, but we may limit be limited by payers that we can actually go to and contract for some of those services.
00:03:17.360 --> 00:03:21.840
And so there are some challenges as you look at it, is trying to be consistent in what we do.
00:03:21.919 --> 00:03:26.719
And we want to have a consistent kind of experience for our patients that come into our stores each and every day.
00:03:26.879 --> 00:03:45.280
So, you know, I tie eCamps being important because the more that we can open up a national platform that I can then train at national scale and give a consistent experience for anybody that walks into our Walgreen stores, whether you're in Florida, California, or here in Illinois where I am, that's probably the easiest thing for us to do.
00:03:45.520 --> 00:03:46.639
Doesn't mean we stop, though.
00:03:46.719 --> 00:03:51.919
So I mean, you look at states like Idaho or others, we have to be very thoughtful on, you know, what do we want to do?
00:03:52.000 --> 00:04:03.759
Where do we want to contract, and how do we really think about training and getting the right execution on these services for our patients and making sure it's a good experience, not just for the patient, but also for our team members and our stores.
00:04:04.000 --> 00:04:11.439
What I think is challenging when it comes to some of the states, though, is we have to also think as a profession, how do you contract in those states?
00:04:11.599 --> 00:04:21.519
And so what ECAPS does is it gives a more broad standard by which payment kind of gets tied to a percentage of um physician uh fee schedule, right?
00:04:21.759 --> 00:04:25.199
When you go into states, there's not really a standard that you're going off of.
00:04:25.360 --> 00:04:29.839
And so sometimes you'll end up uh kind of negotiating against other providers.
00:04:29.920 --> 00:04:36.319
And I think that makes it more challenging of saying what's a reasonable uh reimbursement when it comes to services that we're actually providing.
00:04:36.560 --> 00:04:48.560
And so I think there is some challenges when you look at it from a state-based perspective on, you know, uh how's uh pharmacy A uh really negotiating their reimbursement versus us versus somebody else?
00:04:48.720 --> 00:04:55.839
And you kind of get it back into negotiating against yourselves as a profession, which is what has been the challenge when it comes to dispensing and medications as well.
00:04:56.000 --> 00:05:08.000
So I know I kind of said a lot at you there, but I think what's really important to think about, you know, we have to think about an ecosystem and how do we actually think about not only locally within a state, but how that kind of manifests out over the nation.
00:05:08.079 --> 00:05:22.399
And then how do we not kind of shoot ourselves in the foot in the near term by contracting things that probably aren't fair reimbursement until we get to a place where we can actually have a broader discussion of what's fair reimbursement for the profession as a whole from a federal-based perspective.
00:05:22.720 --> 00:05:26.160
So there's a couple big themes in there that I would love to dig into a little bit more.
00:05:26.240 --> 00:05:28.160
The first is the difference from state to state.
00:05:28.319 --> 00:05:31.279
And this is something that we think about all the time, and you're talking about.
00:05:31.439 --> 00:05:37.120
I think what I'm hearing hearing you say though is although it can be different from state to state, that doesn't mean you wait until it's all the same.
00:05:37.279 --> 00:05:37.360
Yeah.
00:05:37.519 --> 00:05:47.120
Because one of the things that we've seen is showing success for one kind of care, uh, for one kind of access to care in one state can help bolster the argument across other states, right?
00:05:47.199 --> 00:05:54.399
And so do what you can where you can, and there's a huge opportunity to impact a lot of uh patients and customers and also evolve a business.
00:05:55.040 --> 00:05:55.759
You agree with that?
00:05:57.040 --> 00:05:57.199
I do.
00:05:57.279 --> 00:06:05.519
I do that the the one nuance I'd put to that is you you have to really understand what consumers are wanting us to serve uh when it comes to some of those solutions.
00:06:05.600 --> 00:06:16.720
And so, said differently, uh if you just launch a bunch of cash pay things in a state, what we've seen historically is patients are assuming that their healthcare services are going to be covered on their insurance.
