DIR Fees, DIR Fees 2024, Pharmacy Growth

The Bottom Line Pharmacy Podcast: Practicing to the Fullest Extent of Your License Featuring Ashley Moose

As independent pharmacy continues to evolve, it’s more important now than ever to diversify your services and be the healthcare hub of your community.  

On this episode of The Bottom Line Pharmacy Podcast, we sit down with Ashley Moose from Moose Pharmacy and CPESN to discuss clinical services such as long-term care, pharmacy integrated networks, cash-based revenue opportunities, and more!  

Join the discussion with us! 

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 Sykes: Good morning, everybody. Thanks for listening in to The Sykes Bottom Line Pharmacy Podcast. Today, we have Ashley Moose with Moose Drug and also a CPESN in Director of Network Development I think I got that one right. And we appreciate you getting on Ashley, why don’t you tell us a little bit about what you do at CPESN, but before you get to that, I know we have a long history here at Sykes & Company with Moose Drug. My dad knew, is that your grandfather? 

Ashley Moose: You mean my in-law. Yeah, my father-in-law. 

Scotty Sykes: You’re in law. Okay, you’re in law. And they go way back to the 80s and 90s. Anyway, we appreciate you getting on and love to hear about all the exciting things you’re doing over there. 

Ashley Moose: Well, thank you for having me on. And I hope, Scotty, that we can go way back and talk about community pharmacy from 40 years ago one day… 

Scotty Sykes: Yeah, let’s do it.  

Ashley Moose: Because it’s quite a legacy to have community pharmacy and Sykes and the contributions that you guys have provided to community pharmacy over the years. It’s just, it’s really important to appreciate that, you know, the value that’s being provided with Sykes and for community pharmacy and keeping us all in business. And that’s what CPESN is about too, right? So, our goal is to aggregate community pharmacies, to be able to express themselves on a level that other people don’t realize we’re doing. We’re, community pharmacy is here to be a solution for problems, for cost problems for patient information and without them knowing how many community pharmacies have that passion, it’s really hard for value purchasers to work with us. And so CPESN is looking to solve that problem and that’s what we’re here for and to really give community pharmacy an elevation and a way to find us and express the value that we provide in each of our communities across the United States. 

Bonnie Bond: Awesome.  

Scotty Sykes: Yeah, I know CPESN, you guys have been doing a lot of work, a lot of good work. What are some of the more recent initiatives you guys are kind of focusing on in this new environment, so to speak, that pharmacies in today? 

Ashley Moose: Yeah, the turn of the year has just been really, really busy. And we’ve been really hyper-focused on a few initiatives. I think a few weeks ago, you may have had the guest, Lindsay Dymowski which is the coolest name ever.  

Scotty Sykes: Mm-hmm. Yeah. 

Bonnie Bond: It is, yeah. 

Scotty Sykes: She’s very sharp, yep. 

Ashley Moose: But she’s also really a really cool girl, too, and very knowledgeable about the LTC. Yeah, so it’s been really a great experience. It’s a joy to work with Lindsay on just understanding the LTC space a little bit closely and CPESN, of course, is working really closely with Lindsay as well and the LTC team that’s been assembled to position community pharmacies to get into not the combo pharmacy space, but also closed-door pharmacy operations. And I think what really hit me around the work long-term care pharmacy is doing is, we’ve been operating with combo shop models for a while in community pharmacy, but it hit me one day when I heard Lindsay talking about the quality, you’ve gotta be a quality provider. And that’s true for the retail side, but it’s really, really true in the LTC space as well. And then I noticed, slowly we were starting to get more and more desk audits, and then an invitation for an on-site audit. And you know, it’s that drive and that need to perform at a really high level is there or you’re gonna get in trouble for it, you know? So, I think that we have to have integrity and the type of workflow and the type of services we’re providing on the long-term care space. And what Lindsay is working with CPESN on is helping make sure that we are as high performing long-term care pharmacies that’s possible. And so CPESN at the end of the year, I think, opened up for the first time to the clinically integrated network, closed door LTC pharmacies to join CPESN. Before it’s only been retail pharmacies that had open door patients coming and going. And so now CPESN, if you are a closed door or LTC pharmacy and you wish to join a CPESN you can do that now. And so that’s been a lot of effort and Lindsay has helped to kind of really position the community pharmacy space to be welcoming to the long-term care side of practice, but then making sure that everybody’s practicing at the top of their game and knowing the rules and the ways to take care of people the best way we can. And so, we know that the population is trending that way, right? So, we have more and more folks. 65 years of age and older that wants to age at home, that it’s expensive to age anywhere else but home. But aging at home can bring its own set of complications.  

