This program is approved by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit. NCPA is approved by the Accreditation Council for

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1 Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presented by: Cynthia Stamper Graff, President & CEO, Lindora Health Clinic Jack Tawil, CEO, CheckUps Verne Mounts, RPh, Director of Pharmacy, Buehler Food Markets, Inc. 7:45 a.m. - 9:15 a.m., Sunday, October 14, 2007 Anaheim, California Evaluation # P This program is approved by NCPA for 0.15 CEUs (1.5 contact hours) of continuing education credit. NCPA is approved by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

2 Educational Objectives Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenters: Cynthia Stamper Graff, President & CEO. Lindora Health Clinic Verne Mounts, Director of Pharmacy, Buehler Food Markets, Inc. Jack Tawil, CEO, CheckUps Objectives: 1. List attributes necessary in a pharmacy to accommodate the addition of an in-store. 2. Outline market conditions that should be evaluated prior to investing in the in-store clinic niche. 3. Evaluate the potential return on investment in the in-store clinic niche for a community retail pharmacy. 4. Demonstrate the potential applicability of a Convenience Care Clinic in a practice site? 5. Provide insight into the thought process of one organization s approach to include a Convenient Care Clinic in their business. 6. Suggest collaborative opportunities are offered with a Convenient Care Clinic? 7. Elucidate potential opportunities that might lend themselves to expansion of the Pharmacist s Professional Practice Model? 8. Suggest tools to measure ROI.

3 Educational Objectives Presentation Title: Investigating the ROI: Are Convenient Care Clinics a Sound Decision four Your Pharmacy? Presenter: Verne Mounts, R.Ph. 1. Demonstrate the potential applicability of a Convenience Care Clinic in my practice site? 2. Provide insight into the thought process of one organization s approach to include a Convenient Care Clinic in their business. 3. Suggest collaborative opportunities are offered with a Convenient Care Clinic? 4. Elucidate potential opportunities that might avail themselves to expand the Pharmacist s Professional Practice Model? 5. Suggest a few tools to consider the objective measurement of success to establish an ROI.

4 Verne L. Mounts Mr. Mounts currently holds the position of Director of Pharmacy Operations for Buehler Food Markets, Inc. In this capacity, he is responsible for the day-to-day operations of 11 Pharmacies in this 13 store Grocery/Pharmacy chain. Prior to joining Buehler Food Markets, Inc., he developed, managed, and staffed his own relief pharmacy service, which serviced primarily retail independents and chains. His clients included Tops Markets, Kroger, and several independents. Over the years, Mr. Mounts developed, owned and managed an independent Pharmacy in Ohio. He has managed numerous retail pharmacy operations. He has five years management experience in relief pharmacy and practiced as a staff pharmacist in that industry for eleven years. Mr. Mounts has experience in independent, clinic, retail chain, inpatient, home healthcare, mail order, nursing home, Indian Health, public health, county jails, state prisons, and consulting pharmacy. Mr. Mounts is a columnist in six newspapers in Ohio, Your Hometown Pharmacist, where he attempts to be an advocate for the profession of Pharmacy. Mr. Mounts holds a B.S. Pharmacy degree from the University of Washington in Seattle. Mr. Mounts was the recipient of the following: 2006 Beal Award from the Ohio Pharmacists Association for Outstanding Contribution to the Profession of Pharmacy, Ohio Northern University College of Pharmacy Community Preceptor Award , Ohio Pharmacist s Association 2002 Media Award co-recipient, and the Pfizer Pharmaceutical Community Pharmacy Externship Award Mr. Mounts holds several NIPCO Certifications: Osteoporosis Care, Antimicrobial Therapy, Group A Beta Hemolytic Strep Screening. And the Ohio Northern University Immunization Certification. Mr. Mounts serves his community as a board member for the Ashland Symphony Orchestra, Ashland, Ohio; Vice President of the Ashland County Cancer Association, National Reye s Syndrome Foundation Regional Coordinator and is co-instructing a Pharmacy Technician Training Program for the Ashland County West Holmes Career Center, Adult Education. Mr. Mounts is also a member of NCPA since 2001, APhA, Ohio Pharmacists Association, and the North Central Ohio Pharmacists Association. Mr. Mounts is recognized as a visionary for leveraging technology and technical staff to provide time management opportunities so that Pharmacists may practice the profession as it was intended to be practiced.

