Sei sulla pagina 1di 12

Help Your Heart

Hypertension Management Program

Midwestern Chicago College of Pharmacy

555 31st St

Downers Grove, Illinois 60515

Proposed on April 20th 2018

Alaina Karamitsos, PharmD candidate 2021

Jayson Karuna, PharmD candidate 2021

Tu Le, PharmD candidate 2021

Jeel Patel, PharmD candidate 2021

Table of Contents:
Executive Summary……………………………………………………………… 2

Environmental Scan……………………………………………………………… . 2-3

Mission and Vision ……………...……………………………………………..… 3

Description of Program & Services………………………………………………. 3-5

Description of Operations…………………………………………………………. 5

Facility & Equipment………………………………………………………………..5

Operational Structure, Processes, & Management……………………………...…... 5-6

Marketing Plan………………………………………………………………..……. 6-7

Financial Summary………………………………………………………….………7

Evaluation.…………………………………………………………………….……. 7-8

Appendix A……………………………………………………………………....... 9

Appendix B………………………………………………………………………….. 10

References……………………………………………………………………………. 11

Executive Summary:
The mission statement is to improve the quality of life for hypertension patients through
medication drug therapy and lifestyle management. This business plan was created to help

1
empower, and educate patients with hypertension or at risk of hypertension to achieve positive
long-term health outcomes regarding their condition . By collaborating with the pharmacists,
patient will be provided with knowledge, resources, and gain relative confidence in order to
strengthen their ability to manage their condition. The proposed service of the hypertension
management program is to offer a personalized plan to patients that have hypertension or at risk
of it to better help manage their condition and related afflictions. To formulate a successful plan,
the pharmacists and technicians need to collect all relevant patient information from the patient
and provider. The trained pharmacist will evaluate what lifestyle modifications and medication
problems need to be adjusted in order for the patient to receive the most optimal healthcare.The
program will be offered within a pharmacy, specifically in a private consultation room. This
space will have several advanced blood screening machines, like the Omron’s IntelliSense
Professional digital blood pressure monitor. Omron Health Management software will also aid
pharmacists in reading and analyzing the patient’s plan. Pharmacists must possess the knowledge
to create a precise plan that proposes optimal care options and medication management for
patients. Therefore, training and certification in hypertension will be necessary for pharmacists to
obtain before providing consultation. This program entails a cooperative clinic with a competent
provider to work to collaborate with the pharmacist. The biggest expense is the pharmacists
salary, and costs associated with the start up itself. After the first year, the costs associated with
the program will remain relatively leveled. The net income projected for the first year is $63,000.
The program offers one time complementary blood pressure screen reading to introduce the
services to those referred or introduced to the service. The atmosphere of the private consultation
room, which is adjacent to the clinic provides a welcoming and professional atmosphere. The
technology will be the most up-to-date to ensure pharmacists prioritize a patient focused
approach. The staff will be aware of the program and there will be advertising, such as brochures
and direct advertising to high risk demographic groups . Insurance will be billed by the provider
after the screening in collaboration with the clinic.The process of hypertension service will be
provided in the most efficient and understandable method. In all, the information and
convenience this plan offers will improve the overall health of patients by providing them with
the most optimal healthcare solutions.

Environmental Scan:
External: According to a research study conducted by “Project ImPACT” by the American
Public Health Association, pharmacist intervention heavily benefited patient overall hypertension
goals. Patients became more educated and informed to incorporate better lifestyle changes after
similar programs were conducted. However, certain barriers were still present hindering the
overall success of the program. Inaccurate measurements decreases the overall effectiveness of
the program. Proper training and suitable equipment can lessen these types of inaccuracies.
Collaborating with other healthcare providers and ensuring patients are gaining useful
knowledge results in the most success for these types of program.s.

Internal: As other pharmacies or institutions offer similar hypertension management programs,


our program prioritizes comprehensive wellness. The goal is not simply to lower patient’s
unhealthy blood pressures, but also make a significant impact in improving their well being
altogether. The hypertension plan our program provides will incorporate modifications and
therapy management that focus on the quality of life of the patient. As a healthcare related

2
business, organizational needs should always depend on type of superior quality of care, aside
from strictly financial motivations.

Mission/Vision Statement:
Mission Statement: To improve the quality of life for hypertension patients through
pharmaceutical care of drug therapy and lifestyle management.

Vision Statement: To be the first choice for patients visiting a pharmacy with the ultimate goal of
providing excellent service to limit risk factors of hypertension.