00:06:16.800 --> 00:06:27.839
And so we have to be very careful on how you either price it or that you go and get the services and it's easy to communicate to consumers so that they're not really trying to understand why they would come to a pharmacy versus not.
00:06:27.920 --> 00:06:39.839
And so I do think leaning in at a state-based level to get expertise and to get uh continuity on what you're doing to expand it nationally for us is actually a very, very uh smart way of doing it.
00:06:40.000 --> 00:06:42.639
Uh, it's just like a big pilot for us if you think about it that way.
00:06:42.800 --> 00:06:51.920
But those are important things for us to do, you know, and I think we do it a lot when it comes to uh state-based health plans, like uh Blue Cross Blue Shield of said state, right?
00:06:52.000 --> 00:06:52.480
Whatever state.
00:06:52.560 --> 00:07:07.759
And so though those are easy to kind of tie into or Medicaid in a state itself, because then you're really tied within the geography of the borders of a state and you can go within your platform in that state itself and then learn to say, how can we actually expand this across other states?
00:07:07.920 --> 00:07:14.560
But, you know, it's hard for us when I look at having 50 different um offerings in 50 different states.
00:07:14.639 --> 00:07:25.600
And so we do try to find where I can do consistent things across maybe 10 states or 15 states, or I have, you know, five to 10 key states that really serve the most of our patients, and those are the ones you'd want to go into.
00:07:25.759 --> 00:07:28.160
So we are always thoughtful on trying to get into those.
00:07:28.399 --> 00:07:37.040
So a Texas, a Florida, an Illinois, California, some of those big states where we can do these things or where we really want to lean in and see what we can do.
00:07:37.360 --> 00:07:37.839
Yeah.
00:07:38.000 --> 00:07:47.920
Um, I always love asking my guests about stories of what you're hearing about the impact that you can have in your customers and patients' life by expanding access to care.
00:07:48.000 --> 00:07:56.560
And sometimes that's formal in terms of services that you might be building under, you know, medical coverage, and other times it's informal and just you know, meeting the patients where they are.
00:07:56.720 --> 00:08:02.319
Have you seen you you have a bunch of different roles that we talked about in the beginning and a pretty exciting range of perspectives?
00:08:02.480 --> 00:08:03.439
What have you seen out there?
00:08:03.519 --> 00:08:06.560
How how can this make a difference in just care delivery in the country?
00:08:06.879 --> 00:08:14.399
Yeah, you know, I I think that's actually where we can have the biggest impact is if you look at all the communities that we're in that they don't have um uh care.
00:08:14.639 --> 00:08:25.519
You know, I I think the stats that that you may have heard me say before, but I think you know, uh I think it's 9% of physicians practice in rural settings where I think it's over 25% of uh Americans actually live there.
00:08:25.600 --> 00:08:33.440
And so you think about the impact or the lack of care that a lot of those uh communities are getting, and I think pharmacy can play a huge part of that.
00:08:33.519 --> 00:08:50.159
And so, you know, I think those are the areas where you think about expansion, testing, test or treat, those types of things, and you hear things where people wouldn't get actual care before, or they would actually end up trying to get into hospitals that are not close to them, and pharmacy can really step forward and solve for it.
00:08:50.240 --> 00:08:55.120
You know, I think when I talk to pharmacists, they're more excited to do care-based programs than ever before.
00:08:55.360 --> 00:09:05.759
And I think when it comes to the simple things, like even getting people on therapy and making sure that they stay on therapy to start with, the simple things that pharmacists should be doing just have huge impact to care.
00:09:05.840 --> 00:09:18.080
And so, you know, how we launch programs now and looking at when somebody starts nudotherapy on something that we know if they stay on the second and third um course of therapy, they are gonna stay on it long term and stay adherent.
00:09:18.320 --> 00:09:27.919
Those stories that you hear from our pharmacists every day, having a phone call, understanding why patients fall off those therapies, and then really saying, you're gonna have a hard time for the first two weeks.
00:09:28.000 --> 00:09:34.480
This is what you're gonna see, but you've got to get through through the 30 days, and then you're gonna actually get uh better adherence from that point forward.