5 Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Cynthia Stamper Graff Lindora, Inc. Convenient Care Clinics CLINIC BUSINESS MODEL Walk-in convenience Limited scope of services Reasonable price with payer coverage Lower labor cost and smaller space Tech-based protocols; physician oversight Convenient Care Clinics What is driving retail clinics? Shortage of Primary Care Physicians Health Care costs are increasing DIY approach to healthcare Services and devices for home care Access to technology Investors funding 1

6 Convenient Care Clinics Retail Clinic Type Services Allergies Athlete s Foot DTaP (Diptheria/ Bladder Infection Cold Sores (ages 12+) Tetanus/Pertussis) Bronchitis (ages 10-64) Deer Tick Biters (12+) Flu (Seasonal) Ear Infections Impetigo Hepatitis A (adult) Pink Eye and Styes Minor Burns/Rashes Hepatitis A (child) Sinus Infections (5+) Minor Sunburn Hepatitis B (adult) Strep Throat Poison Ivy (3+) Hepatitis B (child) Chlamydia (16+) Ringworm IPV (polio) Flu Diagnosis (10-64) Swimmer s Itch (3+) Meningitis Mono Pregnancy Testing MMR (Measles/Mumps/ Swimmer s Ear Rubella) Pneumonia List courtesy of MinuteClinic Convenient Care Clinics Convenient Care Clinics Clinics Opening in the U.S 6000 Number of clinics CAGR = 311% Scott & Co. Jan Dec May-07 Dec Dec Dec Dec

7 Convenient Care Clinics Retailers are testing while expanding 2500 stores in the next several yrs. 400 clinics in next three yrs. Up to 2000 clinics in five yrs. 55% stores by clinics in clinics 5,000 + U.S. retail clinics Convenient Care Clinics COMPANY FIRST ½ 2006 APRIL 2007 Aurora Quick Care Retail Clinic Comparisons (Open Locations) Corner Care Clinics Curaquick MediMin MEDPOINT express MinuteClinic My Healthy Access QuickHealth RediClinic SmartCare Solantic Sutter Express Take Care Health System (includes 10 in OR which closed in Sept. 06) The Little Clinic TOTAL Convenient Care Clinics CONSUMER SURVEY: IN-STORE SERVICES Vaccinations 62% Minor illnesses, infections, injuries 50% Prescriptions 44% Weight loss/management 43% Diagnostic tests 40% Counseling 35% Suturing of cuts 30% Physical exam 30% Chronic diseases 30% Rehabilitation 23% Well-child care 23% None of these 14% 3

8 Convenient Care Clinics In consumer surveys, who indicated a likelihood to use retail clinics? All 2+ Children Hispanic Younger, <40 No Family Dr. Long Wait to See Dr. Lower Income HDHP Consumers 49% 58% 62% 57% 50% 55% 52% 68% 4

9 Convenient Care Clinics Consumer concerns about clinics have declined but remain...while satisfaction of users remains high Overall, how satisfied were you with your or your family member s experience using an onsite health clinic in a pharmacy or retail chain on the following items?" Source: Harris Interactive Survey, April 2007 Convenient Care Clinics 5

10 Building A Convenient Care Clinic Jack Tawil Healthcare Crisis Approximately 47 million Americans uninsured in 2005 Over 16 million American are underinsured $2.0 Trillion in healthcare spending Reduced number of medical professionals Reduced access, extended wait times, clogged ER s NP vs. MD Corporate Practice of Medicine Laws will differ from state to state Oversight Physician Laws differ from state to state

11 NP vs. MD What is a Nurse Practitioner? Nurse with Masters in Science of Nursing Certified Family Nurse Practitioner by AANP or ACNP DEA numbers in 29 states for full prescriptive authority NP vs. MD Nurse Practitioner Can do 80%-90% of primary care Diagnose, treat, describe Prescriptive authority varies by state Cannot admit or discharge from a hospital MD must sign and approve all protocols Medical Doctor No prescriptive limitations Can admit and discharge No supervision needed Building a CCC Two models Company owned Franchise

12 Building a CCC Dedicate space 120 square feet to 650 square feet Smaller model: $50,000-$75,000 in build out cost Larger model: up to $150,000 Partner with a bank for lease Building a CCC Small Model Single exam room Staff NP only Large Model 2 exam rooms Bathroom Laboratory Staff NP and MA Building a CCC Computer Technology Single platform Practice Management and Electronic Medical Records Inventory Control Protocols Consistent, quality care Stipulates what is beyond the scope

