DIR Fees, DIR Fees 2024, Retail pharmacies, Pharmacy Growth, Startup Pharmacies

Going the Extra Mile with Long-term Care Featuring Debbie Marcello

In today’s independent pharmacy landscape, it’s crucial that you go beyond filling scripts. Your pharmacy must become the healthcare hub of your community.  

One of the best ways your pharmacy can become the healthcare hub is through community-based services such as at home care! This helps your pharmacy stay proactive to what the community needs and keeps cash-flow positive.  

In today’s episode of The Bottom Line Pharmacy Podcast, we take you beyond prescriptions and sit down with Debbie Marcello to discuss Happier at Home, cash-based revenue sources, and more!  

The Bottom Line Pharmacy Podcast is your regular dose of pharmacy CPA advice to fuel your bottom line, featuring pharmacists, key vendors, and other innovators.

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If you prefer to read this content, the video transcript is below:

Scotty: All right, good morning, everybody. Welcome to another episode of the Sykes Bottom Line Pharmacy Podcast here, and we are happy to have Debbie Marcello. Did I pronounce that correctly? 

Debbie: You absolutely did. Yes. 

Scotty: Nice. All right. With Happier at Home. So, Debbie, thank you for being here on the show today. And, why don’t you tell us a little bit about yourself and Happier at Home and what you guys do.   

Debbie: Thank you so much for inviting me. I love that you’re bringing in so many different resources for the independent pharmacies. So, I am originally a registered nurse. I continue to be, but my focus is really business development, business expansion. That’s where I found my talents lie. In the past, I was a trauma nurse and really love that. I love that excitement. I actually had an experience back in 2007 where my mother at the age of 64 was diagnosed with primary brain cancer, which is a glioblastoma. So, during her six months of her treatment before she passed, we had to have home care come in and my experience and my family’s experience with home care was really awful. Different caregivers coming through the house all the time, not really doing anything, sitting at the couch watching TV. It was really frustrating, especially feeling like we didn’t have any control over what was going on in our home.  So, before my mother even passed, I decided that things needed to change, and that the delivery of care could be improved upon. I started Happier at Home locally. I’m from Rochester, New York. That’s where I’m coming to you from now. And developed our business model to be really focused on the family and the. patient. We also call them clients, so they don’t feel so, just objectified as a patient. I want them to be part of their care plan. So, we, yeah, it’s, and even our caregivers when they go out in the community with our, clients, we don’t have them dressing scrubs so people know that they’re patient that type of thing. So, I developed Happier at Home and really saw that we helped our patients to be able to remain as independent as possible. We kept continuity and caregivers, so always making sure they had the right, the same caregiver involved the family in the care plan to make sure they had the schedule that they felt was necessary, of course, with our professional guidance to make sure they know what we think that they really need. And really working closely with the caregivers who we have a low turnover rate in comparison with the rest of the industry. I saw that we have this really unique business model in comparison to others that I’ve seen out there. So, I decided to turn that into a franchise model and share it with other businesses, so that they could expand into home and community-based services as well. 

Scotty: This area of…is just not going away anytime soon. In fact, it’s growing every day. Can you give us a little, insight into kind of the macro environment here with long term care and what you’re seeing, in terms of the growth in that area, how pharmacies can play a role in that, and so forth? 

Debbie: If you look at the large companies, the large health care organizations, maybe the big box stores, if you search the internet or if you know what’s going on in your own community and you see what’s happening, there are mergers of health care organizations. They’re growing. They’re absorbing other companies, they see the writing on the wall, they know what’s going on, so they are expanding and have this vertical into expanding into home and community-based services. One of the problems for independent community pharmacies. Or smaller health care organizations is that, these large organizations or these conglomerates are just eating everything up. We, as the business owners, need to be proactive because if you’re not being proactive and growing, you are falling behind. And if you’re not scared, you should be. I hate to say it that way, but you really need to, strategize for your growth. So, to me, this means take a look at what the big guys are doing and see what they’re doing. They’re doing exactly what we are suggesting. You would diversify and you expand into home and community-based services. 

Bonnie: Yes. 