Scotty Sykes: Got that right. 

Ashley Moose: So, if community pharmacy can play a role in the med management and making sure that there’s mobility features that we can provide, DME types of equipment, whatever can make someone comfortable with a high quality alive at home, then that’s what we wanna do.  

Bonnie Bond: Why not? Yep.  

Ashley Moose: And CPESN is perfectly positioned for that. So that’s one area 

Scotty Sykes: Yeah, for sure. And that’s one area. And I’ll tell you, you know, ever since, for the past six, eight months, that long-term care has really been highlighted and it’s continuing. I mean, this is the third, third or fourth episode this year where long-term care has come up as, a key area of pharmacy and just very interesting how that’s really taking hold. 

Bonnie Bond: Yeah, and I think, I think Scotty too, we learned on one of our podcasts when we were talking about it is there’s a lot of pharmacists that think they don’t have the ability to do that or they don’t have the patience for it. But someone was mentioning, they made a really good point that I hadn’t really even considered either like you don’t realize what could possibly be out there. You really have to take a look. A deep dive into your customer base and your community and there may be more opportunity out there than you realize. So, that is something I took away from some discussions we had about that. So don’t just consider that without really looking at it, don’t just X that off. It could be an opportunity that you’re not utilizing. 

Ashley Moose: That’s so true. And it’s like, you feel a little bit nervous about getting into that space. How do you do it? I don’t understand the rules or which of my patient population would qualify for that. It feels like a heavy lift. But once you get you start…kind of making steps toward it, it’s not that difficult, but there’s huge reward in it if you do it effectively and correctly. And so, and that’s, you know, there are other companies out there that can help you with that we work really closely with as well. I think it’s a very collaborative model as a whole. And CPESN can help you, kind of guide you in where to look for those resources. So, it’s not, you don’t have to figure out everything on your own. That’s the beauty of collaboration with other community pharmacies and other entities that are skilled and specialized in that. 

Bonnie Bond: Yeah, let people help you out. Yeah, so what’s number two, Ashley? What else do we got? 

Ashley Moose: Number two, so special purpose networks, those are going very, very well. So special purpose networks are part of CPESN activities, but they’re more turnkey-like niches. So, let’s say you want to put a primary care clinic in your pharmacy. How in the world do you go about doing that? Well, there are resources for that through a special purpose network. Big Tree Medical has partnered with CPESN to help with that. We actually launched at Moose Pharmacy of Monroe, where my site is, we launched a Big Tree Clinic in September. I’m happy to tell you, I just got my financials for January. This is our first break even month. 

Bonnie Bond: Nice. That didn’t take too long. That’s good. 

Scotty Sykes: No. 

Ashley Moose: So, we are past the initial upfront investment, and we are, yeah, we’re moving now. We’ve got about 109 patients. 

Bonnie Bond: I was waiting for this one to come up. I knew this was going to be one on your list. We’ve got a lot of clients that have jumped into this as well about that same time frame. 

Ashley Moose: Absolutely. They’re growing very rapidly actually. And there are some things in the model, you know, being the first to launch, you learn some lessons, and everybody tries to get better at the improvement. So, it’s making its way into being a very, very efficient model. But it’s a really cool model at the, just at the concept as a whole…  

Bonnie Bond: Agree. 

Ashley Moose: Coming in for cheap primary care like, easy access, virtual or in your pharmacy. It’s just, it’s a really cool solution for anyone really. It’s a direct pay model, but when you look at the big scheme of things, there’s no wait times.  

