New England chain establishes infrastructure
for delivering pharmaceutical care in the new millennium
It's not everyday you find a pharmacy chain that strives to make its slogan
ring true to customers, employees, and the community. Brooks Pharmacy stands
out as a chain for its success in delivering its promise, "You'll like what
we do for you" to each of these sectors. The Warwick, R.I., chain is also blazing
a trail in pharmaceutical care throughout its market. These achievements led
Drug Topics' editors to select the company as our Pharmacy Chain of the
Year for 2001.
From launching RxCare Centers for patient consultations, to providing half-hour
lunch breaks for the 757 pharmacists it employs, to providing disease state
management counseling, to awarding scholarships to local high school students,
Brooks is one of the top chains doing business in six New England states and
Brooks is owned by the Canadian firm, The Jean Coutu Group, the chain's eighth parent. Following a decision to make its U.S. entry, the Longueuil, Quebec-based company opened under the banner of Maxi Drug in West Springfield, Mass., in 1986. The company established one store at a time and had five stores by 1990. That same year, the firm bought a 16-store chain called Douglas Drug in Providence, R.I., bringing the total number of stores in its stable to 21. Then, in 1995, the company acquired the 220-store Brooks chain from Revco.
The Coutu family is no stranger to health care, noted Brooks president/CEO Michel Coutu. His father Jean Coutu, founder of the company, and his brother are pharmacists, his grandfather and uncles are doctors, and his son is about to become a pharmacist.
Brooks garnered sales of $1 billion for the past 12 months, ending February 2001, averaging $4 million per store. "Our business is 65% pharmacy, 35% front end. We've been growing at a rate of 14.4% in same-store sales in the past fiscal year. Five years ago, we had $350 million to $400 million in sales with the same number of stores. We basically doubled our volume with the same-store count," he boasted. Brooks fills 16.5 million to 17 million scripts a year. "In the past five years, we nearly doubled the number of scripts per store," he said.
What's driving this growth? It can be attributed to a plan implemented four weeks after Brooks was purchased. The plan was to create a new consistent personality for the chain, which consisted of stores ranging in size from 3,000 to 12,000 sq. ft. "When we started the first store in 1986, we were 35% third party, 65% cash. Now it's 90% third party, 10% cash. This changed the way we look at the business and the way we have to design our pharmacies," said Coutu. "We've been trying to reorganize our company to move from a dispensing facility to a provider of health-care services."
Positioning for the future
In order to make this transition, last year Brooks began implementing a redesign of the layout of its pharmacies. Among the striking changes are a separate drop-off area for prescriptions, a separate area for pick-up, and an RxCare Center.
Karen Steber, R.Ph., the manager of pharmacy program development, said, "We've put a lot of thought into the process of work flow and how important work flow is to productivity." The pharmacy island is 750 sq. ft. and is intentionally shaped like a square so pharmacists travel less footage back and forth. "We floated the bays forward, so the pharmacist and technician can walk all around," she said.
In two stores, Brooks is piloting automation with the Baker Productivity Station, which houses the top 100 countable drugs. In one store, the firm has installed a ScriptPro robotics unit, which houses 185 countable drugs and offers three vial sizes. A digital Rx Ready sign that hangs over the pharmacy and alerts customers that their Rxs are ready is being tested in four stores.
Brooks' redesigned prototype layout has been completed in 18 stores, and is
under construction in another 13. A crucial part of Brooks' plan to transition
to pharmaceutical care is the installation in 59 stores of The RxCare Center,
a glass-enclosed consultation center next to the pharmacy. The centers allow
privacy for counseling as well as a place for patient education, screenings,
and immunizations. A total of 70 stores will have the RxCare Centers by the
end of the year. Completion of RxCare Centers in all stores is slated to occur
within three years.
In order for R.Ph.s to provide patient education and counseling, Brooks is busy providing credentialing in disease state management in diabetes and asthma. Future educational programs are planned in osteoporosis, cardiovascular health, hepatitis C, and HIV. Once pharmacists receive training and certification, programs will be rolled out to the community.
