Three Bold Predictions for the Future of Pharmacy
Blair Thielemier, PharmD, founder of BT Pharmacy Consulting and creator of the Pharmapreneur Academy, joins Tim Ulbrich on this week’s podcast episode. Blair shares about how she unexpectedly lost her full-time job as a clinical hospital pharmacist when she was 6 months pregnant, how she dove into entrepreneurship with MTM consulting, and her three bold predictions for the future of pharmacy practice.
About Today’s Guest
After graduating with her Doctor of Pharmacy from the University of Arkansas for the Medical Sciences in 2011, Blair unexpectedly lost her full-time income as a clinical hospital pharmacist in 2014. She was asked to serve as an independent Medication Therapy Management Consultant Pharmacist, a niche position that was entirely new to her at the time but would be instrumental to her future success and entrepreneurial journey. For the past three years, Blair has been focusing on elevating the profession of pharmacy through advanced clinical services. In 2015, she founded a pharmacy consulting business BT Pharmacy Consulting, LLC and currently trains and coaches other pharmacists looking to start their own consulting businesses through an online e-course and membership site at the PharmapreneurAcademy.com. In April 2017, she launched the first online pharmacy conference in the industry. In 2018, based on the success of the first summit, she hosted a five day encore event in partnership with the National Community Pharmacists Association’s Innovation Center. The Elevate Pharmacy Virtual Summit featured pharmacists of various backgrounds practicing pharmacy at the peak of the profession. She is also the author of the Amazon bestselling book How to Build a Pharmacy Consulting Business.
Summary
Blair Thielemier, founder of BT Pharmacy Consulting and the creator of the Pharmapreneur Academy, joins Tim Ulbrich to discuss her three bold predictions for the future of pharmacy practice.
First, Blair shares how she lost her full-time job as a clinical hospital pharmacist in 2014 when she was 6 months pregnant. She describes that she felt disillusioned when she was working as a clinical pharmacist; she didn’t love her job but was terrified to lose it. Now that she had, she didn’t know where to turn. She started working with independent community pharmacists and fell in love with doing MTM. In 2015, she built BT Pharmacy Consulting, a MTM consulting business that works with independent community pharmacies that are doing MTM programs and helping get clinical programs set up. Blair enjoyed it and wanted to grow the business.
Blair says that pharmacists are experiencing a “career climate change” and sees that the job market is shrinking or is becoming saturated, there are more graduates coming into the workforce, older pharmacists are being pushed out due to ageism or because of their high salaries, and new graduates are forced to take lower paying jobs because they have no choice. She explains that pharmacy is currently a product centric business which is a commodity. She says that what isn’t a commodity is the drug knowledge and skills that pharmacists have. Blair explains that pharmacy needs to shift to a service centric system and has to be rebranded. The questions pharmacists need to ask themselves are, “How can we add value? What do patients want? How can I leverage what I know and create programs people want?”
Blair then dives into her three bold predictions for the future of pharmacy. Her first prediction is that dispensing of medication and the distribution process have a high likelihood of becoming automated. She says that instead of fighting this, new revenue streams need to be added like services. She also explains that pharmacists can shift away from dispensing medications and that there are opportunities in preventative medicine.
Her second prediction is a shift to an appointment based model. Blair shares that innovative community pharmacists are already doing this, but her vision is that pharmacists can help counsel on health, wellness and prevention.
Blair’s third prediction is that pharmacists will be embedded in every primary care setting. She explains that primary care physicians have issues with medication related quality metrics that pharmacists can help with, such as medicine reconciliation, pharmacogenetic tests, and creating aligned programs.
Blair then discusses her Business Blueprint in the Pharmapreneur Academy that teaches the places pharmacy entrepreneurs can make the biggest impact, identify pain points and learn how to start conversations. There are modules for narrowing opportunities for pharmacists to three pathways: physician/office, pharmacy/clinical and patient pay.