Bonnie Bond: All in one place, yeah. 

Ashley Moose: There’s, you know, it’s relatively cheap compared to the marketplace. It’s going really well and more and more patients are hearing about it. I think that the play that community pharmacies really wanna focus on as they start to launch something like this is getting in with self-insured employers, making sure they’re aware that this program exists because I think it can save self-insured employers a lot of money, but also be a really tremendous resource for employees and it be a very effective benefit for employees for quick health access. So that’s going really well. And they’re launching, like I said, Victory based out of Missouri is launching with community pharmacies that are CPSM members that have interest in seeing that. What do you need to start? A commitment to do it at a 10 by 10 room space.  

Scotty Sykes: Yep. 

Bonnie Bond: 10 by 10, that’s right. 

Ashley Moose: They help you with…they help you with most of the other details. And we were really lucky because we’ve got this amazing physician assistant. She’s awesome. We work really well together. It’s pretty risk-free. I mean, from a community pharmacy standpoint, the only thing you’re risking is if your roommate, your personalities don’t match or something like that with your nurse practitioner or physician assistant… 

Bonnie Bond: Hahaha! 

Ashley Moose: But we’re lucky because she’s awesome. So things are going really well. 

Bonnie Bond: That’s awesome. Selfishly on the customer level, I wish I had something like that in my area. I would use that. 

Ashley Moose: Yeah. 

Scotty Sykes: You’d be a regular. Oh, you’re in there. 

Bonnie Bond: Yeah, there’d be a kid in there at some point. 

Ashley Moose: I think in a time it’s probably coming to a neighborhood near you or will be soon because it’s… 

Bonnie Bond: I hope. 

Scotty Sykes: I’ll tell you, I mean, what, what perfect sense does that make having a pharmacy and having a 10 by 10 in there? Genius. 

Ashley Moose: Yeah, which everybody, almost everybody has or can do. 

Bonnie Bond: And just be seen and have the script field right there. 

Ashley Moose: So, the others… 

Scotty Sykes: Makes perfect sense to me. Go ahead, Ash. 

Ashley Moose: I was going to note the other special purpose network that I think is, well, there’s several that are really cool. I, we probably could have five, six podcasts on each special purpose network because there’s so many offers, so much opportunity and there’s cross opportunities within each of these. And so you’ll see like the special purpose network that’s the physiatry physician collab or physiatry pharmacist collaborative. This is really cool because it focuses on physical, medical, and rehabilitation models for patients that are aging at home as well. So, you can kind of see a theme, community pharmacies, caring for the Medicare type population who wishes to age at home, gets you in the LTC space. You can start then doing some remote patient monitoring and physical assessments working with a physiatrist. There is a medical billing model that’s set up for this.  

Bonnie Bond: Mm-hmm. 

Ashley Moose: So, if you’re already servicing Medicare patients, you may want to look into this special purpose network because there are revenue opportunities that are set up to, again, turnkey opportunities to help you understand and learn this space, but it’s activities you are already spending time on, right? So, you may, you’re already managing medications, you’re already answering questions, you have relationships with these patients. Now the next layer of this is monitoring blood pressure and weight and other things like that, that you’re installing that technology at home and monitoring and responding to it. And it’s a pretty cool program that’s getting started. 

Scotty Sykes: So, what does that look like? Is that where, you know, how, how are, how are the pharmacists, how are they monitoring those patients? Like, what does that look like from a monitoring? 

Ashley Moose: Yeah, so you have someone deploy into the patient’s home or the patient’s facility. It can be a pharmacist, it can be a staff member that you’ve trained, it could be anyone on your team that you trust to go out to the patient’s home. And they set them up with the proper equipment, which is very easy. It’s simply sliding your blood pressure cuff on, doing that measurement. That measurement uploads to a EMR that you have access to, that this special purpose network equips you with all the resources that you need to pull this off. And you have somebody on the other side of the pharmacy monitoring for trends. There’s protocols in place. You have a physician that’s overseeing it, the physiatrist, and you help to manage and respond to trends when they’re going the wrong direction before a patient has to do an unnecessary hospital visit or emergency room visit, even simple med changes can take place. And you’re at the kind of the cusp of identifying when those trends are going the wrong direction. If you have a heart failure patient that’s gaining weight, well, that’s a red flag. Let’s get involved and do something about it. So, it’s a whole other element of practice that you can incorporate, but there’s billing codes for it this special purpose network teaches you how to utilize those billing codes and have non-DIR revenue which is important right now.  