Description of Services:
Hypertension is the leading cause of heart disease and stroke, so managing this condition can
make a dramatic difference for millions of Americans. Our proposed service is to offer a
comprehensive, personalized plan to patients who have hypertension or are at risk that will
suitably manage their condition and aim to reduce any possible related complications. Our
service is intended for those suffering from high blood pressure and key demographic groups that
are specifically at a higher risk of having high blood pressure. Such as patients with conditions
like kidney disease, high cholesterol, or diabetes. Also patients that are elderly, African
American, and/or overweight will be marketed towards more heavily to use our program due to
their increased risk factors. Due to limitations in payment options for pharmacists that provide
patient care services, patients must be initially referred to use our program from the adjacent
clinic by an eligible provider so they can subsequently bill for the pharmacist’s services. The
services will be offered in the pharmacy’s consultation room and therefore will not take any
additional space. Existing patients that have hypertension or that are included in a high risk
demographic group will be referred to the adjacent clinic by the pharmacist for further
consideration of our supplementary services.
In order to achieve our objectives and give patients a successful plan they can follow, our
pharmacists/technicians need to initially collect all necessary patient information from them and
their healthcare provider, including all relevant medical records. Pertinent biometric tests, a
physical assessment, and overall medication history is also necessary to obtain. After patient
information is gathered, the pharmacist will analyze the records and evaluate issues that can most
effectively be addressed through the hypertension service. Lifestyle modifications, medication
problems, and limiting the patient’s risk factors will be primarily considered. Next, in
conjunction with the clinical provider and the patient, the pharmacist will develop a detailed plan
that targets areas for improvement to provide patients with the most optimal healthcare. The
hypertension program itself will include the frequent monitoring of the patient’s blood pressure
to examine the health outcomes of the plan’s proposed medication management and lifestyle
changes. The results of our services can then be determined using monitoring parameters that
evaluate whether the consulted adjustments made a beneficial impact. To best alleviate workflow
impairments for the pharmacist, additional technicians will be needed. Technicians will be
trained to properly document patient data, but only pharmacists will be trained to give accurate
blood pressure readings. Obtaining accurate blood pressure readings is absolutely crucial to the
success of our services, so both pharmacists and technicians will be required to complete a blood
pressure certification course before they can give readings.Technicians can partake in such
opportunities also. The pharmacists will contribute to the service by actually accessing the data
and constructing the plan itself. A provider will need to refer appropriate patients to the

3
pharmacy’s hypertension program, so our service can only be offered at a location with a
collaborative provider.

SWOT Analysis:
● Strengths
○ One on one private counseling can provide patients with better insight on
lifestyle management to influence the most positive long-term health
outcomes for chronic conditions
○ Blood pressure screenings, counseling, and health education helps patients
control their blood pressure
○ Providing availability to consistently meet with patients encourages and
motivates them to stay on course with healthy choices
○ Can integrate existing services such as MTM, adherence, and dispensing
services that the pharmacy already provides

● Weakness
○ Minor errors in techniques when measuring blood pressure could lead to
inaccurate results and subsequent mismanagement of treatment strategy
○ Pharmacists are knowledgeable about many different disease states, but
still lack sufficient expertise about the causations and pathologies of
conditions that physicians possess
○ Payment model struggles due to limitations of pharmacist provider status
and third party negotiations

● Opportunities
○ Increased accessibility to care, patient can seek additional clinical services
and long-term monitoring without the need of a specialist or frequent
provider appointments
○ Patients gain more knowledge to obtain a healthy lifestyle by
communicating one on one with a pharmacist, these general lifestyle
promotes overall wellness and longevity
○ The success of the patient care service can influence needed legislation
regarding pharmacists’ provider status

● Threats
○ Other pharmacies that offer similar hypertension programs, such as CVS
Minute Clinics that monitor blood pressure
○ Campaigns that increase services and offer collaborative solutions offered
by foundations, such as American Medical Group Foundations’ “Measure
Up Pressure Down” campaign
○ General blood pressure screenings already offered in wellness centers,
clinics, and hospitals

Description of Operations:

4
Facility, Technology and Equipment
The hypertension management program will be provided in a pharmacy and the
monitoring/consultation aspect will operate in an private room within the pharmacy. Additional
space and renovations is not necessary if the pharmacy already contains a consultation room. The
pharmacist will discuss necessary patient information and health records. Patients that come to
the pharmacy can be referred to our program for further consideration if they show risks of
having high blood pressure. The private consultation room will have multiple advanced blood
pressure screening machines. Specifically, Omron’s IntelliSense Professional digital blood
pressure monitor (HEM-907XL model). This equipment is a one-time purchase that
increases accuracy by averaging out multiple measurements in one reading and
automatically predermines cuff inflation level. Additional equipment costs include
computers and the supportive software system for our blood pressure monitor called Omron
Health Management software. Pharmacists will use the Omron software to seamlessly upload
readings and analyze measured data to construct a successful patient plan. Existing computer
software within pharmacies will be able to document patient's’ medical and medication history.
However, software similar to E-Prescribing software ERx is preferred to flag existing patients
currently on hypertensive therapies, taking hypertension medication, or have chronic conditions
associated with hypertension. Utilizing a software that can notify pharmacists about qualifying
patients will increase enrollee opportunities. Variable resources are mostly centralized to
medications already offered in the pharmacy and important paperwork denoting the various
aspects of the plan.