Mentioned on the Show
- CommonBond
- YFP 039: One Pharmacy Entrepreneur’s Journey to Maximizing Income and Paying off Debt w/ Blair Thielemier
- YFP 089: From Unemployed to Successful Pharmacy Entrepreneur w/ Blair Thielemier
- Pharmapreneur Academy
- BT Pharmacy Consulting
- AACP 2019 Graduate Student Survey
- The End of Jobs: Money, Meaning and Freedom Without the 9-to-5 by Taylor Pearson
- Pharmacy Workforce
- Pharmacist Moms Facebook Group
Mentioned on the Show
Tim Ulbrich: Hey, what’s up, everybody? And welcome, as I have a special guest with me today, Dr. Blair Thielemier, who you may have heard from before on the podcast, episodes 039 and 089. We’re going to have her share some of her story for those of you that may not be familiar with her work. But we’re also going to spend most of our time talking about her bold predictions for the future of pharmacy practice. Obviously, a timely topic as we’ll outline here in a few moments. She’s got some great ideas about where we’re heading as a profession into the future, so much so that she was hosting a webinar recently on this topic and as we’ve found out, it’s not just Ralph that breaks the Internet, it’s also Dr. Blair Thielemier that breaks the Internet. So Blair, how are you doing?
Blair Thielemier: Doing well, yes. That was a blessing and a curse, I guess.
Tim Ulbrich: It was the first thing I thought of when you sent out some of those messages about, we had over 1,100 people register and we literally broke the Internet. My boys love “Ralph Breaks the Internet” movie, but certainly obviously I think that shows the importance of this topic, and it’s something that we need to continue having a conversation about as a profession in terms of what are some of the challenges that we’re facing as a profession but also what is some of the innovation that’s happening in the profession? With any challenge comes opportunity for innovation, for entrepreneurship, and I think certainly this is the case for us here in 2019, and so we’re going to talk about your bold predictions and then also what people can begin to do to think about how they can put themselves on the path towards being a part of that innovation. So why don’t we start, again, you’ve been on the podcast before, episodes 039 and 089, so we’ve talked a little bit about your journey, the Pharmapreneur Academy, but some listening may not know that story in terms of how you got started in pharmacy but then also how you jumped into starting your own consulting firm and then the academy. So why don’t you take us through some of that.
Blair Thielemier: Yeah, so I was one of those people — we’ve been hearing about Walmart cuts, we’ve been hearing about Walgreens closing — I was one of those people that my position was eliminated. And this happened back in 2014, so this was awhile ago. I was about six months pregnant with my daughter at the time, and I got the news: “Mrs. Thielemier, we regret to inform you that your position is being eliminated. All your benefits are being removed, and you’re cut back to peer in status.” So you know, at that time, being six months pregnant, I was like, “Oh my goodness, what am I going to do?” And I was really disillusioned. It was like one of those things that I talked about on the call last night was as much as I didn’t really love my job and what I was doing, I was still terrified of losing it. And I think a lot of us can relate to that too. It’s like even if you’re lucky enough to have a position right now, you may not be feeling fulfilled, you may not be 100% satisfied. But then also you’re scared of what’s on the other side of that. So I was forced into entrepreneurship. I didn’t go willingly. What happened afterwards, though, it definitely changed my life because I started working with these independent community pharmacies and then in 2015, I built this MTM consulting business where I was going out, working with independent community pharmacies, doing their MTM programs and helping them get set up with clinical programs. I enjoyed that so much that I said, “This is going to be something I want to do. I want to grow this business. How do I do that?” And that’s where this really led me to this billable pharmacist services. What are the opportunities that we have for building innovative programs leveraging our existing clinical skills, so that really led me to MTM consulting and eventually billable pharmacy services in the ambulatory care setting as well.
Tim Ulbrich: And so we’ll talk later on about your academy as I certainly think that’s a great example of a community that is really being innovative in their approach and that you’re really fostering that innovation and sharing of ideas as people I would say kind of moving this next evolution of our profession. And while you were kind of forced into it, I think there’s many that are listening right now or certainly I’m sure many that were on your webinar as well that are finding themselves maybe in a position of I haven’t had my hours cut, I haven’t lost my job, but I feel this itch — right? I mean, it’s called the entrepreneurial itch — I feel this itch to do something different or to supplement what I’m doing or I really see this problem that could be solved, and I really feel like I have a solution, but I don’t necessarily know where to start. I don’t know what it looks like and I’m scared and all of those questions that come from that. And we’ll talk about those here in a few minutes. One of the things I love — and I’ve shared this with you before, I’ve shared with others, and I have a lot of respect for the work that you’re doing — is I think there’s so much negativity right now in the profession. And what I love about your approach is that I think you are honest with what the data says. I mean, if we look at the data around the market and in terms of where we’re at with jobs and the reality of some positions getting cut and others losing hours, I mean, those are facts, right? And we’re certainly seeing new graduates that are struggling in some areas, but with you, the conversation doesn’t stop there. And that’s what I’m excited about here today is that it’s about, OK, so what are we going to do about it? How can you as a pharmacist potentially reinvent yourself, re-pioneer the work that you’re doing, what’s the skill set that you’ve been given, what are the opportunities that area head? And as you and I both know, when it comes to any great movement, idea, or business, it always comes down to solving a problem and in finding a solution and a solution that is one that people care about. And I think as we look at some of the challenges we’re facing today in terms of the dispensing process and automation and PBMs and all these things, two ways of looking at that. One is certainly it presents a problem; the other is there’s great opportunity for innovation. So what do you make of the climate today? I mean, just to rattle off some of the facts that come to mind, we think about some of the announcements we’ve heard around Walgreens, around Walmart, Kroger and Harris Teeter cutting hours. I was recently reading the AACP Graduating Student Survey where about 22% of graduates said they strongly disagreed or disagreed with the statement that they would reenter pharmacy school if that were to be their choice all over again. We know the average student loan debt is $173,000. So it’s easy to look at all that and say, “Wow, we’re dealing with a lot.” I mean, what do you make of that data and also the opportunities that we have going forward?
