Pharmacy Innovator of the Year: Albertsons puts patients in the spotlight
Albertsons’ long game has seen it bet big on patient care — and it’s paying off
Albertsons Companies officials realized a long time ago that a focus on patient care could win out. Though the Boise, Idaho-based company — which operates in 35 states across 21 banners — has made its name as a powerhouse in the grocery industry through its acquisition of Safeway, its ownership of meal kit maker Plated and its portfolio of multiple $1 billion private-label brands, the work done by its roughly 1,800 community pharmacies is cementing its place in the lives of its patients and setting it apart as a pharmacy operator.
The retailer has managed, in many areas, to take the practice of pharmacy to the next level. Not satisfied at having been the first national chain to roll out pharmacist-administered immunizations and have the first pharmacist prescribe birth control to a patient in Oregon, in 2017, it became the first national chain with pharmacy technicians immunizing patients in Idaho under state law. Collaboration with state boards of pharmacy has kept it on the forefront of pharmacist prescribing capabilities in such states as Washington, California, Colorado, Oregon and Idaho; and a combination of combining pharmacists’ clinical skills with infrastructure from the Safeway merger and its recent MedCart acquisition has led Albertsons to make strides in its specialty pharmacy approach.
For these reasons and more, Albertsons has been named Drug Store News’ 2018 Pharmacy Innovator of the Year. Its pharmacy prowess starts with a strategy based on the role of its stores in its shoppers’ lives.
“In many of our markets, we trade in, we have No. 1 or No. 2 market share — we’re very entrenched in our communities,” said Nasri Massaad, vice president of Albertsons’ West region. “The high-level strategy is the same across all our pharmacies — to run strong patient-centric pharmacies, where our pharmacy teams provide personalized wellness experiences to every patient with every interaction, drive more customers to the pharmacy and the store, and convert our grocery shopper into a pharmacy shopper — all making them customers for life.”
Integral to this strategy has been leadership that recognizes the value of a pharmacy patient — whether it is a new one or a converted shopper.
“It starts with our CEO Bob Miller, and now following him Jim Donald,” said Tom Rousonelos, Albertsons vice president of pharmacy operations. “Bob’s philosophy has been that the pharmacy patient is the most important customer to us for a myriad of reasons — they’re the most loyal, they’re the stickiest and, quite frankly, they spend the most.”
As a result, Rousonelos said, the company has developed a three-pronged approach to pharmacy and converting grocery shoppers into pharmacy patients — focusing on scripts, standards and service. These aims begin with filling prescriptions, but are largely focused on efforts that go beyond it — both as margin pressures increase and payers, federal and private, keep their eye on patient outcomes when reimbursing pharmacies.
“We’re looking to expand beyond conventional fee-for-service prescription fills. Our big emphasis is on patient care,” Rousonelos said. “We’re a community retail pharmacy. For us, it means we attempt to practice pharmacy like an independent pharmacy does, with a very personalized approach. It also means encouraging our local pharmacists to engage the community, so they have a local pharmacy that can deliver many of the services they need, and they know about the services.”
Among the services Albertsons provides, besides a host of immunizations, are medication therapy management, comprehensive medication reviews and travel health offerings undertaken in partnership with a physician to provide both necessary immunizations, oral prescription and OTC medication to name a few. MTM administrator OutcomesMTM has recognized Albertsons as its top large pharmacy chain for nine straight quarters, noting the impact that an Albertsons pharmacist has on optimizing drug therapy. And while payers look at outcomes on such services, executives said that isn’t the main reason these services are integral to its pharmacy offerings.
“The way we look at it is, that’s just part of the job, whether you get paid for it or not,” said Mark Panzer, senior vice president of pharmacy, health and wellness. “Looking at the complete medication reviews and medication therapy management — that’s what we should be doing with a patient, making sure they get the best possible outcome based on their medications, their disease state or health condition.”
Beyond more traditional pharmacist enhanced services, Albertsons works closely with state boards of pharmacy to get in on the ground floor of expanded abilities for its pharmacists. Even before the Idaho law that allowed pharmacists to prescribe urinary tract infections and cold sores treatments, as well as statins for patients with diabetes, Albertsons was working with the board of pharmacy on a pilot that ensured its pharmacists were ready on day one.