Debbie: So being able to have a business model. To have another program for your independent pharmacy to be able to expand helps to improve your chances of survival. It also, with our business model, we have a positive cash flow, if you’re following our processes and procedures. So, definitely making sure you have that source of cash flow, and the source of payment is actually cash. It’s not insurance company based. 

Bonnie: And we love to hear that. 

Debbie: Yeah, it chills go up your spine when you say, “oh, got to submit to the insurance company…” 

Bonnie: And it’s such a hit on cash flow, I think also looking at some of these bigger boxes and seeing what they don’t do well is also an opportunity to turn that around and do much better in your store. So, something like this. 

Debbie: Yeah.   

Bonnie: Something like this where that, individual touch and that care and just going an extra mile to offer something to, your patients, or your clients, that, nobody’s going to walk around the desk at a big box and say, “hey, have you thought about doing this? Or this is an option, or you should, reach out to Debbie for this situation.” Nobody’s going to do that there. So, sometimes these things may not generate major revenue for you, but they can in other ways, but offering something that, like a big box store would never do is just… 

Debbie: Well, and making the point of coming out behind from behind the desk, your community pharmacies have that relationship and that reputation, sometimes generational with, the community and pharmacy together the customers come in and have those conversations with, maybe the staff could be the pharmacist “hey, my mom is doing really poorly, unfortunately”, or the people at the desk notice that someone else is picking up medications for them. So, you have those conversations and instead of referring out home care to other companies, you’re able to keep that revenue under your own roof.  You have a trusted reputation, so they naturally are going to feel that they want to go with you anyways.   

Bonnie: The other thing That’s just so huge with our independents, is to offer, it’s just beyond scripts at this point. We have to move to a point where we, yes, we have to fill the scripts, and that’s important, but we have to do many other things, for revenue. 

Debbie: And if you think about it, if you start a business where you’re providing home care and I’m not talking about scaled nursing care, I’m talking about things like light housekeeping. Meal planning and preparation, maybe helping them in the shower, so… 

Bonnie: Medications. 

Debbie: Yes, medication reminders, care management, like advocacy, if you’re providing those and you’re, building a patient base in the home, you have this whole…excuse me source of customers that you could expand your long-term care or your medical at home base with through your pharmacy That the revenue…excuse me…*coffee break*…my throat just got a little dry there…and maybe my body just needed the coffee. 

Scotty: It’s a little early in the morning. 

Bonnie: It is early. Take a hit. 

Debbie: Yeah. So, you know that the revenue for those medical at home patients is higher than providing prescriptions to those that are walking into your store. Looking at, the trends in the industry, you need to definitely be able to diversify and expand. So, if you have this medical base or patient base in their homes, as you said, Bonnie, you can look at your different programs. Are you doing, you could do point of care testing to those patients, you could offer home immunizations. There are so many things then you could do free home evaluations to offer what durable medical equipment that they may need through your pharmacy. And this business model is not limited just to retail pharmacies. We have very, as a matter of fact, my most successful, Happier at Home franchisee is a long-term care pharmacy,  based in New York. It works because you have these different connections with the healthcare profession and arena, which, that’s another point, you have these connections made with the healthcare professionals already and let’s say, for example, physicians that are referring to you or if you’re servicing long term care facilities, transitional care, what happens when their patients are being discharged from rehab?  They want to make sure that they have a very safe discharge home, so they don’t bounce right back into the hospital and cause them to lose more money. So, knowing that they could refer to, someone or a company that they have a trusted relationship with already and they know that you haven’t let them down as that pharmacy owner to be able to then refer to you to provide that home care for the safe discharge home would be a natural transition for them. 

Scotty: Yeah, and I like what you mentioned because there is just a whole bunch of opportunity with, in this area. There’s a lot of need in this area. There’s a lot of opportunity for a pharmacy owner in this area and people are willing to do what it takes for their loved ones as well. If they need the services, they’re going to help pay they’re going to find a way to pay for it to help their loved ones. How does this if a pharmacy is doing a long-term care setting, medical at home, how does this area that you have fit into that. Is this a, a pharmacy has this also as a separate entity LLC that services those patients in addition to the medical at home, long term care setting is that…? 