Blair Thielemier: So I call this career climate change, and I think it’s occurring right now for several different reasons. I think Tim Baker said on the recent Your Financial Pharmacist podcast that pharmacy’s really right-sizing right now. So what I’m seeing is the job market shrinking or at least becoming saturated, more and more people graduating, older pharmacists being pushed out of their positions due to ageism or just too high salaries and then new graduates who are graduating being forced to take these lower paying positions because they don’t have a choice. They’re drowning in debt. $175,000 in student loans is absolutely insane. And so there’s not a lot of other options. So what I see in pharmacy having this kind of product-centric business model is it’s a commodity, right? What isn’t a commodity is our drug knowledge, is our medication management knowledge, our pharmacokinetics and pharmacology and biochemistry. How can we leverage and take what we already know and already understand, how we’re trained so differently from any other healthcare provider, and create programs that people actually want? You know, I think that pharmacists, we don’t articulate our value very well.
Tim Ulbrich: Yes.
Blair Thielemier: And a lot of times, it’s like, well I’m the medication expert. Well how does that really help anyone else, you know? That almost makes it sound like you’re the most important person in this scenario when really, it should be the person in front of you, so whoever you’re wanting to help and wanting to buy this service. And so that’s really what I’ve tried to shift the idea and rebrand pharmacy as like how can we actually add value? What are the quality metrics that physicians in primary care are being graded on now in the new pay-for-performance model? What are things that payers want in terms of preventative services for patients? What are things that patients want? You know, anti-aging and help with nutrition and weight management. So shifting this idea of like people are going to come to the pharmacy when they’re at their very most sick to what can we actually do before those people get to that point and what are some programs we can create that will help them that are innovative, that are entrepreneurial? Because my great-grandfather was a pharmacist in Chicago in the 1940s, and I think that kind of getting back to our roots, the drugists back then, they were entrepreneurs. Like they had to market and sell their services. They built the industry mostly on independent community pharmacies. So this whole idea of a chain pharmacy is a relatively new concept, but as we’re seeing kind of the job market right-size, as Tim said, what are other opportunities and what are other avenues that we can still take our drug knowledge, take our clinical skills, and apply them to things that people actually want, programs that people want to buy?
Tim Ulbrich: Yeah, and as you mentioned, I think that’s a stark difference. Even though it goes back all the way to the roots, it’s a stark difference for how many of us were trained. And we’re seeing an evolution that’s happening in PharmD education to have more of those entrepreneurial types of training and skill set. You know, I firmly believe that every graduate today needs to come out ready and prepared to know how to justify a position that they’re in, which means aligning yourself with quality metrics, which means communicating value, which means making yourself an integral member of the team, all the things. But if we think back to our PharmD training, that wasn’t what we were doing, right? I mean, we packed knowledge into our brain. And I know for me, graduating in 2008, we were walking out into a market that was basically, you as the graduate were calling your shots. So whether we can consciously or subconsciously admit it, I think there very much was a climate that I was a part of and others where you didn’t necessarily have to figure out how to justify and learn some of those skills. And I think we certainly are seeing a shift of that, and it reminds me — I don’t know if you’ve read the book, “End of Jobs,” but I recently read it. And it talks about how to your point about a commodity and kind of shifting from where we are to where we are today, he talks about this concept that here we are today, really in an age of entrepreneurship. And I really believe that the term ‘entrepreneurship’ I think for many pharmacists makes them feel very overwhelmed, you start to think about the Mark Zuckerbergs, the Elon Musks of the world, maybe one that hits a little bit home for us, the TJ Packers of the world, some that it’s unattainable, I have to start my own business. But it’s really about the entrepreneurial mindset, whether you’re starting your own thing or you’re working for a big-box pharmacy, that’s the skill set, as he articulates in that book, that’s the skill set that today’s graduate needs. And I think a lot of the work that you’re doing and we’ll talk about here at the end as well the Academy members I think is really starting to address that mindset and skill set. So let’s jump into your bold predictions. So three bold predictions for the future of pharmacy. And No. 1 here is we’re talking about this concept of the dispensing of medications and the distribution process and the likelihood of much of that becoming automated in the future. So tell me more about your prediction here.