00:09:34.639 --> 00:09:37.039
Those stories I hear all the time when I'm out in stores.
00:09:37.120 --> 00:09:41.440
Uh, I think what we have to do though is enable uh our practitioners to have the time to do that.
00:09:41.519 --> 00:09:50.960
And I think that's the other challenge that we have in the industry as well, is reimbursement makes it challenging from some of those things, but we've got to lean forward and really uh advance care in the ways that we can.
00:09:51.279 --> 00:09:53.679
Well, this is a thing that you and I have talked about before.
00:09:53.759 --> 00:09:55.679
I think uh reimbursement and time.
00:09:55.759 --> 00:10:01.279
You talked about having the time to do these things, are so closely linked and arguably actually the same thing, right?
00:10:01.440 --> 00:10:07.279
Reimbursement offers more opportunity to support the staff that you need to be able to provide these kinds of services.
00:10:07.440 --> 00:10:09.679
And so I think that's part of the reason it's so critical.
00:10:10.000 --> 00:10:18.799
You brought up something a little bit earlier on that I think would be useful to go back to about some of the challenges and potential pitfalls in dealing with contracting um for services.
00:10:19.039 --> 00:10:32.159
It's not something we've talked a lot about on the podcast, but I would be curious on your perspective on your advice to the industry on how to navigate that and make that as smooth as possible as we move forward and expand access to care through pharmacies.
00:10:32.720 --> 00:10:37.919
You know, I just think it goes back to um that there are standards for pricing that comes across.
00:10:38.000 --> 00:10:43.919
And that's what that's where federal reform, I think, helps because it does set a standard by which you can kind of anchor off of.
00:10:44.080 --> 00:11:01.360
I would just say when we look at it uh as we go state to state or even payer to payer, we're we're trying to pin ourselves to uh physician-based reimbursement uh for the services they provide, understanding that we can do it uh a lot of times at scale more broadly and across more patients, and we can do it at a lower cost.
00:11:01.440 --> 00:11:15.200
And we're okay actually saying we'll do a lower cost, but we need to make sure that we're not just pinning random uh values, if you will, into what we'd be willing to accept as a profession going forward without pinning it to something that can be more durable in what we're doing.
00:11:15.279 --> 00:11:25.039
And so, you know, I look at a state like in Idaho that has, you know, broad, you know, you can basically um practice it at what your education is, and as long as you have contracts, you can go and do it.
00:11:25.200 --> 00:11:44.080
My my fear is we have people out there that are contracting on what sounds good today, um, and saying, you know, this this service will take$20 versus something else and not actually pinning it to a fee schedule that we could say as we pivot into a more of a federal-based solution that would actually be uh a durable based reimbursement for us going forward.
00:11:44.240 --> 00:11:49.919
Uh, worst thing that we can do, and we've seen it over time, is you negotiate against yourself each and every year, right?
00:11:50.080 --> 00:12:01.919
And so instead of saying that you're gonna put more investment into driving more and better outcomes, which means your reimbursement should actually get better year over year because you're actually driving more value in an ecosystem.
00:12:02.159 --> 00:12:12.799
What's happened with reimbursement for prescriptions is you're fighting against yourself each and every year to say we're trying to take costs out of the system to uh kind of parallel what you're seeing in reimbursement.
00:12:12.960 --> 00:12:20.000
If we do the same when it comes to services, we're just gonna be negotiating against ourselves each and every year, trying to maintain what we have.
00:12:20.159 --> 00:12:35.919
You've got to really start to pin it to something that you can say will change as time goes forward, we'll be uh recognized as there's more costs that may be into it because you have uh the cost of your infrastructure, you have your cost of your people and your resources and everything else.
00:12:36.159 --> 00:12:38.559
And generally they know that those costs go up every year.
00:12:38.639 --> 00:12:40.879
So your reimbursement should go up every each and every year.
00:12:40.960 --> 00:12:47.279
And that's where I think we just have to be very thoughtful when you're negotiating in the States on how you set that up to be durable going forward.
