Using Technology to Expand Services: THE NEED FOR HEALTH CARE

Thundermist has identified several significant health needs and concerns of the medically underserved and has responded with a variety of service options, including:

• increased health services for its targeted patients. To address the lack of these services in the community, Thundermist implemented a mental health program, including psychotherapy, evaluations, crisis intervention, and psycho-pharmacological medication management.
• chronic disease-prevention efforts among targeted patients. Roughly 25% of all pediatric patients at Thundermist have asthma; this is a much higher rate than the statewide average. As a result, Thundermist is participating in the Asthma, Diabetes, and Diabetes Prevention Collaborative.
• adult medicine. More than 10% of the center’s adult patients have diabetes. Thundermist has reshaped its care and treatment of diabetic patients, extending lessons learned from the work of the collaborative to the management of other chronic disorders (e.g., substance abuse), which is also a major health problem among these patients.

Uninsured adults have little access to affordable medications, and they must rely heavily on the local community health centers for relief. Most of Thundermist’s elderly medical patients fall below 100% of the federal poverty level and have various health and social service needs. The largest unmet need among older patients is their inability to afford prescription medications. One third of all elderly adults in the northern sector of their service area have low incomes (below 200% of the federal poverty limit).
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Planning

In order to expand services to clients by providing access to low-cost pharmaceuticals, the Chief Executive Officer (CEO) of Thundermist decided to create an in-house pharmacy. The CEO performed preliminary background research by communicating with the federal Office of Pharmacy Affairs, a branch of the Health Resources and Services Administration (HRSA), and by visiting other health care centers that had in-house pharmacy operations. This planning process began in the fall of 2000.

In January 2002, Thundermist hired a consultant, trained in both pharmacology and business, to provide expertise in pharmacy operations and to supervise federal and state licensing requirements, the contracting of third-party payment plans, and the design and operations of the in-house pharmacy. In June 2002, the consultant was hired as the in-house Director of Pharmacy Operations. The Director supervised final construction of the pharmacy, initiated contracts with drug wholesalers, completed state and federal pharmacy licensing, and acquired the necessary hardware and software for pharmacy operations.

The Director of Pharmacy Operations filed the necessary paperwork to create the pharmacy as a 340B entity, which meant that Thundermist was able to purchase medications at deeply discounted prices. This status allowed savings to be passed on to uninsured and low-income patients. The Director also initiated contracts with the Texas Association of Community Health Care Centers, a large national buying association of not-for-profit community health care centers. This group allows members to buy drugs from manufacturers at a very low cost, often below the price available through the 340B federal program.
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The pharmacy was constructed within Thundermist’s medical facility, located in Woonsocket, Rhode Island (the northern section of the state), at a cost of approximately $18,000. Construction of the pharmacy was completed in October 2002.

To inform the patients about the new service prior to startup of pharmacy operations, Thundermist began limited promotions focused on internal service providers. Physicians were given fliers to distribute to patients during office visits. The fliers, announcing the opening of the new pharmacy and the services offered, and an accompanying public relations release to the local media were the only promotional activities used to support the introduction of the new center and the services to the community. The targeted market for pharmacy operations was active patients of Thundermist, because only prescriptions written by Thundermist physicians could be filled by the in-house pharmacy.

Table 1 Pharmacy Usage within the Satellite Distribution System

Table 1 describes pharmacy usage from October 2002 through the most recently available data. During the first three months of operation, 569 total prescriptions were filled for 315 patients. Over the next three months, the total number of prescriptions grew to nearly 1,600, and the number of patients increased to 761. By the end of the fourth quarter of 2004, the total number of prescriptions filled had reached 4,963, and 1,787 patients were served. erectalis 20