The Bottom Line Pharmacy Podcast: Elevate and Collaborate Featuring Amina Abubakar, PharmD, CEO of Avant Pharmacy and Wellness Center

Pharmacy Owners…It’s time to elevate your pharmacy and reimagine clinical care with the power of collaboration.  

In this episode of The Bottom Line Pharmacy Podcast, Scotty Sykes, CPA, CFP and Bonnie Bond, CPA sit down with Amina Abubakar, PharmD, Founder and CEO of Avant Pharmacy and Wellness Center to discuss:  

• Expanding Services Through Collaborative Clinical Care 
• Gaining and Building Trust with Local Providers 
• Improving Patient Outcomes 

And More!  

Join the discussion with us! 

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More resources about this topic:  

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Series – Master The Margin 

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

Scotty Sykes, CPA, CFP®: Thanks Amina for getting on. I know we’ve tried to get you on, you know, a while now. So, when we get you on, I’m late. So, I apologize for that. But we’re glad to have you on the podcast. You know, you are a superstar in the industry. We go long, we go way back Amina. When I had first started getting into pharmacy years ago, you were one of the first ones I remember working with to some degree out there in mutual days, the mutual days back then. Seeing you at the mutual conference, I believe it was back in late 2000, early 2010, somewhere around there. And then to see you grow to where you are today, the leader you are today in the industry, the pioneer you are in the industry is just really cool to see and witness. And a fellow North Carolinian here, so we’re just glad to have you on and look forward to a good conversation with you. 

Amina Abubakar, PharmD: Yes, my pleasure. Excited to be here. 

Bonnie Bond, CPA: Give us a little background and our listeners a little background about you and kind of how you’ve progressed over the last few years. 

Amina Abubakar, PharmD: Sure, so I’m a pharmacy owner in Charlotte, North Carolina. We have four locations in the Charlotte area. And our pharmacy is a little bit different, and it was by chance, you know? It really was, as Scotty said, when I was getting into the pharmacy industry, there was so much to learn. I don’t come from a background of business owners. I definitely don’t come from a background of pharmacist or pharmacy owners. So, this was a whole new world for me. And after pharmacy school, I was really on the track of going into clinical pharmacy. And so that was my pathway. That was my journey. My goals were either to be a clinical pharmacist or academia. Those were my two focus areas. But for those who don’t know, when I graduated as an international student, not an American citizen, you have to be very wise with your choices. And so, the pathway of going through academia or a clinical pharmacist didn’t have guarantees that I would get a sponsor to stay in America. And so at that time, CVS had the greatest option. And so, they had the work visa pathway. So, I worked with them, but boy, was it very, very different. And so, in my search to balance what I want to do, what I like to do, and versus what’s in front of me, I ended up the pathway of pharmacy ownership. And this was also by chance because I was staffing for an independent pharmacist on the side who then passed away, I mean, who then was diagnosed with cancer. And so, she was trying not to work as much. She was spending more time with her family. And so, she inspired me and said, Amina, you know what? I think you can take care of these patients. And I’m thinking this woman’s out of her mind. And anyways, so long story short, I got in to the industry and ever since I was just shaping what I wanted to do from the very beginning. And it’s to be an educator and to be that clinical pharmacist. And so, my collaborations with other clinicians in our area, the physicians, the specialists allowed my pharmacies to be I say adopted, you know, into partnerships and be able to serve patients what I thought would be the best. While we have four locations that do traditional pharmacy dispensing and taking care of patients, the day to day as we know pharmacy, we also contract our services and expertise to a lot of primary care in the area and specialists. 

Scotty Sykes, CPA, CFP®: So, that’s a great background, Amina, but what are those contracts? What does that look like? What are you doing in that space in particular with those providers? 