Blair Thielemier: Right, you talked about my boy. That’s Elon Musk. So I am a big fan. I mean, I love everything he does.
Tim Ulbrich: So he sent a Tesla into space. What do you got? Are you going to send something pharmacy-related into space then or what?
Blair Thielemier: That’s a good idea. I mean, I did bury a time capsule of these three predictions, so maybe I should shoot one into space as well. But yeah, this is my time capsule of these three predictions. If you saw that silly Facebook video of me, I ran ads too, I was burying this time capsule in my backyard with my three predictions for the future of pharmacy. So yeah, the first one was definitely that dispensing, the process, a lot of it can be automated. So you mentioned we’re seeing the tech model and technician verification. We’re only a few steps removed of that even being remote verification and things like that. So my thing is instead of fighting this, instead of saying, “No, we are hanging onto dispensing, we’re hanging onto our current product-centric business model,” looking at, OK, let’s just say what would happen if we let that go and free up time for other types of services? So what I’m suggesting is shifting or at least adding a new revenue stream so it’s not just dispensing services only is the only way that pharmacies make money. So dispensing plus services to make money. And so that’s what I mean by shifting from the product-centric to a service-centric business model.
Tim Ulbrich: So one of the things — to play devil’s advocate to that, you know, I think of the recent workforce survey. I think it’s 44-45% of all practitioners are in the community setting and most of them in a traditional chain setting, maybe a smaller portion in an independent setting, so when you think about that much of the workforce — and certainly, as you mentioned, we’re seeing some right-sizing correction of that potentially, and then you think about what’s happening with Amazon’s acquisition of PillPack, the challenges we’re having with PBM pricing and transparency and a lot of medications being dispensed in terms of under-reimbursement of what it costs them to do that, so the sustained ability of that business model I think is very much in question. So one of the counterarguments, which I think is great that we’re having this discussion here is so what is the timeline of this? You know, my wife and I have this conversation all the time that her and I order pretty much anything we can first on Amazon. So I’ll be the first to admit that I am probably, my kids, me, are probably not walking through the doors of a pharmacy to get my medication unless that looks different in some way, shape, or form, which I think is kind of what you’re getting to in terms of some of the clinical services and add-on things to the dispensing process. But how far away do you think are we from that? And then what does that mean for 44% of the workforce?
Blair Thielemier: So that’s a great question. And you know, I think what we’re seeing too is this shift away from the dispensing model. I mean, we’re talking maybe in the near future the possibility of 3D printing medications in your own home. So if that is a possibility and the Walgreens are going away or at least moving into more like a mail-order type of model, what can we do in the community, in the local community setting to add value to patients? I mean, people aren’t getting less sick. People aren’t taking less medications.
Tim Ulbrich: That’s right.
Blair Thielemier: There’s opportunities in preventative services as well. I think that the interest is growing in things like nutrition and functional medicine, and those are things that are not easily scalable. I mean, Amazon’s not going to figure out how to help you with a personalized DNA recommendation or pharmacogenomic report anytime soon. So where I see pharmacy is having this opportunity to shift and create new revenue streams and also create new jobs is going back to this less scalable model, which is helping patients more one-on-one.
Tim Ulbrich: Yeah, and I think it’s your second bold prediction around really the evolution from a product-centric service to a clinical service and more specifically, appointment-based model. So tell us more there about what you’re envisioning for the future. And I find it interesting you say less scalable because I would agree at a surface level from dispensing, but from an impact level, especially if you think of value-based contracts and where things are going, that’s where I really feel like you start to make true inroads into being a valuable member of the team that sticks. So tell us about the appointment-based evolution model and what you see there in the future.