00:12:47.679 --> 00:12:50.159
And so that's really just a change in mindset, right?
00:12:50.320 --> 00:12:57.919
And this is a mindset that's more about recognizing the pharmacist as a provider in these services rather than dispensing.
00:12:58.080 --> 00:13:05.440
And there's other historical precedents to look against that, but realizing that it's a different kind of business in a lot of ways it's the same.
00:13:05.600 --> 00:13:22.799
And one of the things that we're passionate about is making it simple so that the patient understands that they can come to the pharmacy for these types of care that really make sense at the pharmacy, but then not having to worry about exactly how it works and we can take care of dealing with your medical insurance if there's something that's covered or whatever the case may be.
00:13:23.039 --> 00:13:34.559
Um, but recognizing from the operations of a business that this is a new and different thing, that we want to feel we want to feel consistency for the patient, but it's a different way to look at part of your operations.
00:13:34.879 --> 00:13:35.120
Right.
00:13:35.440 --> 00:13:38.320
And I think it's it's understanding what customers are comfortable with.
00:13:38.399 --> 00:13:44.320
And quite honestly, I think I think COVID changed the game for what consumers will get comfortable with going into pharmacies.
00:13:44.399 --> 00:13:50.000
And it's not that we didn't do things like vaccines and testing before, we didn't do it at the scale that we did during COVID.
00:13:50.080 --> 00:14:00.960
And I think that kind of opened patients' eyes to say, oh, that can be easy, that can be convenient, they can actually care for me in a way that I used to only go to physicians for or in urgent care or wherever, right?
00:14:01.120 --> 00:14:03.919
And so I think that there's a different permission that we have now.
00:14:04.159 --> 00:14:09.279
We just have to really think about how do we open up and continue to lean into the things that consumers are looking for.
00:14:09.360 --> 00:14:13.759
And I think that they're wanting us to help them make it easy for them going forward.
00:14:13.840 --> 00:14:23.519
And then I think once they understand that we can build for that, make it easy for them, uh, create the scheduling ecosystem, whatever it is we're trying to do, I think consumers will actually run towards that more than not.
00:14:23.840 --> 00:14:26.399
Is there something that you've seen that's been surprising?
00:14:26.559 --> 00:14:35.279
Things that consumers have been really um excited to adopt uh in terms of access at a pharmacy that you were surprised by.
00:14:35.519 --> 00:14:42.559
I mean, we all saw the graphs and and the information about vaccine delivery, but you know, eCAPS is around respiratory test to treat.
00:14:42.639 --> 00:14:46.399
What else has been out there that you've seen that is has been kind of shocking?
00:14:46.799 --> 00:14:49.120
You know, I I don't know if there's anything that that's shocking.
00:14:49.200 --> 00:14:51.120
I think sometimes we still hold ourselves back.
00:14:51.279 --> 00:14:58.799
And so when you wade into services that we can provide, it's easier to go to like the the simple test and test and treat and those things.
00:14:58.879 --> 00:14:59.440
And I think they're great.
00:14:59.600 --> 00:15:02.639
And don't get me wrong, I'm not saying it's the wrong thing that we should be doing.
00:15:02.799 --> 00:15:06.799
But but you know, pharmacists are highly trained uh professionals, right?
00:15:06.879 --> 00:15:10.320
If you think about the impact that they can have on diabetes, right?
00:15:10.399 --> 00:15:25.039
And so um when you go into testing of things like A1C and then actual therapy changes that you can actually do with them to keep patients on the right therapy to get their A1C in the right areas, we know that that actually drives down healthcare costs long term.
00:15:25.120 --> 00:15:33.279
And so why we're not leaning forward into uh broader um ecosystems where we can have a bigger impact is where we should be going at the end of the day.
00:15:33.440 --> 00:15:40.399
And so I think it's easier for us to kind of take a step and kind of take a little bit of ground and say and prove out what we can do.
00:15:40.559 --> 00:15:44.720
There's going to be a point at which I don't think there's gonna be enough providers across the country.