Debbie: Yes. Yes. It’s set up as a separate entity. And, of course, they would speak with their trusted advisors, such as your company, to make sure they know what the best structure for them is. I’d have to say all of our franchisees right now are set up as LLCs but that is their choice. That’s what is best for them. And it, does have to be a separate entity, but what we do is make sure that even though you’re separate entities and a lot of that is having to do with HIPAA, licensure, just so many different reasons. You want to keep it as a separate business but we like to make sure that we are connecting the pharmacy with you’re Happier at Home company. So, our marketing department they make sure they’re placing your pharmacy with a link on our websites, anything we could do to also promote your pharmacy without any problems that is a no brainer for us because we want your pharmacy to be, successful,  Happier at Home in itself, freestanding for our independent pharmacy owners makes good money, if you follow the processes and the procedures. We have a business coach that meets with you even before you start training. So, we want to make sure you’re successful because if you’re successful, then we’re successful, of course. 

Bonnie: Right. 

Debbie: Yeah. 

Scotty: So, what’s a good market for the franchise? Is this a rural setting? A lot of pharmacies are in a rural setting. I don’t know if that’s a the right market for this, or is this more of a more populated area where this is, can be more successful or not? So, what’s the marketplace for pharmacy? 

Debbie: I’m so glad you brought that up because people bring that concern up. And the other concern that they bring up is, I don’t think my customers are going to want to private pay.  So, in regard to the demographics or the setting of where to have a business like this, we have businesses like this in metro areas. We have in the rural areas, but the important thing is that when we’re doing our discovery process with you, we look at the demographics. So, we want to make sure that we’re giving you territory that’s protected. No other Happier at Home company can come in there. We give you a territory that’s at least 300,000 in general population and we also look at the senior population and we look at what the average household income is. So, we just make, we look at those numbers to make sure, even if it’s going to be large geographically, that it’s going to support private pay business in your area. So, some territories might be geographically smaller, and some may be very large but if they’re very large in rural areas, we know how to market to those areas too. So, it’s all part of our training and support that we provide too. 

Bonnie: That’s really smart and glad to hear that. That’s kind of part of that’s the same when people are looking to open or purchase pharmacies is that demographic information is very important. So, it’s awesome that you do that before just getting going and not work out. So yeah, doing your homework for sure. 

Debbie: Yeah, definitely. 

Scotty: Yeah, it’s just like a start up pharmacy, and you need to know the marketplace and everything. Right. Yeah.   

Bonnie: Yeah! Make sure it makes sense. Yeah. 

Debbie: Right. And as far as people feeling some people aren’t going to want to pay, there are going to be people who don’t want to pay, but that when they’re faced with a choice of am I going to go into a nursing home or assisted living, or do I want to stay home and what is the cost, difference between them where I know it varies across the country with, long term care is skilled nursing home but right now, it’s $18,000 to $20,000 a month….You’re not going to have to pay that to stay home, even to have a one-on-one caregiver, in your home, 24 hours a day, seven days a week. So, it does save them money. They want to be in their home and you could start off with shorter shifts and as their needs increase, then those shifts… 

Bonnie: Make those adjustments. 

Debbie: Can increase too. Yeah. 

Bonnie: And I had a pharmacist that told me one time and I’ve never forgotten it. It’s been a couple of years ago he works in a very affluent area. And we were discussing the products that he offers versus what some do not, because that, that belief that people won’t pay for certain things, but he had explained to me that he doesn’t really believe that because he sees time after time that people will come in and purchase things that are very expensive and maybe they really can’t afford it or it’s very tight for them, but if they find that it works for them and it helps them, they will, and they’ll keep coming back  because, and the same thing here, I think if it, like you mentioned, you can’t just assume that someone maybe would not pay for something if it’s, maybe the cost isn’t that different or like you said, if they really want, they care for a loved one and they want to make sure that they stay home. It’s very important to them. They may find a way to make it work so. 

Scotty: We’re talking about peoples health and well being here.  

Bonnie: Right.  

Scotty: People are willing to… 

Bonnie: Do what they gotta do… 

Scotty: Open the pocketbook to stay at home vs. Stay at a nursing home.  

Debbie: A lot of people save for their whole life for that. 

Scotty: It’s a different mindset when talking about paying for health and being versus going out to dinner or something. So it’s…can’t be fooled by that. 