Blair Thielemier: So I think that innovative community pharmacies are already this to a point. So looking at, like I mentioned, things like functional medicine, helping counsel people on health and wellness and adding these preventative type services. The biggest thing I hear people say about cash-based services is my patients won’t pay for that. And what I think is interesting about this is from a community and population health standpoint is the same patients that are coming into your pharmacy that are on six or more medications with two or more chronic diseases aren’t exactly the same people that are going to be enrolling in your weight management and your anti-aging functional medicine or BHRT programs. So we’re actually talking about a new customer, a new patient, that you can attract and bring into your pharmacy world. So there’s a time and a place for MTMs, for Medicare beneficiaries, but for the most part when we’re talking about preventative type services, especially cash-based services, I’m talking more the younger patient, catching them 15-20 years before they develop these chronic conditions.
Tim Ulbrich: You know, what I like about that idea and that thought is when you think of market share, you’re now talking about expanding the market of people who would traditionally walk in the doors of a pharmacy, right?
Blair Thielemier: Exactly.
Tim Ulbrich: We’re talking about not just sick care, but the other side of that spectrum. And I think we would all agree, we’re trained to be ready to help in that area in terms of prevention. And we can’t forget the assets and the strengths that we have. You know, I think it’s easy to stop the conversation at the distribution side, but one of the arguments for the brick-and-mortar pharmacy is obviously accessibility, you hear that over and over and over again how accessible pharmacies, how accessible pharmacists are in both hours, in terms of location. So I think there’s certainly the assets that are there and then also back to your point about what is and is not a commodity, I think that’s an excellent discussion for us to brainstorm and think of further because as you think about logistics companies and people like Amazon and PillPack and others, they’re looking at scalability and automation of processes, right?
Blair Thielemier: Right.
Tim Ulbrich: So what is currently happening that is valued by payers that can’t be replaced by that, and how can we grow and scale that and align that with value-based contracts and other things? And as I mentioned to you before we jumped on, we’re working on implementing a new community-based pharmacy course for our Masters students here at Ohio State, and while we tend to lump together community-based practice, I think we’re really doing a disservice when we often do that. I mean, the spectrum of innovation that is happening in community-based practice is really unbelievable and I think we tend to start and stop the conversation around big-box pharmacies and dispensing lots of medications, but there’s really a lot of innovation, as you mentioned, in the community space. And we can’t forget, even though we’re seeing great innovation in the hospital inpatient setting — what is it, 99.9%, whatever percent of time people are spending out in their community at home, whether that’s in their community, at their place of worship, but that’s where they are. So we can meet them there and provide services. No. 3 here, which I think is a really bold vision around where we’re going to see pharmacy going, has to do with pharmacists being positioned and placed in primary care settings. So tell us here what you see for the vision.
Blair Thielemier: So you know, I said on last night’s webinar really, if we’re looking at pharmacy practice in September 2029, my vision is to have an embedded clinical pharmacist in every single primary care practice. So a few things that I have to work with is primary care is — they are having issues with medication-related quality metrics that pharmacists can help with. From a quality care coordinator standpoint, they are having to do medication reconciliations. They now have access to these pharmacogenomic tests with not really sure how to use them, how to integrate them into their practice. So they’re getting more and more data and more and more information, but being able to put it together and create a program that aligns with the quality metrics, that aligns with what the payers want to see as well in the new pay-for-performance thing, they don’t have a member on their team that can do that. And I think that’s where the pharmacist can really come in and a lot of value. So a lot of times, pharmacists in the hospital settings will be on the team that’s making sure that we’re meeting the quality metrics on the hospital team. So did the patient get an antibiotic started within two hours of admission with a diagnosis of pneumonia? That’s one of those things. Or on metoprolol after a STEMI. So looking at pharmacy from a quality standpoint, it’s like how can we add value for payers and physicians’ offices by focusing on quality? That’s where I think we can make the biggest impact. And so I always share that my mom is actually a nurse practitioner, works with a clinic, like an FQHC, and she goes to a lot of primary care conferences. And one of the ones she went to last year in D.C., she came back and she said, “Everyone is talking about pharmacists and speech therapists in primary care.” And so that just made me feel good. It’s like oh, well, I can get behind that.
Tim Ulbrich: Absolutely.