00:15:44.799 --> 00:15:52.320
And that's not just pharmacists, that's gonna be nursing, that's gonna be uh primary care physicians that can solve the patient's needs in these highly complex areas.
00:15:52.399 --> 00:16:05.039
And I think we've got to kind of lean forward and get comfortable saying that we can do this and we can prove out that um the therapy monitoring that we can do and therapy changes that we can do really have a huge impact uh for patient care.
00:16:05.440 --> 00:16:18.639
Yeah, and I would say one of the things that's been awesome for us to see is just the um the value that providing preventative, I would call them clinical services to patients through the pharmacy can can really provide.
00:16:18.799 --> 00:16:25.120
I mean, you know, you know, some of the at-home cancer screening stuff that we're doing, changing people's lives, right?
00:16:25.200 --> 00:16:26.480
Like really having an impact.
00:16:26.559 --> 00:16:42.960
And there's just something so special that we continue to see in the data and the experience that we all read in the statistics about the role that the pharmacy plays in the community and meeting the patient where they are and having that important conversation at the right time, just because they're seeing the pharmacist so much more frequently.
00:16:43.120 --> 00:16:59.039
I think there's a bigger scope of the slightly more complex kinds of clinical services, especially in the preventative bucket, that can really change the industry and have huge outcomes for patients, but also that flows down through the insurance companies and businesses and providers and that whole thing.
00:16:59.200 --> 00:17:01.039
So I get really excited about it.
00:17:01.360 --> 00:17:06.079
And I just want to jump on that real quick because I I think you know there's a trust factor.
00:17:06.160 --> 00:17:07.680
And you you kind of used that before.
00:17:07.839 --> 00:17:12.240
And I think it can be from a simple thing we're trying to get somebody to follow through on a test.
00:17:12.319 --> 00:17:15.759
And so thank colorectal screenings are an at home test for that, right?
00:17:15.839 --> 00:17:16.000
Yeah.
00:17:16.160 --> 00:17:29.200
So we've worked with some of our payer partners, and we've actually gone and used our our in-store pharmacist and uh call center pharmacist, and they use their resources to reach out to patients to just to educate them and make them not afraid to do this.
00:17:29.359 --> 00:17:36.720
There are places where pharmacy can lean in and help educate and bring down barriers or uncertainty of care.
00:17:36.880 --> 00:17:40.079
And it kind of really goes across an entire gamut.
00:17:40.240 --> 00:17:44.720
And so we really have to think about where's the most impactful places that pharmacists can kind of play that role.
00:17:44.880 --> 00:17:47.359
And then how do you kind of lean forward and really drive that care?
00:17:47.440 --> 00:17:48.640
And so that's just one example.
00:17:48.720 --> 00:17:53.039
But yeah, it's a simple example where I think it happens more than people understand.
00:17:53.119 --> 00:17:58.400
And I think that's a place where they're a trusted resource, and we we should lean into that more effectively.
00:17:58.720 --> 00:18:00.079
But and we see it in the data.
00:18:00.160 --> 00:18:18.000
We see that when the pharmacy teams are engaged, it it it provides a sense of support and also maybe accountability, and people are uh, you know, can really make an impact on how compliant people are to a bunch of different sorts of things, but in addition, making sure that they do those screenings that they really should be doing.
00:18:18.160 --> 00:18:21.200
So I don't know, there's a bunch of regional things that we see.
00:18:21.359 --> 00:18:30.079
I like to tell the story we have some of our partners that are doing anti-nausea medication prescription because they live in a touristy coastal destination.
00:18:30.240 --> 00:18:35.920
I do think that's a little bit different than what you've been talking about, which is really focus on things that can have a broad appeal.
00:18:36.079 --> 00:18:45.680
That's great for those sorts of pharmacies and those communities, but to really drive the industry forward, I think thinking about those broad things that can really drive outcomes is an important thing.
00:18:46.160 --> 00:18:58.079
Can you share, based on how you're thinking about things in your organization, what would you tell the rest of the industry who may not have quite the footprint you have, or maybe they do, but what would you encourage them to do today?