Debbie: And I understand that I saw it with my own grandfather. He was, he immigrated here. He was a tailor and he didn’t spend a dime, but you talk about the millionaire next door. There are a lot of elderly people out there like that they save and save and if they need it, then it’s there. The other thing is that even though, we are a cash-based source of revenue, there are other ways that we connect them with different resources. The Alzheimer’s Association sometimes has scholarships that will pay for our care… 

Bonnie: Grants and things. 

Debbie: Or yes, there’s a veteran’s aid and attendance benefit that a lot of people don’t know about that if they qualify, then this will pay for their care and the surviving spouse of a qualifying veteran as well for long term care insurance which it has that term insurance on it, but I love long term care insurance. It’s great when someone says they have a long-term care insurance policy. All we do is help them file that claim and, hopefully it’s approved, and we move on from there and that really helps them to be able to pay for services like this in their home.   

Bonnie: Right.  

Scotty: We met at, Debbie, we met at the, NCPA conference, we were on the panel together with RxSafe talking about long term care and, that was a good panel. It’s, hard…There was about, what, six of us on the panel? So, it’s hard to talk about anything for 30 seconds when it’s your turn to talk. But no the, automation is a key part to long term care, especially in a pharmacy setting. But…I don’t know where I’m going with this, but you’re… 

Debbie: I think that you are going to make a great point in that, connecting… 

Scotty: Sometimes I just ramble. 

Debbie: With RxSafe or if you’re doing compliance packaging, it’s nice because yes, those medications can be delivered to the home, but then what happens when they’re there if the person has a memory problem or  they just don’t feel like taking them,  then having a caregiver in the home and being able to close the gap there and earning money from it, too. You’re helping to improve that quality of care of your patient, increase the medication compliance, which we all know is one of the main problems in our country then having that resource of having a caregiver in the home helps to work hand in hand with a company like RxSafe. 

Bonnie: Debbie, one of the things that we do at the end of our podcast is we do what we call our bottom line,  just the summary or final closing point from each of us from what we’ve gathered and talked about today because I’m already talking, I’m just going to go first, if that’s okay with the group. 

Scotty: You always go first. 

Bonnie: I always go first. I don’t want anybody to take mine. But I think it was before we even started recording today, you mentioned the benefit, or we were discussing the benefit of something like this, just adds to the independent having to be this hub for our patients, or clients, it’s just another item or service that can be offered to people who walk in and doing anything you can to diversify, go that extra mile for your patients,  offering something like this when you see that it makes sense. No different than when  we talk all the time about pharmacists, they fill a script and at a big box they would just fill a script and hand it to you, you pay for it, you walk out. Independents a lot of times they see that, “oh, you’ve got this script that’s probably gonna upset your stomach. You probably should grab this and that from OTC that go ahead and prepare them for that and help them with that.” And again, that’s just a little extra something there to care for that patient and to look out for them. So, this would be no different. Just another aspect of something when you see. As a pharmacist that someone may be going through something similar to this to offer that and be that hub for, extra information and helpfulness that you can do. 

Scotty: That might be the longest bottom line we’ve ever heard. A record. 

Bonnie: But it was a good one.  

Scotty: It was a good one. It was a good one. 

Bonnie: We can make a whole podcast of it. And, when we do some editing, we can maybe use it for a two minute clip. 

Debbie: That’s right. Turn it into a post. And you know what though, honestly, pharmacists don’t give themselves enough credit sometimes that you have so much that you could bring to everyone, just not selling just prescriptions. There’s so much that they could do and be that hub for the community. 

Scotty: Oh, that’s a great one on there. 

Bonnie: Yes. She did the same thing I did, but it was just way shorter.   

Scotty: No, my bottom line is you have some pharmacies putting nurse practitioners in their pharmacies. This is the other end of that, servicing the long-term care patient, beyond just the prescription side and,  it’s just another area, another angle of, services out there. Something to keep in mind for those pharmacies that have the right marketplace and demographics for this. Debbie, we certainly appreciate you getting on and sharing the story and sharing your insights with us and with the audience and…  

Bonnie: It was very interesting 

Scotty: Hope to see you out on a trade show, in the coming year. 

Debbie: Yeah. I hope to see you guys very soon. Thank you so much. I really appreciate you inviting me on. 

Bonnie: We appreciate you. Thank you, Debbie. 

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