Point-of-care testing? Check.
Medication therapy management? Check.
Chronic disease management programs? Check.
Specialty pharmacy? Check.
Primary care and clinic services? Check.
Staff dietitians and nutritionists? Check.
Collaboration with physicians and large health systems? Check.
COVID testing, COVID vaccines, and flu and pneumonia shots? Check.
This is a checklist for any retailer looking to make a mark with the pharmacy and something that supermarket operators need to understand is essential if they want to thrive in the competitive pharmacy business in the future.
The big questions are whether supermarkets are willing to dive completely into the pharmacy business and whether they can utilize their obvious advantage in food to maximize their potential in the category.
The rewards accrued from offering these clinical services can be substantial in terms of clinical outcomes, not to mention revenue and customer satisfaction. In fact, pharmacy expansion into primary care is driving significant increases in both satisfaction and consumer spending, accor-
ding to the 2020 U.S. Pharmacy Study from J.D. Power.
The study found that customers who use at least one health-and-wellness-oriented service provided by their pharmacy spend an average of $11 more per customer than those who do not use these services ($35 versus $24, respectively) When customers use two or more health-and-wellness-oriented services, that average spend climbs to $58. Among customers who use two or more health-and-wellness-oriented services, overall satisfaction jumps to 907 versus 861 for those who don’t use any service.
How can that translate into sales and profits for supermarket chains involved with pharmacies?
Starting with Food
One of the experienced players that is focused on dietitian services is Kroger, which has 2,254 pharmacies in 37 states and the District of Columbia. The grocer also has operated clinics since it purchased The Little Clinic in 2010. It has 224 retail health clinics in Arizona, Colorado, Georgia, Indiana, Kansas, Kentucky, Ohio, Tennessee and Virginia.
Marc Watkins, Kroger’s chief medical officer, said that the pandemic accelerated the grocery chain’s decision to offer a 50-state telenutrition service with its registered dietitians. “It offered an opportunity to connect more Americans to our nutrition programming,” he said.
Kroger also revamped its OptUp healthy eating and nutrition platform with a food-scoring app, which evaluates and ranks food based on its nutritional content. “It measures not only the nutritional value of the food, but puts it in a scoring mechanism that makes it easy for consumers to digest what is in their basket,” Watkins said.
Customers can personalize their choices by assigning dietary tags to see where the foods they are choosing fit in, for instance, if they have diabetes or are on a keto, paleo, Mediterranean heart healthy or gluten-free diet. When customers scan the bar codes of items with their mobile phones, they can see the score in real time.
“For good health, a basket should be 50% or more in the green, although you can have a red score if it’s not more than 10% of your basket,” Watkins said. “That’s one of the ways we’re guiding our customers through this journey of not only changing the way that you eat, but also putting you on the road to being the best person of you and living a healthier life.”
Stop & Shop, which has 253 pharmacies across Connecticut, Massachusetts, New Jersey, New York and Rhode Island, is another formidable player with a focus on nutrition. As part of its Nutrition Partners program, last June the company’s dietitians went virtual with complimentary services for customers.
“The virtual program has allowed us to provide diabetes education and resources to people at home,” said Brittany Moriarty, a registered dietitian at Stop & Shop.
Stop & Shop’s team of registered dietitians also is partnering with its pharmacists for a series of weekly educational webinars on such topics as heart health and eating for diabetes. “We also do cooking demos, and we have resources on our website and blog, as well as an email address where customers can reach out to us at any time with questions,” Moriarty said. “The email communication is a great way for us to reconnect with the pharmacy if any customer has a question, for example, after a heart health webinar or if they have an issue with their medication, we can send them to the pharmacist we are working with,” she said.
Stop & Shop also went virtual with its monthly education health classes, which focus on a variety of conditions, such as diabetes awareness month in November, heart health in February and allergies and asthma in May.
“We saw a huge influx when we launched webinars last summer,” Moriarty said. “People were at home looking for
health-and-wellness resources, and they continue to be popular. During diabetes month in November, more than 100 people registered for each class. There’s definitely a need for that in the community.”
Publix, which operates 1,179 pharmacies across Alabama, Florida, Georgia, North Carolina, South Carolina, Tennessee and Virginia, also is a leader in connecting food with health. Maria Brous, director of communications, pointed out that Publix has created multiple resources to support patients’ dietary needs both in store and on its website.