00:18:58.240 --> 00:19:05.440
Um rather than you know, continuing to watch the eCAPS podcast and talk to your legislator and get them uh that's important.
00:19:05.519 --> 00:19:06.720
Yeah, that's important stuff too.
00:19:06.799 --> 00:19:08.160
Yeah, it's important stuff.
00:19:08.319 --> 00:19:08.640
Yeah.
00:19:08.799 --> 00:19:16.720
Um, what else can you do as a pharmacy in your business today to continue to expand access to care?
00:19:17.039 --> 00:19:20.079
Yeah, yeah, you know, I I think there's a couple of things.
00:19:20.480 --> 00:19:22.720
And and I'll I'll give a couple examples here.
00:19:23.119 --> 00:19:26.960
We've got to speak uh with one voice in in the industry.
00:19:27.039 --> 00:19:38.400
And and why I say that is when we talk with associations in each state, we talk with individual pharmacy, we talk with legislators, we talk uh with uh independence, chains, everything else, right?
00:19:38.480 --> 00:19:50.480
And and the the challenge I think we have is that a lot of times when we go and advocate, we're not as consistent when we advocate uh into state legislatures and or or uh uh from a federal perspective.
00:19:50.640 --> 00:20:03.119
And and what what you see with physicians and we see with nursing is they are hyper-focused, they know exactly what they want, they are consistent at how they do it, and they're not going in asking for different things when they go and talk to their legislators.
00:20:03.279 --> 00:20:06.000
Um, and I don't think we actually do a really good job of that.
00:20:06.079 --> 00:20:18.640
And so I'd say it doesn't matter what size of pharmacy you are, let's just all make sure that we know what we're trying to solve for and that we're consistent in our messaging and we are all going and using the same voice and the same vernacular to try to get things across the line.
00:20:18.880 --> 00:20:24.400
There have been times that that I know that we've gone uh through whether it's any CDS or Walgreens on our own.
00:20:24.559 --> 00:20:32.480
And what we hear is that it could be independents are saying something different or associations are saying something different, or what we're trying to advocate for really isn't gonna help us.
00:20:32.559 --> 00:20:34.400
We think in the way that we want to.
00:20:34.559 --> 00:20:38.079
Um, and it makes it challenging for us to get things across the finish line.
00:20:38.240 --> 00:20:40.000
Um, I always give examples.
00:20:40.240 --> 00:20:48.240
So the example I'll give is uh remember during reform uh back in the day, and uh everyone was like, we got to get during reforms across.
00:20:48.400 --> 00:21:02.160
And you know, what we said is you have to get during reforms, but you also have to have the right uh measures on the back end so that you can actually prove out quality and make sure that you have measures tied to quality outcomes that we could then get paid for appropriately.
00:21:02.319 --> 00:21:13.039
Well, we got during reforms across, and what happened is all the funding that payers went to that had funding for these programs that were forced to do it went away because you didn't have the measures on the back end of it.
00:21:13.119 --> 00:21:15.119
And so we kind of shot ourselves in the foot in that process.
00:21:15.200 --> 00:21:24.640
And so when I look at what we can all do together, it is gonna be let's find those things within a state that we want to expand uh as a profession, right?
00:21:24.799 --> 00:21:30.720
And say what's good for pharmacy and then say if we're all aligned to whatever it is, is it gonna be oral contraceptives?
00:21:30.799 --> 00:21:31.039
I don't know.
00:21:31.119 --> 00:21:32.240
Is it gonna be something different?
00:21:32.559 --> 00:21:35.680
Whatever that is, we should all go and say, let's advocate together.
00:21:35.759 --> 00:21:46.160
And then let's make sure that once we get this across the finish line, that we then all go and work with payers and say, how do we as a profession go back to payers and make sure that we as a profession are reimbursed appropriately?
00:21:46.319 --> 00:21:50.240
And then let us go out and make the best solution for consumers.
00:21:50.319 --> 00:21:56.400
Then you can go back and compete with consumers and say, this is why you should come to us for what the profession can actually do for you.