Amina Abubakar, PharmD: Yes, so when you imagine a primary care provider, they see everyone and they are overwhelmed. And every patient who needs them in reality probably needs an hour with them versus the 15 minutes or seven and a half minutes that they can give for the economics. So, I realized many of them wish they had more time with the patients. But the reality is they can’t solve a lot of those problems during the office visits. And many of them don’t want to open up that can of worms and ask beyond, what are you here for today? Because they realize they can’t solve them. So that became an opportunity where they said, you know, when I proposed, I said, we spend a lot of time with these patients in the pharmacy when they come in, as they wait for their prescriptions, as we call them monthly. So, we have these touch points that we could help, “what is it that you would love to solve for your patients?” And it started from that concept. And so, we found a way that they could bill legally for our time. So, they could contract us to address whether it’s vaccination gaps, to address why they are not meeting their blood sugar goals, their blood pressure goals, to address and stay ahead of their refills. So, it doesn’t overwhelm the providers when the patients are out or even to assess health literacy in the counseling, because they see them for seven and a half minutes or 15 minutes, then they prescribe these medications and don’t see the patients for another maybe three to six months. So, there’s not enough time to do that extensive education, the teach back and follow through. So, our pharmacists are contracted as those extenders for these providers. So, when we get a prescription, we’re getting a prescription with instructions on how to manage this patient. And then we record our time. And the time is what they’re able to bill. And these are mostly for Medicare patients. 

Bonnie Bond, CPA: And you, I’m assuming that you’re finding that providers are on board with this because like you said, they’re so swamped with so many patients that they’re very happy to collaborate in this way with you, I’m assuming. 

Amina Abubakar, PharmD: So initially, you know, this relationship is based on trust, you know? And initially, that’s what got us to the table was trust, because they have to open their electronic medical records to you. You see more than what normally you would see in a pharmacy. Once you have that trust, it’s much easier to get in. However, what kept us there was healthcare was also changing at the same time. Then they were now in what we call value-based medicine. They were not getting paid just because they saw the patients. Just because you had X number of office visits, never equal to your bottom line. Now they were being paid if their patients improved in the outcomes. So that’s what kept us because we were now able to review their contracts and say, wow, you would make X amount of money if X number of patients from this pair had blood pressure at this goal or had their diabetes metrics. And they said, yes, but who’s going to do it? And that’s how we’re like, okay, we are in it. So that’s kind of how what we do. And now it’s all linked to outcomes. So, our pharmacists are the quality metric experts, because when you find the problem, the clinics know the problems. They knew their reports. It’s like a pharmacist saying, yes, I’m being dinged for these DIR fees because of this non-adherent and all, know, non-adherent or any of these issues. But the pharmacist is really limited in what they can do without having a full picture of the patient, right? So, when you combine with the data from the doctor’s office and you see the hospitalizations and you see the missed office visits as well, together you are now all winning because we were all being measured on the same patients. I’m looking at them on their star ratings with their medications. They’re looking at them with their quality metrics. So, when we came together, we were able to address it a lot easier for these patients. 

Scotty Sykes, CPA, CFP®: And it adds a layer of accountability to the patient as well. You know, having that more interactive experience, if you will, I’m sure. So, the outcomes are better. 

Amina Abubakar, PharmD: Yes, outcomes are better. And through this, one doctor said, I don’t know how you guys got this patient at goal. And I’ve been their physician for these years. And what we realized with the Medicare patients, by the way, one of the number one social determinants of health is loneliness. So, as we were building relationships, it was increasing. They liked it because they actually felt like someone is listening and someone cares. So, we were able to go beyond the layer of like, why aren’t you getting at goal? And we were learning from income, patients were struggling to afford medications, food insecurity, or just sad that either their spouse has passed, their friends at that age. And so there were other things, you know, that we needed to kind of help them with, not that we were therapists, but kind of letting them, hey, we got your back. That’s why we’re here. You let us know, but we need you to take your medication so that way, you know, you’re well and better so that they felt someone else cared for them to be alive. 

Scotty Sykes, CPA, CFP®: Not just a number, I guess, you know, a little extra touch point there. How, how… Go ahead, Bonnie. 