In store, there are visual shelf tags, which direct patients to Better Choice options, such as for patients who need more fiber and less saturated fats; Wellness options; Organic options; Made Without options for patients needing to avoid preservatives, colors and/or flavors; Gluten Free options; and Vegan options.
On Publix.com, meal recipes are available in a variety of categories to support patients’ dietary needs, including heart smart, carb smart, vegetarian and gluten-free.
Getting Smart About Streamlining Operations
The ability to leverage technology to improve patients’ health is yet another hallmark of successful supermarket pharmacies, as evidenced by Kroger’s decision to provide pharmacists with data from its AssureCare platform. The technology platform runs on Medcompass’ platform, and the data enables pharmacists to make real-time decisions about impacting the care of their patients.
“What begins to happen is you develop a relationship with our pharmacist,” Watkins said. “Your pharmacist is providing this high level of care, but it’s personalized. They know a little bit of something about you.”
This technology will be deployed in all of Kroger’s locations in a stepwise approach over the next several months. “We’ll continue to leverage the technology in a way to give us real time insights to what’s going on with our patients,” Watkins noted. “That’s a point of difference that our pharmacy teams will have, this granular detailed information at the tips of their fingers, which better provides them the ability to take care of their patients.”
Publix also has taken technology to new heights. “We have developed backend services to help take the workload off of our pharmacists at the stores, so they have more time to build relationships and provide services to our patients,” Brous said. “One of our most impactful backend tools to date is our central pharmacy in Orlando, which comprises central fill and central processing, which assist stores across the chain with workload balancing using a team of pharmacists and technicians.”
As supermarkets work to deliver optimal care to patients, another ongoing area they’re growing their capabilities in is improving medication adherence.
One just has to look at Publix’s extensive medication synchronization platform. This is an appointment-based model that leverages text message reminders to prompt patients to inform the pharmacy about changes to their medications a month before their appointment. The patient also receives text messages reminding them of their appointment.
“This model allows for the pharmacy to better plan workflow and ensures each patient receives optimal care as they know in advance when the patient will be in the pharmacy and can plan to offer additional services like immunizations and/or comprehensive medication reviews,” Brous said.
Stop & Shop’s Time My Meds medication synchronization program is yet another illustration of what supermarket pharmacies are doing to be a true health destination. “People can get all of their prescriptions filled at the same time or, if it’s more economical for their budget, they can break it up to receive them at multiple times,” said Katie Thornell, the chain’s director of pharmacy operations. “It helps keep people on track if they are using pill boxes. We get in touch with their doctor to get their refill, make sure the medication is in stock when they need it, because we know when they are coming in to pick up their medication.”
Getting Creative with Chronic Care
Helping people manage chronic conditions also has become a priority and capability of supermarket pharmacies.
Publix is a case in point. The supermarket pharmacy has created a closed-door specialty pharmacy offering, which Brous noted “ensures a smooth process for patients that are directly referred to the specialty pharmacy or for patients who present to one of our retail locations with a specialty prescription.”
Kroger is no stranger when it comes to managing chronic conditions. It is leveraging its dietitians and nutrition experts to help patients with obesity, heart disease and diabetes via Food as Medicine, a campaign it launched six years ago that offers medical nutrition therapy solutions.
“The Food as Medicine campaign is a way to address some of the issues around chronic disease. We believe we can do that from the lens of a grocer in conjunction with our Kroger Health business with the pharmacies and the clinics,” Watkins said. “As these patients are entering into either the clinic or pharmacy or health system, the pharmacist, nurse practitioners and PAs are aware of the service, and they can also direct patients to our dietitians for free telenutrition visits.”
As part of Kroger’s free virtual visits with a nutritionist, patients receive a meal plan, counseling and a road map to success in the form of a plan of action to take with them after their visit.
The ability to collaborate with physicians and health systems and forge partnerships is becoming a signature of many successful supermarket pharmacies.
Watkins pointed out that Kroger’s clinic business has been really focused on addressing gaps in care. “If we notice that we can impact care by beginning to treat things like diabetes and high blood pressure, we go ahead and initiate treatment and work with their primary care doctors.”