“When it comes to those types of programs that require some legislative efforts, we work with our local state boards of pharmacy and legislators,” said Nikki Price, director of pharmacy operations at Albertsons’ Intermountain region. “We’re really instrumental in helping get those laws passed to allow us to do those services. We see the benefit of being able to service our customers and provide that additional care to them, so they come see us instead of another pharmacy.”
The company’s approach to patient care also encompasses specialty pharmacy, an area where it’s been gaining ground, in particular around how and where specialty medications are delivered. Brian Hille, vice president of patient, specialty and wellness, said that while the company does a good portion of mail-order fills around specialty, it also is offering in-store services — from pickup and counseling to the administration of long-acting injectables. It’s another way the chain makes itself a partner to manufacturers, as well as patients.
“Our next phase for some of these medications is what I call community pharmacy augmenting specialty services,” Hille said. “What we offer is specialty pharmacy services for medications, with the ability to send the fill to the community pharmacy so the patient can pick up their specialty medication along with the rest of their community pharmacy medications. This makes their specialty-medication fulfillment the usual rather than the unusual.”
All of these patient services position Albertsons for future growth by converting patients in-store, as well as by differentiating itself to managed care partners who can drive new lives into the pharmacies. This long history in pharmacy sets a strong foundation with one repeating lesson. “We’ve learned to keep the sacred relationship between the pharmacist and the patient at the center of everything we do” Panzer said.
The company’s size is another driver pushing Albertsons forward, said Dan Salemi, Albertsons group vice president of pharmacy services.
“One of the differentiators with us is we’re large enough to have some significant volume and get some interest with manufacturers who want to run a program, and we’re small enough to be nimble to pull it off,” he said. “We’ve got a reputation for executing well, so we’re in the sweet spot of moving quickly and having enough volume and scale to make an impact.”
Albertsons takes personal approach to specialty
As more specialty medications are approved, and as they eat up more of healthcare spending, companies are faced with the dual need to offer these drugs — some of whose distribution is limited — and contain the costs. Albertsons Companies has taken that dual goal and added a few of its own — delivering on convenience through its network of roughly 1,800 pharmacies.
One of the areas Albertsons pioneered is its now ACHC- and URAC-accredited specialty approach that has been through its pharmacists being able to administer long-acting injectables to patients in 20 of the states it operates in. That required the company to build a model that facilitated seamless communication from the prescriber to its Boise, Idaho-based care coordination center, which in turn communicates with pharmacies and its two fulfillment centers — MedCart in Livonia, Mich., and another in Santa Fe Springs, Calif. — or any in-store pharmacy.
“Through the process of connecting specialty to the community pharmacies, we found that there are a lot of other opportunities where that model of care can be applied to a whole host of additional medications,” said Brian Hille, Albertsons vice president of patient, specialty and wellness. In particular, manufacturers that want to build more support into their delivery channel, including such reimbursement support as benefits verification, prior authorization and co-pay assistance all can be done in this model. Then a patient picks up the specialty medication at any of its roughly 1,800 community pharmacies.
“The community pharmacy fills a prescription that’s fully supported by the centralized specialty pharmacy team, just like the care provided by traditional specialty pharmacy today, but it doesn’t go to the fulfillment center and ship to the patient’s home,” Erin Shaal, director of specialty care said. “Actually, we’ve seen some significant advantage with patients picking up their specialty medication at our community pharmacies. Utilizing community pharmacy is just a lower cost, more personal approach, with the opportunity to provide patients face-to-face services.”
Building out specialty is key to a strong pharmacy offering, said Mark Panzer, Albertsons senior vice president of pharmacy, health and wellness.
“That’s where the growth is going to be as far as taking care of patients, as well as the companion script that comes along with it,” Panzer said. “Having the correct patient care protocols and having the relationship with that patient, their doctor and their healthcare group is important.”
Albertsons’ empowerment gives pharmacists an edge
Albertsons has long recognized its pharmacists’ clinical skills and continues to expand them
At the center of Albertsons Companies’ pharmacy strategy is patient care — and at the center of its patient care efforts are pharmacists who have been empowered to put their significant clinical education and skills to work.
Executives said the chain realized early on that making sure pharmacists are empowered to provide clinical services and build patient relationships — and thus loyalty — were two sides of the same coin.
“The priority is one and the same: to become very accessible to the patient, to remove friction and be able to improve their health care with whatever project we may be able to do,” said Dan Salemi, Albertsons group vice president of pharmacy services. “It drives the incremental sales, which is great, but it also builds that relationship with a patient that is ‘sticky’ and keeps them in our stores. To take care of that patient and be able to differentiate ourselves from our competition is going to pay off in the long run.”