Bonnie Bond: It’s huge. Hahaha. 

Ashley Moose: So it’s a great opportunity. 

Scotty Sykes: Practicing to the full extent of your license. 

Ashley Moose: Absolutely. And getting non-PBM rewards. 

Bonnie Bond: Yes. And I would imagine anything with codes and things like that… Yeah, I would imagine anything with getting the right codes can make or break a situation. I know just going to the doctor’s office, if you use… if they just code one little thing incorrectly, it makes a big difference. What’s covered and what’s not. 

Ashley Moose: Yeah, that’s what the beauty of this is with the special purpose networks. These are experts that have, you know, they have dived in, they know the ins and outs of the system, they know how to help optimize your performance and you’ve got somebody to lean on when you have questions about, you know, providing the best care you can or billing the most appropriate way. It’s all there in that packet. And so, it’s really helpful to get things to that. 

Bonnie Bond: It’s really just about knowing somebody that knows how to do it. Save some money. 

Ashley Moose: Yeah. 

Scotty Sykes: And that would be CPESN, Turnkey Solutions. 

Ashley Moose: Yeah, I think it is, it is. And then we’ve got…  

Scotty Sykes: Right Ashley? Got a good plug there?  

Ashley Moose: Appreciate that. We’ve got other SPNs too. We’ve got health equity, which is utilizing health coaches to, you know, serve an undefined or a need in the community that otherwise hasn’t been met in other ways. And so, your community pharmacy armed with all the resources from social work to someone going out making sure patients’ homes are not at risk for falls or other types of social determinants of health that are identified, how much better can you care for someone when you know what other factors are influencing their overall healthcare? And that’s what health equity is about. And states have a lot of resources to help fund programs in the community that help for social determinants of health awareness. So, Missouri is like, the place where this is started also unrelated to the Big Tree program. Yeah, this was started out of Trip Logan’s shop and a few others. And they have come together to really figure out how to go state by state and maximize those opportunities for health equity. And I think it’s going really well. I think Tennessee is really seeing a lot of effects from it. 

Bonnie Bond: It’s a lot going on in Missouri. That’s awesome. 

Scotty Sykes: Boy, there’s a big need for that. My goodness. 

Ashley Moose: Oh, there is there is.  

Bonnie Bond: Yes. 

Ashley Moose: That’s exciting and that’s more of a network based special purpose network. So you need more than yourself in it the others are more you wake up one day and you decide you want to do it you go off the health equity SPN you really got to have a network of committed community pharmacies that want to deploy this model throughout the network and then you really start to get a lot of state awareness about hey, we’ve got solutions we’re CPESN local network and we want to make sure we deploy our health coaches into communities and make a difference in that arena. So, it works really well. And you know what’s neat about this is it’s already built into our infrastructure because a lot of places or a lot of pharmacies that are engaged in this model have trained their delivery drivers to be community health workers. So, you already have the staff for this. It’s just a matter of four-hour training… 

Scotty Sykes: On training them. 

Ashley Moose: And understanding what social determinants of health are, the solutions in your community and how you can bring value to utilizing those resources for your patients that are existing in your population. 

Scotty Sykes: Makes perfect sense to me. I mean, you know, the patients, they want, they want that level of care too, cause they don’t know, you know, they don’t know what they don’t know. So, a lot of opportunity there, I think for sure. What else is CPESN doing? Ashley, I know y’all got some things, you know, planned in the future. So, what, what you got outlined out there? 