Bonnie Bond, CPA: So how, I was just gonna say, so we preach this in many different ways to our clients and other pharmacists out there. Just filling scripts these days is not enough. So clinical care is huge, it has been very important. The things that you have just described, how would a pharmacy that is not doing any of this right now try to break through and start something like this? Like what would that look like? 

Amina Abubakar, PharmD: The truth is they’re already doing it. They’re already caring for the patient beyond the prescription. What they need to do is trace that patient back to their physician and have a conversation. Hey, Dr. So-and-so, I’ve been taking care of this X number of your patients. I’m curious to know how they affect you on your metrics, right? Because there is a way that we could work together, and I can alleviate the pressures you may have to get to these metrics because in the pharmacy, I’m already filling their prescriptions. I have time to talk to them every month. Will you be open to include me as part of your care team and be able to service these patients where you can bill for my time, and I’ll happily take care of the patient? So, this is actually the best time for people to reach out because before a lot of the physicians didn’t think this would happen. You know, many of them stopped taking Medicare. So, if you’re in your areas and you’ll hear this clinic no longer accepts Medicare, they no longer accept Medicaid. Well, it’s because they didn’t want to do this extra work. However, if they’re good business folks, they realize Medicare is a steady payer. You know? So instead of walking away, embrace the collaboration with the pharmacist and then everybody wins. And these patients still have a place to go because when you stop taking Medicare, where are these patients going to go? 

Scotty Sykes, CPA, CFP®: Are these, are these like independent providers? these like, cause we have a hospital system here that’s connected to a university and all that, you know, those, these big conglomerate systems, is this independent providers or are you able to get through to, to these providers in these big systems? Yeah. 

Amina Abubakar, PharmD: So, we’ve had success with both, but it looks different. Independent providers are much easier. They are very similar to independent pharmacies. You talk about pressure points, they know it, they agree with you, and they can make changes really fast to accept you. The health systems could be for a specific health plan. It could be for a specific metric. So, they may not just bring you in 100 % and say, come into our practice. They may look at their performance on the outpatient providers that are under the umbrella who are hurting them. And they might assign you X number of patients that may be in your geographic area, zip code, and see what you could do. So, when you approach a health system, you don’t approach as a whole. You say, what is the worst metric you have, right? That we can help. So, it could be really vaccination gaps. It could be blood pressure at goal. It could be health risk assessments, reviews. So, you have to listen to what their pressure point is and start there. But once you start there and you move the needle, then they’re able to expand. 

Scotty Sykes, CPA, CFP®: And what, what additional skills does a pharmacist need to have to add to this layer of care, if any, that they already have? 

Amina Abubakar, PharmD: None. They already have everything because it’s really clear.  

Bonnie Bond, CPA: Like you said they’re already doing it. Most people, yeah. 

Amina Abubakar, PharmD: It’s really, if you think about it, it’s care coordination. There’s no time a patient has come to a pharmacist and said, hey, I don’t know what to do with my medication. Or can you tell me why I can’t afford this? What are the options? Can you tell me how to take this medications or following up to make sure they’re making their appointments before the refills are running out? A lot of it is that. And another layer is that  the pharmacist because of our ability not only to understand the medication, but the costs, we help the physicians a lot because they don’t, don’t know how much it costs. I wrote this, the patient can afford it. I wrote the next one, the patient can afford it. So, I don’t know. With those costs too, and also because we understand Medicare plans and can help make sure the patients are on the right plans to cover their medications. The only thing that I feel like pharmacist’s struggle with is making the economics work. 

Scotty Sykes, CPA, CFP®: And that was going to be my next question. 