00:21:56.480 --> 00:21:58.319
And I don't think that's what we're doing, right?
00:21:58.640 --> 00:21:59.759
And if we go back to competing.
00:22:00.160 --> 00:22:07.200
Just on convenience and convening, competing on what we can do for uh a patient and showing outcomes, that's where we win.
00:22:07.359 --> 00:22:16.160
Right now we're competing on just the little uh bits and pieces of how the legislation looks and not making sure that we're driving the profession forward as a whole.
00:22:16.240 --> 00:22:18.880
And I think that's kind of what's holding us back if that if that makes sense.
00:22:18.960 --> 00:22:32.559
And I know I probably went into a little bit of a rabbit hole there, but I I just get I get exhausted by us not just saying let's just drive the profession forward and then let's invest in our platforms and consumers will choose where they want.
00:22:32.640 --> 00:22:34.160
And we all want consumers to have choice.
00:22:34.240 --> 00:22:37.039
And I think that's how pharmacy is going to be best going forward.
00:22:37.359 --> 00:22:37.759
Yeah.
00:22:38.000 --> 00:22:50.480
So one so I think it's really valuable to take a step back and make sure that as an industry and as independent um, you know, participants in that industry focus our folks are focused on the right thing.
00:22:50.720 --> 00:22:52.720
I do a lot of downhill ski coaching.
00:22:52.799 --> 00:22:56.640
I have for since I was in college and my daughter's team and all that sort of thing.
00:22:56.720 --> 00:23:02.319
And one of the things that I've learned in coaching is it's hard to focus on anything other than what you're saying.
00:23:02.480 --> 00:23:06.400
So if you talk about the things you don't want to do, it's hard to not do the things you don't want to do.
00:23:06.480 --> 00:23:08.720
It's really valuable to think about where you want to be.
00:23:08.880 --> 00:23:11.680
Go to you know, go to the place you want to be.
00:23:12.000 --> 00:23:17.839
Can you give a quick summary again of rather than like, let's not get focused on the wrong thing, what is the right thing?
00:23:18.000 --> 00:23:22.880
If you could, if you could choose, if you could wave your magic wand, what is the message that you want right now?
00:23:22.960 --> 00:23:31.759
Which is here's the the direction we all want to be going together, and here's the vision of where we're heading towards that that does make sense that we can have consistency around.
00:23:32.079 --> 00:23:46.559
Well, I I I think it goes back to, you know, uh it seems like where consumers are most uh wanting pharmacy to lean in uh into it's gonna be in the more simple services to make it easier for them to get in the store.
00:23:46.640 --> 00:23:53.759
So I do think testing and test and treat are probably the next natural extension of where we should go um and get consistency across where that is.
00:23:53.839 --> 00:24:04.559
Now, whether that's oral contraceptives or whether that's strep or that's flu or whatever it's gonna be, I think those are those are kind of different flavors of a similar kind of offering that we could put out into consumers.
00:24:04.720 --> 00:24:09.680
And so I do feel like we should be leaning into where consumers are saying they want to go.
00:24:09.839 --> 00:24:22.319
And oh, by the way, you can start to prove outcomes by saying that yes, you might increase utilization as a payer when it comes to more tests being provided, but you're also deflecting urgent care and ER visits down the road.
00:24:22.400 --> 00:24:28.319
So you can start to have a conversation about how that utilization investment is actually deflecting costs down the road.
00:24:28.559 --> 00:24:30.319
Same thing that we did with vaccines, right?
00:24:30.400 --> 00:24:31.440
It's preventative care.
00:24:31.519 --> 00:24:36.400
You're actually keeping people from getting sick so they're not getting all those other costs that are coming down the road.
00:24:36.559 --> 00:24:45.519
So a very similar approach on how we could talk to it from a payer perspective, but it's also what consumers are saying they would actually do when they felt comfortable going into pharmacies to do.
00:24:45.599 --> 00:24:50.559
So I think that's that's the first place that'd be the easiest one for us to really expand into if that if that makes sense.
00:24:50.640 --> 00:24:55.039
So I was trying to simplify something that could be more consistent across what we're doing.