Blair Thielemier: And someone said recently that there was a Florida pharmacists meeting. They actually sent a representative from the American Medical Association to the pharmacists meeting, saying, “Hey, guys, we want more pharmacists trained up to work in primary care, to work with physicians. Let’s try to figure out how we can make this really happen.” And so that’s exactly what we’re doing in the Academy is building business models around preventative services in community pharmacy, in building business models around consulting programs in primary care.
Tim Ulbrich: And I think if you think of that vision of having a pharmacist in every primary care provider across the country, and as I’m sure you’re also aware, the incoming AACP president mentioned a similar vision for the future, and when I think about impact and where things are going from a pay-for-performance and where you have a pharmacist positioned to be able to impact those quality metrics and how they’re intervening in a way that is post-diagnosis but before a patient shows up at the pharmacy, right, where you’re often kind of working back issues and challenges, so I think there’s a huge role there and where we think about, again, pay-for-performance contracts. And I think scalability, you think about OK, the infrastructure is there, there’s opportunity there across the country, but just as quick as you can begin to think and brainstorm, the objections start coming out and people shoot down that idea, right? So how do we scale this when we have NPs and PAs that are a cheaper resource and their enrollment is increasing, they have billing privileges and so forth. How do we scale this when every state has different regulations and requirements around collaborative practice agreements? And the list goes on and on, right? And I think that what we’re doing here is beginning a conversation to say, well, that’s obviously not going to happen tomorrow, but there’s some best practices in cases that are happening, that you build momentum, just like any other model. You know, I think about I’m sure the history of NPs in clinics and how they evolved to be commonplace and depended upon. I’m sure a similar conversation was happening 15, 20, 25 years ago with similar objections. So what do you say to some of those objections that people may point at and say, “It’s not realistic, Blair. It’s not going to happen.”
Blair Thielemier: Oh yeah. I mean, I’ll state all the objections for them. We’re too expensive, we’re not providers until federal Medicare, physicians won’t want to work with me because we’re challenging their turf, they don’t want to see pharmacists add these clinical services or get prescriptive authority or whatever. For every objection, there are pharmacists working in primary care centers right now, and there are physicians saying, “This is helpful to me. It’s helping me be more productive, it’s helping me be more profitable. It was not what maybe I thought it was like in the beginning before we started this pilot program, but now I just want to keep adding to this pharmacist. Like we’re looking for more pharmacists to join the team now.” So that’s what really keeps me going is yes, there are absolutely challenges. There’s state scope of practice challenges, there are federal challenges around billing for pharmacist services in primary care. But for those challenges, we’re still seeing pharmacists doing it, and we’re still seeing them getting great results and having a lot of positive feedback from providers. And part of that I think is having the confidence and being able to go out and pitch your services. And that’s what I’ve really built with this new course in the Pharmapreneur Academy. It’s called “The Pharmapreneur’s Business Blueprint,” and what it does is it teaches you the places you can make the biggest impact, but it also helps you to identify those pain points. It’s like, yes, there’s these challenges here. What are some ideas for overcoming them? And how to start these conversations. So a lot of pharmacists say, “Oh man, I’d love to reach out to my local physician and see if we can collaborate on something, but I just don’t know what to say.” I’m like, “Well, you never know if you don’t ask.” So we’ve got literally scripts for cold calling, like calling up the practice and saying, “Hey, can you meet for a lunch? Or I’ll bring donuts one day and we can have a conversation about this.” So the way that I like to talk about it — because like you mentioned, there’s so many different innovative opportunities — is narrowing them down to the three paths. And we call these the three pharmapreneurial paths. So the first path is the physician’s office path, and in the course, say you’ve chosen to do the physician’s office path, you’ll only go through that module track for the physician’s office path. And it helps you put blinders on. It’s like, yes, there’s a lot of opportunities in functional medicine and cash-based stuff, but I’m on the physician’s office path.
Tim Ulbrich: Which is so important when you’re getting started in anything, right?
Blair Thielemier: It really is.
Tim Ulbrich: Because it’s very easy to go in any direction.
Blair Thielemier: And then your second is like the pharmacy clinical service path. If you’re an independent pharmacy owner and you’re looking at how can we add services here in the pharmacy. And then the third would be the patient pay path. So it’s really kind of like a choose-your-own-adventure of like put your blinders on, just take the first steps to call your potential leads. We have like a framework that we use for customer development interviews that walks them through the four A’s of selling your services so that you can feel like you’re selling and able to articulate your value with confidence, and it doesn’t feel sleazy selling like sales pitch-y.