Kroger also has entered into a partnership with a health system in Little Rock in which it embedded one of its pharmacists with the clinical team. “We focused on not only medication reconciliation, but how could the pharmacist impact and drive care for their diabetic patients,” Watkins said. “As a certified diabetic educator, she was able to counsel them with food choices and diet, and since she was practicing within the store, she also interacted with these patients as they were shopping. The group was able to effectively drop A1C by two points, and they were successful in meeting one of their quality measurements. It shows that with a multi-collaborative approach with our pharmacists, you are able to improve the health of that one population.”
Publix also has made a huge commitment to improve patients’ health through collaborations with health systems.
Publix Pharmacy has joined forces with eight health systems in communities across Florida and one in South Carolina. With these relationships, Publix operates 14 pharmacies onsite at hospital campuses and supports 11 other hospitals from a nearby retail pharmacy. Publix Pharmacy offers services that include delivering discharge medications to a patient’s bedside prior to leaving the hospital and delivering medications to hospital employees. Publix also has teamed up with a Volunteers in Medicine Clinic location in Florida to manage a charity care program that supports the indigent population in Stuart, Fla.
“Continuum of care in the medical space is a top priority for Publix to align patients with the ability to transition back home from their hospital or outpatient stay,” Brous said. “We understand that we are an integral part of the healthcare team and can have a significant impact on reducing hospital readmissions.”
Through collaborations with three of its health system partners, Publix has launched 43 Walk-In Care clinics within its retail pharmacy space that allow patients to conduct a virtual visit with a healthcare provider and pick up any prescribed medications directly after their visit.
To expand available services, Publix and BayCare recently piloted a phlebotomy offering at two Walk-In Care clinic locations. A phlebotomist is set up onsite, and patients can schedule an appointment online or in store.
The Pandemic and Beyond
Supermarket pharmacies also have stepped up in the unchartered waters of COVID, making huge commitments and investments necessary to ramp up COVID-19 testing and COVID vaccinations, all while providing a range of other vaccines.
Stop & Shop is a standout on the vaccination front. Thornell said that the chain had a very strong record-breaking flu season, and pneumonia vaccinations were in demand, as well. Stop & Shop also began to administer vaccines to younger children when states, such as Massachusetts, lowered the age limit that was previously set at 9 years old and older. “We worked with pharmacists for refresher training, and we were able to adapt to meet the updated guidelines,” she said.
Additionally, Stop & Shop also offers COVID vaccines and it has hired pharmacists, including recently retired pharmacists who were reactivated to assist with administering these vaccines. In many areas, the chain partnered with testing programs so that COVID testing could be done either in their stores or parking lots.
Kroger quickly rose to meet the challenges of COVID. “In 18 states, we did more than 200,000-plus COVID tests over a period last summer,” Watkins said. “At this point, we have given over 2.1 million vaccines, with more than 113,000 that have been given to our own associates.”
The chain supports mass clinics, deploying staff to assist local and state authorities in delivering the vaccine to the community. For instance, in Cincinnati, its pharmacists are working very closely with the mayor and health department, running mass events and doing some drive-thru testing at multiple sites in Kentucky.
In yet another partnership with IBM Watson, Kroger developed an interactive phone system and online scheduling solution with its technology teams. “In the early part of the vaccine rollout, there were eligibility requirements we had to meet, and we were able to use the bot technology in a way to check eligibility that also allowed you to schedule your round trip appointment,” Watkins said. “That’s a convenient way for our customers to get their appointments. It also streamlines things for our teams because then they know, ‘How can I manage my supply, how do I manage my workflow, the queue?’ as these folks are coming into our location.”
Publix Pharmacy also has stepped up with COVID immunizations, starting on Jan. 7. To date, Publix has administered more than 2.3 million doses. “We have supported over 1,000 pharmacy technicians to achieve the necessary training to become immunizers — a huge advancement for the pharmacy profession,” Brous said.
What will the future hold? It remains to be seen what innovation supermarket pharmacies will embark on next, but one thing is certain, supermarket pharmacies have covered many bases and unquestionably have established themselves as health destinations.
Thornell said she envisions resuming in-store health screening events in which Stop & Shop partnered with sponsors and in-store wellness events with its trained pharmacists based on their state regulations to do blood pressure, cholesterol screenings and blood glucose readings, as well as looking at immunization or medication histories with customers. “You were able to walk up, you didn’t need an appointment and you could participate in in-store events, which were held six times a year,” she said. “It is something that our customers and grocery shoppers, typically those who weren’t familiar with the pharmacy, really enjoyed.” dsn