Such services as medication therapy management, comprehensive medication reviews, diabetes management and immunizations are a cornerstone of Albertsons’ strategy — and they have been longer than there have been central metrics by which pharmacies are measured, from the perspective of both patients and payers.
“What was once ‘my hobby’ is now standard — MTM services is a very standardized service,” said Brian Hille, vice president of patient, specialty and wellness. “We put a huge amount of effort into making sure that our pharmacists can be successful with MTM services. It’s important to show our commitment to our partners that we’re going to do a good job taking care of our patients.”
Besides MTM, Albertsons was the first large national chain to offer immunizations in the late 1990s, and since then has made a point of ensuring it stays on the cutting edge of what services its pharmacies can offer. With regard to immunizations, in 2017, due to an Idaho law, Albertsons and Washington State University College of Pharmacy trained the first pharmacy technician in the nation to administer immunizations. In addition to adding an extra set of hands to the pharmacy, leaving pharmacists with more time for other clinical services, the offering has gotten technicians more invested in the job.
“When you go talk to them at the store directly and ask them how it’s going, they absolutely love it,” said Nikki Price, director of pharmacy operations at Albertsons’ Intermountain region. “They really take ownership from the initial conversation to after they give the immunization.”
Ahead of the tech immunization law being enacted, Albertsons participated in a pilot for the service, an approach it also used this past year when preparing for expanded prescribing authority — treatments for urinary tract infections, cold sores and gaps in care, particularly statins for patients with diabetes — in Idaho to take effect. In both instances, being an early adopter has been a way to set Albertsons’ pharmacists apart through their clinical capabilities.
“You want to be on the ground floor because if you’re waiting to see what’s going to happen, you get left behind,” said Mark Panzer, senior vice president of pharmacy, health and wellness. “If you’re the first to be able to test it, you can take advantage of that as a differentiating point with the consumer and the patient.”
Another differentiator in which Albertsons was getting in on the ground floor on was administering long-acting injectables, a service that began in Texas roughly seven years ago and has expanded to be a large part of how Albertsons sets its specialty offerings apart. In states where pharmacists can — 20 of the states the company operates in — they administer the drugs in a private consultation room when patients arrive to pick them up.
“The direction of travel for therapies in the future is towards long-acting. If you can get one dose once a month or once every three months, that’s fantastic, we just have to solve for the convenience and availability for the patient to receive the administration,” Hille said. So the company built a model in which a prescription goes to Albertsons’ care coordination center in Boise that handles the authorization and affordability, then pushes the prescription to the community pharmacy for administration. With these drugs, which include osteoporosis, opioid recovery and mental health treatments, being able to go to the local store is more than simply an increased convenience, it improves adherence and persistence as compared with traditional administration in a clinic.
“It really improves the convenience and takes the stigma away. Typically you go to a mental health clinic or recovery clinic and there’s a lot of stigma associated with those places. Unfortunately, American society has done that,” Hille said. “Coming into a Safeway, an Albertsons, a Vons, wherever to have this administered, nobody knows the difference.”
Albertsons found that when it comes to patients’ acceptance of pharmacist-administered injectables, it sits around 96%, and a meta-analysis found that its patients see a roughly 86% adherence rate, compared with adherence rates between 33% and 54% in other studies. The company has expanded into ventrogluteal injections and is eyeing subcutaneous administration of immunoglobulin to assist patients with the transition to self-administration at home.
Key to enabling all of these services, Hille said, has been making sure that a pharmacist’s time is not taken up entirely by administrative duties.
“I have this philosophy that I want to keep our pharmacists in the store patient-facing, and not working on administrative work,” he said, and as a result, many of the company’s clinical offerings are outlined for pharmacists through resources they can access before performing the service. “We give them a service outline that tells them how to perform the service and lets them use their education, training and relationships with their patients to change behaviors. In my opinion, that’s how pharmacists improve care,” Hille said.
The Albertsons’ approach boils down to leadership realizing that its pharmacists are the key to improving patient care and to setting the chain apart from competitors. “We look at scope of practice, and we look at anything that’s innovative and ask, ‘How do we be the first to market?’ You jump on those opportunities not because you’re going to be first and it’ll generate sales, but because it’s good patient care” Panzer said. “Pharmacists went to school for clinical outcomes and they have great clinical skills, so why not utilize them?”