Amina Abubakar, PharmD: Yes, so making the economics work because they come from not being paid to do these things and so they’re so used to doing them and not paying attention to how much time they’re spending. So, for example, there’s a code that only takes 20 minutes. Medicare thinks this should only take 20 minutes, but you’re given this code every single month to touch. So, we’ll have pharmacist take an hour, right? And so now if you look at the economics, it doesn’t work. So, it’s the balance between doing the right thing at the right time and not solving all the problems all at once. But with pharmacists, we want to solve everything at once. The economics don’t work. So, I have to remind them if a doctor has 15 minutes to see a patient, what makes you think we have an hour just to do touch base and follow up? So that mindset is what a lot of pharmacists struggle. And so, they’ll get a contract and then they’ll say, this didn’t work, the economics, we hired a pharmacist and we were losing money. So, either that pharmacist couldn’t balance, say, okay, Mr. Smith, I got you. So next month, let’s schedule, we’ll work on that next month because they were fine before they met you. Don’t try to solve a hundred things at the same time. Unless it’s an emergency urgent, they have to make a visit back to the doctor. Right? And so that’s one. And then number two, is not always using the pharmacist 100 % because our technicians actually do so much better during the med sync calls to address some of these questions. So, our pharmacist design questions that the technicians can ask and then if it relates to a medication or an unsolved mystery, then they can task the pharmacist. So, everyone is working at the top of the license. 

Scotty Sykes, CPA, CFP®: And you have a contract with the provider. Are you doing the medical billing or is the provider doing the billing and reimbursing you? What does that look? 

Amina Abubakar, PharmD: So the medical billing happens within their system because it’s their Medicare numbers. It’s no different than their office visits, right? So, whatever the workflow is very similar. When we first started, they would do the billing, but as we grew the patient base, the encounters became too much for their billers to keep up with. So, our team actually manages these specific encounters by making sure we review them and drop in the bills, I mean the billing system, so we help. But ultimately money has to hit their bank first because that’s the contracted provider and then we invoice based on the agreement. 

Scotty Sykes, CPA, CFP®: Interesting. 

Bonnie Bond, CPA: There’s a lot of people that could benefit from doing that, both the, obviously the patient and also the pharmacist, pharmacy and the health plans. 

Amina Abubakar, PharmD: And also, the health plan. So interestingly, we started getting introduced to other practices by health plans. So, they would come, they were amazed at the clinics that we were in, the metrics that they were achieving. And so, they would visit the providers and say, how are you guys doing this? So that way you could let the other providers do it and they’ll say, it’s not us, you need to talk to the pharmacist team. And so, when they would meet with our team, they would ask, do you guys do this to other like at other places? Could we introduce you to this particular clinic? They seem to be struggling. And because there’s a lot of money on the table for them, we look, it’s funny, so you look at the dashboard and it tells them you are away from half a million dollars. And these are your outliers. You know, this is what you need to do with these patients. This is what you need to do with these patients, but they don’t have the time to do it. And so, you’ll have clinics that will utilize their medical assistants to do it. But as soon as they’re short staffed, as soon as they need that medical assistant, they pull them out of that task into the normal routine so they never get to actually be consistent. And number two, when the medical assistants find problems, they can’t solve them. They send an inbox to the provider. Well, I talked to Mr. So-and-so, he said he’s struggling with constipation, boom. So, then the provider is like, I don’t wanna do this program because I just found myself more work because now, I have…all these messages I have to respond to every phone call they did. But when they have a pharmacist, we can advise in any of those things. We can solve those issues and very little go back to the provider when it actually needs them for a dose change or a follow up of a different strategy. 

Scotty Sykes, CPA, CFP®: Wow. It’s impressive. It’s working at the top of your license for sure. 

Amina Abubakar, PharmD: Yeah, so it allowed me to do whatever I really wanted to do, be a clinical pharmacist, teach others how to do this. So, and, you know, be in the community because I didn’t want to be in a health system. I’m more of a community pharmacist. And so, this has given me the best of what I could do in the community. 

Bonnie Bond, CPA: Yeah, you’re doing both like you mentioned in the beginning that was important to you to be, you know, academia and you’re doing the pharmacist part. So that’s awesome. 

Amina Abubakar, PharmD: Yes. Yes. 

Scotty Sykes, CPA, CFP®: Well, I mean, I don’t want to hold you up any longer. This was great touching on this and we’d love to have you back on the podcast, but maybe we’ll see it in NCPA coming up. All right. We will be there. We will be there.