Management Structure
Licensed pharmacists that work at the pharmacy will be the principal managers of the
hypertension management program. The pharmacists must be able to properly analyze and
evaluate issues associated with hypertension. The pharmacists must also possess the knowledge
to develop an accurate plan that offers optimal care options and medication management
strategies for patients. Pharmacists will be trained and certified by an accredited hypertension
management program. Technicians will not be trained to do readings, but will be trained in
facilitative processes of the program to best ease the workload for the pharmacist. The work the
program requires might be quite different than the traditional roles/responsibilities for
pharmacists and technicians, so only distinct types of employees will participate in the program.
Employees who legitimately desire to improve patient healthcare outcomes is a requirement
because improving quality is an expectation for this service, so negligence can not be tolerated.
An additional floater pharmacist(s) will be hired for 10 to 15 hours per week so staff pharmacists
can work on the hypertension program for 2 to 3 hours a day. 2 to 3 part time technicians will
also be hired to further balance out traditional pharmacy workflow, without impeding the
hypertension program. Furthermore, the program requires a cooperative clinic with a qualified
provider to work in conjunction with the pharmacist. However, resources for the clinic should
already be within the clinic and the mutual financial gain from visiting patients should be an
incentive for clinicians.

Processes
Payment options are a delicate component of our offered hypertension service. Incident-to billing
is a method for pharmacists to bill patient services as a non-provider. However, in order for

5
insurance to pay for the chronic care management services for patients, the patients must be
diagnosed with two or more chronic conditions that will last a year or longer. For pharmacists to
get reimbursement as auxiliary personnel, regulatory limitations require collaborative physicians
to actually bill for the service itself.

Marketing Plan:
Our pharmacy follows the seven P’s of health care service to build marketing plan.

Product:
Benefits included:

1. Frequent measurement and monitoring of the patient’s blood pressure


2. Assisting with medication therapy management through recommend adjustments, proper
medication adherence, evaluating adverse reaction, and recommending cost-effective
medications
3. Education based on disease, pathology, and lifestyle education in order to help patients
have a basic understanding of their chronic conditions
4. Counseling and incorporation of lifestyle modifications, such as encouraging recommend
nutrition (DASH diet and sodium reduction), physical activity (exercise), weight loss
management, and smoking cessation
5. Referring patients to supplemental services offered by the adjacent clinic to further
benefit enhance health
Price:
Prices based on demand and operation based. Prices can fluctuate depending on the amount of
patients enrolled in the service and total amount of operational costs.

Place:
The location of our service within pharmacies will correlate with high risk demographics.
Therefore, our programs will be marketed in communities with higher populations of
elderly,chronic conditions and African Americans.

Promotion:
Offer a one-time complimentary public blood pressure reading and consultation to introduce
patients to the pharmacy’s services. Due to the collaborative effort of our program with a clinic,
direct advertising to patients visiting the clinic is appropriate. Additional advertising to pharmacy
patients can be performed by identifying specific patients meeting established hypertension
criteria. These types of promotions manage to advertise our program to individuals who may
require it the most.

People:
Passionate pharmacists and technicians should be responsible for handling marketing methods,
as they are the most informed about the benefits of our program.

Packaging:

6
This includes tangible and intangible factors. Tangible factors focus on the design of the room
where the staff meets patient. Therefore, the consultation room must be tidy and inviting.
Comfortable chairs, non-distracting accessories, and a welcoming atmosphere is needed to
provide a professional, comfortable space. Intangible factors focus on appearance and the
treatment of the staff to patients. The set up the private consultation room will avoid unneeded
chaos within the rest of the pharmacy and ensure ease of communications to patients. Visual
guides such as brochures and pamphlets will also be on display to give patients confidence about
our program.

Process:
In order to achieve consistent results and success within the program, consistent standardization
of procedures is necessary. This includes having the most up-to-date information technology and
ensuring that managing pharmacists prioritize a patient focused approach.

Financial Summary
The biggest expense within our program is the pharmacist’s salary, and associated costs with the
start up. Following the first year, the costs associated with the program will remain relatively
stable. Salary and information technology costs will be relatively fixed expenses throughout the
years. By providing personalized clinical services, the volume and overall visits to the pharmacy
will increase providing various sources of additional profit. In the first year, expected income is
at a conservative value of $63,000.