Tim Ulbrich: And I’ll mention this link again at the very end before we wrap up, but if you go to YourFinancialPharmacist.com/academy, YourFinancialPharmacist.com/academy, that will take you over to learn more about the Pharampreneur Academy, and you can also get $50 off your first month of membership. So again, YourFinancialPharmacist.com/academy. So Blair, I’m thinking of — back to earlier in our conversation, we had mentioned a lot of things we feel like we don’t traditionally get in a pharmacy education, and it feels to me a lot of what we’re talking about here in terms of marketing and selling and justifying and aligning with quality metrics and communicating and practice management and business infrastructure. And I know you just recently went through a renovation — or not a renovation, but an evolution of your course. Talk us more through why you did that, what were you seeing, and the need for some of the additional content that you added.
Blair Thielemier: So whenever I was first building the course, it was all about information around billable pharmacist services. There’s no clinical anything in the Pharmapreneur Academy. It’s focused solely on business models. And what I was building in the beginning is what pharmacists were saying they needed, which was information on CPT codes and diagnosis codes and note templates for the EHR, for documentation, things like that. So over the past four years, I had created that stuff, and then I realized pharmacists were getting stuck in the overwhelm. They were getting stuck in that how do I put blinders on and focus? I want to do all these things at once. So I went back, and what I’ve created in the beginners’ blueprint is this model, this framework that you can go through, and it helps to lead you to the right decision for your business. So I said last night, a lot of people start their business with a logo and a business card.
Tim Ulbrich: I’ve talked about that before, yes.
Blair Thielemier: I am so against business cards. No. I’m not against them, but I think that that’s not the first step. That’s not even like in the first 10 steps of building their business.
Tim Ulbrich: No. Yep, agreed.
Blair Thielemier: So it’s really about identifying which path you’re on, which is essentially identifying your target market or your ideal customer avatar if you’re familiar with that language. So what we do in the beginning is walking through those. We talk about essentials of each paths and timelines because the timeline for starting a program in a community pharmacy setting is much shorter, actually, than starting a program in a physician’s office or really getting momentum in a cash-based service. So looking at timelines, if you need to add a revenue stream like yesterday, it might not be a good idea to try to build a functional medicine cash-based business if you don’t have 6-12 months to build up your clientele. So it helps you avoid these common missteps.
Tim Ulbrich: Yeah, and I think as you and I have talked about many times before, I think when somebody’s excited about a business idea, whether that’s a side hustle or they’re going to jump ship and do something different or work two jobs, whatever, there tends to be the falling back on well, I need to get my corporation set up, and I need my business card, I need my website. And I think sometimes you just have to start, taking one step towards developing the framework, the solution to the problem that you’re working on. It may mean seeing a patient without having a full process fleshed out. There’s so much to learn as you go through that process that will inform what ultimately the business will look like in the future. So who are you seeing that’s coming to the Academy and contributing to the group? Is it people that are looking to start a side hustle? Is it people that are already in their own business and kind of spinning their wheels? Those that are looking to jump to start their own business? What’s the variety of folks so those that are listening might have a better idea of who is a good fit for the Academy and what you’re working on?
Blair Thielemier: Yeah, that’s a great question because what we have tried to create is this kind of peer-led conversation around here’s the opportunities that are out there — and I encourage the Academy members to introduce themselves, to talk about the opportunities that they have in mind. So you know, the most recent post that I responded to this morning was two different pharmacists who had said that they felt like their biggest opportunity was to collaborate with local physicians offices, that they’d actually been approached by local physicians offices about these types of services but just didn’t really know how to implement them and how to put these programs together. So mostly, I would say it’s independent pharmacists who are looking to build these types of practices, whether it’s reaching out to a local private practice physician to go to work in their office or it’s partnering with a local chiropractor to offer nutrition or pharmacogenomic testing in their office. Generally, it’s the individual person. We do have some independent pharmacy owners in there as well who’s looking at OK, I’ve got this pharmacy, but now we are wanting to reach out to physicians and collaborate or offer like point-of-care testing services or tobacco cessation programs or whatever. And they’re looking at how also do I train my staff members to be able to sell these services and offer these services so that I’m not the only person that’s doing them? So we’re seeing a lot of owners also use it to train their staff members as well in these opportunities for these clinical programs. So I’m excited about that too.
Tim Ulbrich: So last question I have for you is September 2029, so we’re going to have hopefully a similar conversation. I don’t know if Facebook Live will be a thing or not, whether we’ll be doing podcasting or whatever.