00:24:55.359 --> 00:25:02.559
And one of the things that I am excited about and I really believe is that consumer preference is gonna evolve much more quickly than many people think, right?
00:25:02.720 --> 00:25:07.759
I just really think it's gonna happen um once the offering is there more broadly.
00:25:08.160 --> 00:25:23.039
Any last stories or thoughts that you want to share with the audience about um anything that you're focused on or access to care in pharmacies or the future of the eCAPS legislation or any any uh narratives uh for the listeners and viewers?
00:25:23.519 --> 00:25:26.400
No, I I would just go back to kind of where what I was saying before.
00:25:26.480 --> 00:25:29.920
And I think a lot of it is I think you know, we're we're excited.
00:25:30.079 --> 00:25:34.880
I think, you know, I can speak for NACS, but I'll speak for Walgreens uh in particular, you know.
00:25:34.960 --> 00:25:38.960
Uh yes, we're a national uh brand, uh, you know, but you know, I'm I'm a pharmacist.
00:25:39.039 --> 00:25:42.640
You know, I started my career working in stores in in Phoenix, Arizona.
00:25:42.799 --> 00:25:45.200
My last store that I had was Fountain Hills, Arizona.
00:25:45.279 --> 00:25:47.279
So anybody that's been there, it's a great place, right?
00:25:47.440 --> 00:25:52.319
Um, I knew every customer that walked in, I knew every patient, I knew their grandkids, I knew when they went on vacation.
00:25:52.400 --> 00:25:55.759
Um, I was part of that community, and that's that's why I wanted to be in pharmacy.
00:25:55.839 --> 00:26:00.240
I started as an independent pharmacist uh uh when I when I was in pharmacy school.
00:26:00.319 --> 00:26:05.680
And and to me, I think that there's just a magic to what we can still do as a profession.
00:26:05.839 --> 00:26:08.400
So let's put aside how many stores we have.
00:26:08.559 --> 00:26:10.319
We we all practice in communities.
00:26:10.400 --> 00:26:14.640
And I think as long as we're focused on driving what's most important to that community.
00:26:14.720 --> 00:26:19.920
So your example of anti-nause pills in an area that's there, that that's important for that community.
00:26:20.000 --> 00:26:26.240
And I think the the more that pharmacists can do that are really gonna impact those patients that they're serving, that's where we should be.
00:26:26.319 --> 00:26:33.759
And so, you know, as I look at it going forward, I think that we all want to lock arms and just say, how do we advance the profession itself?
00:26:33.920 --> 00:26:36.400
Everything else is gonna work out if we figure out ways to do that.
00:26:36.480 --> 00:26:43.519
And I think that's what you'll see myself in Walgreens, and I think you'll see NACDS say is let's just make sure we're consistent in what we do.
00:26:43.599 --> 00:26:48.319
And I think there's just so much more that we can do for all of our patients and all the communities that we're in.
00:26:48.640 --> 00:26:49.039
Yeah.
00:26:49.279 --> 00:26:51.119
Well, thanks for the work that you're doing.
00:26:51.200 --> 00:26:54.880
You're doing great work, and it's I think it's benefiting everyone, and we're excited for it.
00:26:54.960 --> 00:26:55.920
So, so keep it up.
00:26:56.079 --> 00:26:56.880
Thank you for that.
00:26:57.039 --> 00:26:58.880
Um, thanks also for being a guest today.
00:26:58.960 --> 00:27:00.480
It was great to have a conversation.
00:27:00.640 --> 00:27:03.519
Um, look forward to to continuing to see what happens.
00:27:03.599 --> 00:27:05.839
I think we're all going to be watching everything that's going on.
00:27:06.000 --> 00:27:09.599
And thanks for pioneering and being out in the communities doing what you're doing.
00:27:10.000 --> 00:27:12.799
Of course, great, great to be with you, Kevin, and uh nice to see you again.
00:27:13.039 --> 00:27:16.559
All right, and to the viewers, we'll see you on the next episode of the ECAPS watch.