Proposed Business/Service Evaluation


The plan will be evaluated quarterly for success, opportunities for growth, and overall
measurable patient outcomes. The number of patients utilizing the service is the main parameter
evaluation the program's success. There are opportunities that will contribute to the overall
success of the plan that are already pre-existing within the pharmacy’s workflow. The program
will be integrated with these types of services that are already incorporated into the pharmacy.
Patients at high risk for hypertension or are currently taking certain classes of medication will be
flagged by the computer system to give the pharmacist an opportunity to manage their
hypertension. For example, adherence calls, new to therapy calls, and 90-day fill requests are all
further opportunities to help manage patient health manage through our established program.
Some of these non-clinical tasks such as adherence calls can be delegated by the technicians.
Increasing technician support will be crucial in managing costs, minimizing spending, and
optimizing workflow. Pharmacists salary is the most substantial expense, but is justified through
their needed expertise. This significant cost can be managed with increasing technician support,
having floater part-time pharmacists maintain already steady workflow, and to the overlap
responsibilities with staff pharmacists. For new patients, measures of success would include
overall reduction of baseline blood pressure, adherence of medication, and rated surveys
covering general lifestyle changes. The Omron Health management software is capable of
tracking readings, setting goals, and analyzing patient progress.

Parameters to Measure Success


Overall reduction in baseline blood pressure at 90 days

7
Stability in blood pressure accessed after 90 days, and in frequent intervals throughout the yearly
monitoring

Enrolling pre-existing patients who the computer flags as eligible

Increase in overall pharmacy volume

Successful patient outreach regarding adherence or 90-day fill opportunities for anti-hypertensive drugs

Increase the number of antihypertensive prescription filled, picked up, and adherence to therapy

Number of patients partaking in the program

Number of claims successful billed and reimbursed

General lifestyle changes that can contribute to positive health outcomes

Appendix A

Start Up Expenses
Omron IntelliSense® Professional Digital $650
Blood Pressure Monitor

8
Omron Health Management Software $1,500

Software Updates (ERX) $1,000

Conset / Authorization Forms $500

Pharmacists Training and Certification $500

Patient information & Brochures $1,000

Miscellaneous collaboration expenses $500

Total $5,650

Direct and Indirect Costs to Be Considered


Direct Costs

Labor:
Salary, benefits, training and certification

Capital Equipment:
Sphygmomanometers,chair, software updates, clinical resources

Administrative:
Compliance,professional service fees, PBM negotiations, malpractice and liability insurance,
legal fees

Miscellaneous:
Outside consultations, marketing, informational resources, patient record keeping

Indirect Costs

Rent

Advertising

Appendix B:
3 Year Pro Forma
Year 1 Year 2 Year 3

9
Screenings 1,500 2,336 3,103
Screening Cost $150 $200 $250

Expenses

Pharmacists $110,000 $125,000 $160,000


Technicians $25,000 $35,000 $48,000
Benefits $3,000 $3,500 $4,000

Start up $5,650 -- --

Misc $1,500 $2,000 $2,500

Software $8,000 $3,500 $5,000

Rent $20,000 $22,000 $25,200

Total Expenses $173,150 $191,000 $244,700

Revenue

Screenings $225,000 $467,200 $775,750

Increase in overall $11,250 $23,360 $38,787


pharmacy volume

Total Revenue $236,250 $490,560 $814,537

Net Income $63,100 $299,560 $569,837

References:
1. “Getting Ready to Create a Marketing Plan?” Pharmacy Sample Marketing Plan -
Executive Summary - Mplans, 9AD,

10
www.mplans.com/pharmacy_marketing_plan/executive_summary_fc.php
https://yourbusiness.azcentral.com/pharmacy-marketing-plan-discount-pharmacy-
24181.html.
2. Posts about Anemia in CVD Patients on Leaders in Pharmaceutical Business Intelligence
(LPBI) Group. (n.d.). Retrieved from
https://pharmaceuticalintelligence.com/category/frontiers-in-cardiology-and-
cardiovascular-disorders/anemia-in-cvd-patients/
3. An Overview of High Blood Pressure Treatment. (n.d.). Retrieved 2013, from
https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-
treatment-overview#1
4. High blood pressure (hypertension). (2018, February 02). Retrieved from
https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-
treatment/drc-20373417
5. Bonner, L. (n.d.). New AHA/ACC guidelines redefine high blood pressure as 130/80 mm
Hg. Retrieved November 13, 2017, from https://pharmacist.com/article/new-ahaacc-
guidelines-redefine-high-blood-pressure-13080-mm-hg
6. Zanni, G. (n.d.). Effective Counseling for Patients with Hypertension. Retrieved
December 4, 2004, from http://www.pharmacytimes.com/publications/issue/2004/2004-
12/2004-12-9091
7. Role of community pharmacists in hypertension management. (2017). Clinical
Pharmacist. doi:10.1211/cp.2017.20203671

11