Ashley Moose: Yeah, so gosh. So, right now, value-based purchasers are really, really strong right now. Our value-based purchasing team, they’re on the phone constantly with payers. So, large scale payers that are looking to work with networks to deploy different programs. Sometimes they’re disease state-based programs. Sometimes they’re, hey, just say the money, I don’t care what you’re doing, and we’ll monitor those metrics. So, there’s a whole variety of payment models that are out there. Right now, even a unique one is that we have six networks that are part of a clinical trial study, so they’re helping to recruit patients into clinical trials, which has turned out to be a pretty profitable participation opportunity for those six networks. And so, simply just utilizing your existing staff to see if they, or,  existing patient population to see if they qualify for clinical trials, and there’s payment that’s been linked to that. So that’s going really strong. And then we’ve got pharmacogenomics opportunities through a company called Gene Markers that are working with CPESN pharmacies. So, if that’s a space that’s of interest to any community pharmacies, again, there’s information to get you set up on that. You know, we were talking this morning on a Moose pharmacy manager’s call. We meet every Tuesday. And it was so cool because we were going through like, well, we’ve got this program we should be working on and this program we should be working on. We were going through all the lists and it almost took the entire time. And what a world it is now where we, all these things that we dreamed about, telehealth opportunities and diabetes management and all of these really cool programs that are out there. It took us our entire hour to go through the services that we could be providing or are implementing right now. And all of that I would say really just kicked off at the turn of the year, which is the time we need it, right?  

Bonnie Bond: Yeah, it is a great opportunity. So, Ashley, what would you say to maybe a pharmacy who they are not utilizing any of these opportunities? They’re still just filling scripts. I mean, you got to do it, right? I mean, we’re at a point… 

Ashley Moose: Absolutely, yeah. I mean, I think the most I don’t even know the word for it. It is so sad to see all of the headlines that I’m seeing daily about pharmacy closures. We knew it was gonna hit hard at the beginning this first quarter of 2024 and we’re seeing it. And friends that I know, or longtime colleagues are starting to close their stores. And it’s, I’m just, I can’t believe it. 

Bonnie Bond: You’ve kind of got to add some of these things. 

Ashley Moose: Yeah, I saw one last week and I immediately reached out and I was like, is this true? Like, did you… 

Bonnie Bond: Yeah. 

Ashley Moose: really close and there’s ways, you got to fight it though. There are ways to stay profitable. And I just, if there’s a way that we as CPSN, as Moose Pharmacy can help you if you’re struggling, we want to see community pharmacy thrive and be sustainable for decades to come. And so it, you know, the advice I would say is if you’re a community pharmacy out there who’s overwhelmed by all these things and you don’t know where to start, pick one. So, if you service patients that are 65 years of age and older, then tune in to some information calls about long-term care. That will be a really quick and effective way to get into the space, understand it, and see quick returns on your investment for your time spent. There’s informational calls all the time through CPESN, you don’t have to be a CPESN member to even hear these calls. So, there’s one coming up, I think, February 22nd. There’s another one on March 5th. So, there’s a lot of opportunities to start getting involved and hearing about what those steps would look like. If long term care is not the thing you want to do, if you want to get into more cash-based business, we can make sure you’re connected to the direct pay model where you can get a primary care office started without a ton of uplift. It really isn’t that much work on the pharmacy. You just have to wanna do it and be willing to share those opportunities with your existing customer base. So there are ways to kind of start. One, it’s not gonna correct overnight. You heard me say it took four to five months to break even on that investment with the Big Tree Clinic… 

Bonnie Bond: Oh yeah. 

Ashley Moose: But start today and then by the summer or by the fall whenever flu season’s kicking off, you’ve got infrastructure in place to solve.  

Bonnie Bond: You’re ready to go. Mm-hmm. 

Ashley Moose: Yeah, yeah, absolutely, absolutely.  

Bonnie Bond: And how would someone who is interested get started with you guys? They’re ready to go. 

