Like many other veterinary clinics, we at the Wisconsin Equine Clinic & Hospital are challenged to find a way to support the safe and ethical sale of medications to our clients in the face of increased purchases from online and general retailers.
Our continued goals are to optimize drug therapy and improve the therapeutic outcomes for our patients while strengthening our relationships with our clients. In the human health care industry, this is called prescription management or medication therapy management. This type of management includes a broad range of professional activities, including—but not limited to— performing patient assessment and/ or a comprehensive medication review, formulating a medication treatment plan, monitoring efficacy and safety of medication therapy, and enhancing medication adherence through client empowerment and education.
Philosophically, this sounds wonderful, but how can we do it in today’s busy and changing environment with limited resources?
Brakke’s “Equine Market Mega- Study,” published in January 2014, reported that the U.S. horse population declined 14% in the five prior years. In addition, product usage declined in the majority of the equine product categories.1 While the decline in the U.S. horse population might be temporary, it is our current reality. The fact that our clients have fewer horses, are purchasing fewer medications from us and have the opportunity to buy from outside sources represents ongoing challenges: Have horse owners made a permanent change in how they buy medications? Once the horse owner begins purchasing medications outside of a veterinary practice, what happens to my ability to manage those prescriptions and ensure the continuity of patient care? Is this in the horse’s best interest?
A year ago, our clinic investigated two options to better connect with our clients on medical therapy management: 1) We researched the resources needed to develop a system within our clinic utilizing current and additional clinic staff; and 2) We searched for a strategic business partner who specialized in prescription management in the marketplace.
After careful analysis, we opted to develop a strategic partnership and found an industry leader to help us. In this article, I propose that in order to survive, and hopefully thrive, equine veterinarians should embrace today’s technologies to change how they manage prescriptions. In fact, this new approach represents a prescription management “best practice” that can lead to better health outcomes, a new incremental revenue stream for the practice, better medical management of our patients, better business for our practice, improved client relations and additional educational opportunities.
A Blind Spot in Our Business
Before we started with our new approach, we knew that many of our clients were purchasing medications elsewhere. Typically, our clients were buying products and medications at one of the several Internet pharmacies or retailers that offer heavy discounts. We found that quite often, our veterinarians were being asked to write prescriptions to be filled at online stores.
At that point, we were losing control of the process. We had no assurance of the quality of the product, the shelf life of the product or the handling of the product that was to end up in our clients’ hands and in our patients. We also lost an important connection with our clients regarding compliance in cases of medications given for chronic conditions.
Of additional concern was the question of whether horses were being given medications based on refills when perhaps the medication was no longer indicated? Were the clients alerted to the need for refills in a timely manner to avoid lapses in treatment? Were the products they ordered of consistent quality and efficacy? Was this source always cost-effective for the clients over time?
While it is unrealistic to carry all products available to horse owners in our clinic, we realized that we were often sending them to an online or retail source when we did not have a product in stock. As it turned out, we had a real blind spot.
At First Glance: A Unique Online Store
Last summer, we analyzed a novel approach to prescription management focused on and driven by veterinarian/ client relationships. We were approached by a company that presented its version of a prescription management system that served our clients’ needs and allowed our staff to be active participants in the process.
Our initial take on the company’s presentation and offering was lukewarm, but positive. It seemed to be a nice online store that would offer clients a way to buy medications directly from us and additionally benefit from convenient home delivery. We had tried to work with various online stores in the past, but our efforts were unsuccessful, as the process was cumbersome. This new company presented a more modern look and an easier client interface. It was difficult to imagine a process that would add more value to our business than one that involved our own staff.
Our patient/client relationships are our most important assets, and we feel strongly that we need to protect and enhance those relationships. After a thorough examination of our options, we decided that this company offered us the opportunity to maximize the benefits of the online pharmacy while maintaining full confidence in the products our clients would receive, management of the prescriptions and support of the clinic/client relationship. It was important that this company had policies aligned with our culture and values.
A Closer Look: We Needed to Change Our Approach
We launched this new store in August of 2014, and due to the company’s marketing support (included with the service), we realized a surge in activity during the first couple of months. After that, we fell into a steady and considerable flow of business each month. Our clients seemed relatively satisfied, and certainly the store was easy to use for both the doctor and the client.
As I began to understand the scope of the technology, I reached back out to the company to get additional training for myself and my staff.