Blair Thielemier: It will be holographs or something or holograms like on our watches.
Tim Ulbrich: Who knows at that time? What will we be talking about? I mean, do you think that we as a profession are going to face the next 10 years with confidence and really reinvent ourselves and in some way, redefine the role? Or do you think we’re going to see a significant shaping the other way and kind of an evolution towards maybe even further separation of the profession in terms of what an inpatient pharmacist role looks like and a pharmacist who’s in an ambulatory setting? What do you see happening even beyond that 10-year mark?
Blair Thielemier: So really interesting. Someone commented, it was in the Pharmacist Moms Facebook group, and I was talking about this subject and switching from this product-focused business model. And she had mentioned that the banking industry went through similar changes back in the 1800s when their primary method of revenue was selling gold and silver. And when we moved away from the gold standard, they didn’t really have a business model anymore. And they kind of transitioned to now these services and in financial services that what we now think of as the banking industry, if you went in to ask them to buy gold or silver, they’d probably look at your like you were crazy.
Tim Ulbrich: Yeah.
Blair Thielemier: So I’m excited about that. I’m excited about starting these conversations, about reimagining what pharmacy looks like and how do we rebrand pharmacy? So most of the pharmacists that I talk to, they’re like, I want to get my patients off medications. And that’s so counterintuitive because, you know, everyone comes in like, oh, you must be rich because my medications are so expensive. Like no. Anytime somebody asks me for a recommendation for an over-the-counter stool softener or something like that, I’m like, well how much water do you drink? Like that’s usually how I start the conversation is like, let’s talk about water and let’s talk about fiber and let’s talk about all these things. And your last-ditch effort might be an over-the-counter product. So I think a lot of pharmacists can identify with that is that we’re not pushing medications. We’re pushing to get people off medications. We’re looking at how can I — this person’s on 11 medications. How can I combine some of these? Which of these are being used to treat side effects of other medications? How can we get them on the most optimized medication regimen and the least amount of medications as possible for this patient? That’s the conversation I think we’re going to be having in 10 years is like, well, I took my patient from 10 medications down to four. You know? And that’s where I believe we can add value. That’s something that the patients want to see, that’s something that the payers want to see. And physicians, they’re going to be getting better outcomes. They’re going to be seeing reduced readmission rates for their patients. And hospitals, that’s what they’re going to need as well.
Tim Ulbrich: Yeah, and it would be interesting to see — I mean, you used deprescribing as an example, but even more consistent reimbursement for deprescribing, right?
Blair Thielemier: Yes.
Tim Ulbrich: Because I think counterintuitively, obviously you’re reducing revenue to the pharmacy, which is an area I think about if you think about pharmacists in every primary care provider across the country, you know, in theory, that really changes the interaction of a patient coming to a pharmacy. Right? Because you think about ideally, a pharmacist’s role post-diagnosis and then being involved in the prescription process, that really changes a lot of what now is time spent at the pharmacy kind of working back with the physician or providers or you think about a traditional medication therapy management visit, ideally, a lot of that could be happening at the point of prescribing. So how do those intersect and work with one another? What impact do they have on one another? I think what you and I both agree on is that we need more opportunities for constructive, innovative dialogue about what does the future of the profession of pharmacy look like? And I think that there’s unfortunately kind of two camps: one of extreme negativity without constructive dialogue and brainstorming and one of somewhat of an optimistic, idealistic standpoint that doesn’t necessarily acknowledge some of the challenges that are here today. And I think we need both, and we need a space where at Pharmapreneur Academy, at Your Financial Pharmacist, at colleges of pharmacy, at national organizations, in communities that we can have a conversation about hey, if we were to rethink, reinvent pharmacy, all ideas on the table, what might that look like? How could we get reimbursed for it? And what’s the value that we can bring as a profession? And I think that often, these conversations start with a lot of baggage and a lot of loaded opinions, and so I know one of my hopes here today in continuing is to stimulate a conversation and get people thinking more about what the profession holds. So thank you so much for joining. Thank you for your three bold predictions. And again, if you want to learn more about the Pharmapreneur Academy, go to YourFinancialPharmacist.com/academy. You can learn more about what’s involved in the academy, what the community is all about, and what you’ll get. Again, YourFinancialPharmacist.com/academy. And you can get $50 off your first month. So Blair, thank you so much for joining.
Blair Thielemier: Thank you so much for having me.
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