Lisa Marzilli, Pharm.D., C.D.O.E., C.I., Brooks' manager of pharmaceutical care, launched the firm's initiative in diabetes care. The Rhode Island Department of Health has a diabetes outpatient education program that offers reimbursement to patients from United Healthcare of New England and United Blue Cross/Blue Shield of Rhode Island. She said Brooks is the only chain in Rhode Island involved in the program.
This past December, Brooks became involved in the Massachusetts Immunization Initiative pilot. Brooks gave flu immunizations to 100 patients in Massachusetts, the only state in New England where pharmacists are allowed to give flu vaccines, according to Marzilli. The program will be expanded for the next flu season.
In order to make more efficient use of pharmacists' time so they can take
on the additional role of counselor, Brooks is using almost every technological
advancement that has been coming pharmacy's way. This technology also provides
customers with accuracy, quality, and speed of services, according to Coutu.
Glen Santos, R.Ph., manager of pharmacy system development, was instrumental in introducing the foundation upon which several technological enhancements at Brooks are baseda frame relay network that decreases adjudication time of claims from 30 to 60 seconds to five to six seconds.
One enhancement is the RxServer, a centralized database that connects all of Brooks' pharmacies and allows for exchange of information and drug utilization review (DUR) among all stores.
The database also supports Brooks' RxCare Patient Compliance program, through which drug manufacturers send refill reminders to patients. Santos said the program has increased compliance by 22%.
Brooks has instituted an automated refill system called Brooks Pharmacy RxExpress
Refill System, which enables customers to call in and leave their Rx refills
through a voice-activated system using a touch-tone phone. Brooks has also installed
interactive voice mail response (IVR), which allows refill orders from a touch-tone
phone. "This saves a tremendous amount of time on the phone and allows the pharmacist
to organize his workday. Well over 50% of refills go through our IVR system,"
said Coutu. By the end of this summer, Brooks will offer customers the ability
to get refills via the company's Web site at www.brooks-rx.com .
Yet another technological initiative Brooks has rolled out is Lotus Notes that allows pharmacists to use the pharmacy work station to e-mail, access all paper guides and manuals in an electronic format, and reach the warehouse distributor system.
Brooks is launching a pilot for electronic prescribing, and the firm expects to have a central fill operation by May 2002. According to Daniel Haron, R.Ph., v.p., pharmacy and professional affairs, "Central fill will reduce pharmacist workload at store level, create time for pharmaceutical care, and enable us to fill prescriptions centrally on a lower cost basis."
Reaching out to R.Ph.s
In addition to supporting pharmacists by redesigning the pharmacy and enhancing technology, Brooks devotes time to developing relationships with its pharmacists. William Welsh Jr., executive v.p./COO, said that for the past five years, in November and December, he, Coutu, and David Morocco, senior v.p. of marketing, have visited every store in the chain. "That helps with feedback," he said.
The company has also instituted a chainwide lunch break for pharmacists from 12:30 to 1:00. Said Coutu, "I believe in professional quality of life. That's why we instituted a lunch break."
In addition to supporting pharmacists and catering to customers, Brooks reaches
out to the community. A framed crayon drawing hanging in the reception area
of the 252-store chain's corporate headquarters is testimony to Brooks' commitment
to the communities it serves. The drawing depicts people running the Ocean State
Marathon with the words, "Thank you Brooks for running for the kids, your friends
at Hasbro Children's Hospital." The pediatric cardiac unit is a beneficiary
of Brooks' sponsorship of the marathon, which is run in the fall.
For the past five years, Brooks has been partnering with American Greetings for the Brooks Good Neighbor scholarship program, providing a scholarship to every high school in the state of Rhode Island.
What will the future hold? Brooks is slated to open between 15 and 20 new stores this year, and 100 of 150 stores have been remodeled or relocated. "In three years, all stores will be somewhat comparable, from Maine to Connecticut," said Coutu.
Will Brooks expand into any new states? "There's a lot of locations where we can open new stores without cannibalizing any of our existing stores. New York is an opportunity for growth, but I'd rather go with an acquisition at this point," said Coutu.
Sandra Levy. Brooks Pharmacy: A winner. Drug Topics 2001;8:34.