An important aspect of prescription management is educating the entire team in the practice. Our thought process was simple. This service had to meet three criteria: be good for the clients, good for the patients and beneficial for the practice. We wanted a solution to provide better patient compliance with needed medications, a task only accomplished with solid patient/ client relationships. We are not promoting pharmaceutical sales; we are promoting safe and ethical care for our clients’ horses. We are not sales people; we are health care providers using the proper medications to meet the needs of the patient.
Implementing a new program and getting everyone on board can be a difficult undertaking. After having the new program in place for a period of time, the company sent representatives to our practice to do an audit, and we discovered the following:
• Our staff members, especially the veterinarians, were not well-versed in the service. We had not done a good job of getting everyone aligned and trained.
• We hadn’t developed a set philosophy for how we would position the store to our clients, so our staff members were inconsistent in how we presented the online offerings.
• We were not taking full advantage of some of the unique capabilities the service offered for following up on lost sales and making recommendations of beneficial products.
Behind the scenes, we did some of our own analytical work see whether clients who would have purchased products at our practice were now just purchasing online, which could have an impact on our profitability. We also reached out to our current clients for feedback.
A New Best Practice: Technology-Enabled Prescription Management
Our analysis showed that all of the sales through the online store for the first several months were net positive of practicedispensed medications. In other words, we were capturing new sales from clients. Also, we could see from the company’s monthly reports that those clients who began purchasing at our online store returned—i.e., we were seeing repeat buyers.
With this confidence that the service was adding incremental value, I worked with my staff to develop a renewed approach to leveraging the technology that was now at our fingertips:
• We developed a clear pricing philosophy to incorporate in the store. Sales directly from our truck (most clients are invoiced) now have the highest retail price for the convenience. If clients pay at time of service, we offer a lower price point on common medications for dispensing. And finally, sales through our online store are the most cost-effective. We tell clients that because we don’t need to inventory products, we can offer better pricing online. The online store also offers instant rebates that make saving even easier.
• We made sure our entire staff was trained on why we were using this new service, and how to use it. Before we became aligned, we had front staff telling clients to purchase at our new online store while some staff in the back office were still signing off on faxes from the outside pharmacies.
• We began creating proactive recommendations for all clients who decided, for whatever reason, not to make an immediate purchase from us after an exam or visit. In addition, we educated our staff to create proactive recommendations for all the outside pharmacy requests (faxes) we received.
The technology and tracking services offered by this company provide timesaving measures for our staff, allowing them to focus on other tasks. For example, the technology of the service automatically notifies clients when they are due for a refill, and the service displays all prescriptions that are due to expire. It notifies the prescribing veterinarian (or a delegate) when a prescription needs a renewal. This can be set up by the client as an auto-ship feature, which has been very well received. In other words, the system automatically ensures continuity of care, which is better medicine.
With this value-added service, we have found a new way to bring back clients who were purchasing medications elsewhere, and to manage their prescriptions over the life of the patient. Our online store now generates significant incremental revenue and corresponding profits. By bringing clients back to the practice and maintaining good support and oversight of their horses’ prescriptions, we have improved our bottom line, and more importantly, we are providing overall better care to the patients and owners. Leveraging this new technology is truly a “best practice” way to manage prescriptions, with our patients being the biggest winners.
The level of prescription management you want to provide to your clients is a choice. You can do this internally with current or new staff, or search for industry providers. If you use an industry service, analyze a few key points: customer support to handle any store questions, product return policies, credit card bounce-backs, autoship functionality, quality assurances, certification status, and finally, assistance with full order placement over the phone.
Again, the choice is yours. There are many services in the market to explore, and hopefully you will find the right fit for your business.
At the end of the day, we feel this new approach reflects our values of promoting better medicine.
Online Pharmacy Partner
I have been asked by several colleagues to share the name of the service with which we partnered. We selected a company called Vets First Choice as our online service provider. The intent of this article is to share our clinic’s experience and what we feel is an opportunity to build stronger relationships with our clients and promote better medicine. There are many options available, and each practice needs to do its own analysis of what works or doesn’t work for that business. At the time of publication, our experiences and relationships with Vets First Choice have been very positive. Disclaimer: I have not received compensation of any kind from this company for this article.—Robert P. Magnus, DVM, MBA
1. This study can be purchased from Brakke Consulting (www.brakkeconsulting.com/equine-mega-study.aspx)