13 Scope of Practice What to Treat Minimal Comprehensive What to Offer Labs Vaccinations Health Screenings Occupational Health Point of care service Offer more to drive up traffic Scope of Practice Treat Upper respiratory Skin Conditions Well visit Screenings Cholesterol Liver function Package Special Scope Of Practice Retail Setting Market your services Flu shot special Occupational Health Government, Universities, and Corporations Drug Screen DOT physicals Blood draws

14 Profitability Goal is to drive traffic into pharmacy 50% of all visits turn into script Law requires patient have pharmacy options 1-2 patients a day at first Within a year reach 30 patients/day Get the patient into the door Will most likely buy script because of convenience Will buy items Strategic alliance with industry leaders

15 Learning Assessment Questions Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenter: Cynthia Stamper Graff, President & CEO. Lindora Health Clinic Questions: 1. Which of the following is one of the driving forces for retail clinics a. Shortage of Primary Care Physicians b. Increasing cost of health care c. DIY approach to health care d. All of the above 2. Clinics in the United States is estimated to increase to by the year 2010 a b c d Acute care and vaccination drive most clinic visits a. True b. False 4. Pharmacies are adding Care Clinics for all of the following except a. To reinforce their consumer offer all around health and wellness b. To take over part of the prescribing benefits of the physician c. Increase customer visits and time in the store d. Drive pharmacy OTC 5. Consumer concerns about clinics have while satisfaction of users remain a. Increased : low b. Declined : High c. Decreased : Low d. Increased : High

16 Learning Assessment Answers Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenter: Cynthia Stamper Graff, President & CEO. Lindora Health Clinic Answers: 1. d 2. b 3. a 4. b 5. b

17 Learning Assessment Questions Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenter: Jack Tawil, CEO, CheckUps Questions: 1. A Nurse Practitioner has all of the following characteristics except: a. Nurse with Masters of Science in Nursing b. Certified Family Nurse Practitioner by AANP or ACNP c. Has DEA numbers in 29 states for full prescription authority d. Admits or discharges patients from a hospital 2. A medical doctor does not need to sign and approve protocols for a nurse practitioner a. True b. False 3. A large model convenient care clinic would typically have which of the following a. 2 exam rooms & laboratory b. Bathroom c. Staff NP and MA d. All of the above 4. Profitability in clinic care is expected to bring in about 1-2 patients a day at first and up to 30 patients a day within the first year. a. False b. True 5. One of the goals of starting a clinic is to a. Drive more traffic into the pharmacy b. Because 50% of all visits turn into scripts c. Provide convenience & compliance for the patient d. All of the following

18 Learning Assessment Answers Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenter: Jack Tawil, CEO, CheckUps Answers: 1. d 2. b 3. d 4. b 5. d

19 Learning Assessment Questions Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenters: Verne Mounts, Director of Pharmacy, Buehler Food Markets, Inc. Questions: 1. What might be one of the biggest impediments to success of a provider of a Convenient Care Clinic? 2. What physical challenges might you face in considering adding a Convenient Care Clinic? 3. What might the response be of the local healthcare community to your consideration of adding a Convenient Care Clinic to your practice? 4. How might the Convenient Care Clinic impact my pharmacy s prescription volume? 5. How important is store foot traffic to the success of the Convenient Care Clinic?

20 Learning Assessment Answers Program: Investigating the ROI: Are Convenient Care Clinics a Sound Decision for Your Pharmacy? Presenters: Verne Mounts, Director of Pharmacy, Buehler Food Markets, Inc. Answers: 1. The financial stability of the provider and their resources to market successfully. 2. The ability to give up square footage for the Clinic and to locate near the Pharmacy and OTC area. 3. The local healthcare community may respond in various manners, such as: outright threats, challenge ethics and conflict of interest, passive resistance, ambivalence and acquiescing in knowledge that if you do not do it someone else may, to actually embracing the concept as a means of keeping non-emergent healthcare issues out of the Emergency Department. 4. One organization realized a positive 1,200 new prescriptions and 61% of Clinic patients being new to the Pharmacy. 5. Marketing and foot traffic is essential to the success of the clinic to reach the critical 14 patients per day.