Ashley Moose: So, you join.cpesn.com. That’ll be the first step of making your intent, that hey, I’m ready to look into this, I really wanna join. That’s the first step. If you’re not quite convinced, I’m not ready to join yet, but I wanna learn more about this, you can just send a quick message to info at cpsn.com. Reach out to me, I want somebody to call me and talk to me about what opportunities are right for me specifically we’ll do that as well. So, I encourage you just to explore it. You don’t have to commit to anything, just explore it and see if it may be a right opportunity. But you know how it is when there’s a large amount of numbers, there’s more traction. If we can aggregate all the community pharmacies that really wanna provide quality care for patients and serve our communities, then that’s gonna be really impactful, not only to payers such as, you know, Medicare or Medicaid, state Medicaid programs, but also to our, like our state legislators. They want to see a power of community pharmacies coming together for a common purpose to improve quality of care and save dollars. At the end of the day, that’s what gets people’s attention, right? 

Scotty Sykes: That’s the truth. 

Ashley Moose: And I think we’re equipped to do that. And that’s what this model is all about. It’s just to make sure we can express ourselves on a grand scale.  

Scotty Sykes: I always say that pharmacists wear a lot of hats and one of those is advocacy. You gotta wear that advocacy hat. But no, I mean, the pharmacy industry is clearly evolving, and it has been since really COVID pushed it forward. You’ve got to be getting on these things, pharmacy owners out there, you just have to, you don’t have a choice.  

Bonnie Bond: Yep. 

Scotty Sykes: I mean, it’s coming down where you don’t have a choice anymore, you’re gonna have to find those one or two areas, like you said, Ashley, to get you dip your toe in and do it and evolve the pharmacy. Otherwise, you know, you’re going to be fighting uphill. Great points. Bonnie, do you want to kick off the bottom line? 

Bonnie Bond: Yeah, so at the end of our podcast, Ashley, we all have a bottom line, kind of a takeaway, quick takeaway. Apparently, some of mine get long, so I’m going to make it short. Do I want to go first? 

Scotty Sykes: You take them all… 

Bonnie Bond: No, I’m going to do an easy one. I just like with you guys, with CPESN, I think it’s awesome that you mentioned that even if you’re not ready to maybe commit to that, that you guys do offer some free opportunities out there as well. So, you know, you’d be crazy not to at least dive into some of that and get your you know if you’re someone who hasn’t started with some of these different areas look into what you guys have to offer and at least attend some of those courses and things and like Scotty said dip your toe in just a little bit and see what might be out there. 

Scotty Sykes: Yeah, I think CPESN is a great resource. So, check it out. But I also will just say, send my love to the Moose family because I know you guys have done so much in the pharmacy industry and continue to do so. And you guys really deserve a lot of applause for that, for what you guys do in the industry. So I just thank you guys, the Moose family, for all you do. 

Ashley Moose: Well, they send their love right back to you all. Thank you.  

Scotty Sykes: Yep. We love seeing Joe out on the trade show. When we pass him, sometimes we’ll see him in the airport because we’re going through Charlotte all the time or something to the same trade show. Yep. Ashley, what’s your takeaway today? What’s your bottom line?  

Ashley Moose: My bottom line, definitely get into the space of some type of clinical service. Start something new, just start one thing new this spring or this quarter. I think you’ll see that it’ll not only hopefully see some profitability with adding a new service, but you’ll also see things build on each other, services build on each other. So, when a patient comes in for an immunization and you may also find that they may need bubble packing. And if they need bubble packing, they may qualify for your new LTC program that you’re working on. It just continues to build off of each other. And you wanna be the place that offers solutions to the community. And I guarantee that your community pharmacy is outperforming other pharmacies in your area. So, don’t minimize what you do every single day. You’re nimble, you’re flexible, and you can start new things at any timeline you want. That’s the advantage of community pharmacy and take advantage of it because that’s what’s gonna keep you in the marketplace thriving. 

Bonnie Bond: Yeah. 

Scotty Sykes: Get started today. Get going. 

Bonnie Bond: That’s a good bottom line. 

Scotty Sykes: Well, thank you, Ashley, again, for getting on. We certainly appreciate you taking the time, and we’ll have to do it again sometime. 

Ashley Moose: Thanks for having me and great talking with you all today. 

Scotty Sykes: Thanks for everybody listening in. 

Bonnie Bond: Thanks Ashley. See you guys! 

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