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Pharmacy Residency Podcast

Apr 30, 2018

I do a follow-up interview with Mike Case-Haub Pharm.D. on what he hopes for his company and the future of pharmacy. 

Case Haub Consulting (CHC) is a Clinical Pharmacist Services firm dedicated to transforming the future of pharmacy. We believe that pharmacists have unique skills and training that can make a significant difference in improving patients’ overall health care, and our team of more than 100 clinical pharmacists is passionate about engaging with patients, finding solutions to medication-related issues, collaborating with local pharmacies and physicians, and delivering high quality patient-centric care that improves overall health outcomes while managing costs.The CHC model of clinical services is based on reviewing patients’ overall medication therapy needs with a broad, unbiased outside perspective. We provide effective, high quality comprehensive medication reviews (CMRs) with economies of scale. We work with local pharmacies to improve their operations with training and customized solutions. We partner with MTM vendors, health plans, and health systems/clinics to address all varieties of medication related challenges.

Better health outcomes, higher quality of care, lower health care costs: the future of pharmacy starts today.

Full Transcript:

welcome to the pharmacy leaders podcast
with your host Tony Guerra the pharmacy
leaders podcast is a member of the
pharmacy podcast network with interviews
and advice from building your
professional network brand and a
purposeful second income from students
residents and innovative professionals
hey welcome to the pharmacy leaders
podcast Tony guerra I asked Mike case
hob to come back and talked with us he
had some great tips with Ahmet about
becoming an entrepreneur starting your
own business and I just wanted to ask
him some follow-up questions just for
maybe some of the people that are
graduating residency this year and and
kind of or going to go into maybe
thinking about a residency next year and
just kind of get his opinion on that
point where maybe in your p3 year you're
like well what should I be doing what
should I be working towards so Mike
welcome to the pharmacy leaders podcast
thank you something hey the first
question I wanted to ask you was so
they're talking about how excited they
are that they've grown the residency's
from 3000 to 4500 which is a huge number
that means five years ago we had 3000
residency's now we have 4500 but what I
guess I'm concerned about is that those
residency's don't necessarily teach you
how to scale something they teach you
how to work in a job a clinical job and
I don't know that there's many be 1,500
extra clinical jobs I was talking to
someone who was going to start working
for your company and rather than do
residency rather than work retail that
are going to go live where they want to
and work remotely for you so tell me a
little bit about the advantage of
working at case hub consulting yeah so I
think you know at least now I'm gonna
have my my skewed view a little bit on
this of course cuz it's my company this
this isn't this isn't the news this
isn't journalism we don't have to take
both sides you can just take your side
I'll be fair and balanced of it all I
know but but you know that that's a big
part of our model is you know I didn't
want to say hey I'm gonna create this
clinical call center and it's gonna be
in Des Moines Iowa and
everybody has to live in Des Moines Iowa
do this work only here I believe you
know there's there's amazing pharmacists
nationwide that can do this kind of work
and and so again as technology improves
we've got that ability to securely work
from a remote location and I think that
there's a lot of value to that so if you
want to live in Hawaii and you're you
know you're surfing most a day is when
you're gonna be doing your work that
that's great
you know and actually internationally we
have we have some pharmacists that work
in other countries I mean they're
licensed in the US but maybe they spend
part of their time in you know we've got
one person where their home in Australia
we've got Saudi Arabia Canada you're so
so you've got those opportunities to
really be able to do that and it allows
us to kind of cast our net much farther
than to say again we can only hire
pharmacists that are within you know a
40 mile radius of Des Moines Iowa I love
Des Moines the one's a great place to
live but not everybody wants to live in
Des Moines and so we've got those those
options as being able to you know have
folks live and work wherever it works
best for them and their families and
where they want to work and I think that
there is a lot of value to that and at
least from my perspective of course we
talked you talked a little bit about
stability in the beginning of the
episode with Ahmed and I kind of want to
talk about that because I almost lost my
job but didn't because you know the
pharmacy tech program ended up getting
cancelled and then I ended up switching
over to teaching chemistry and
pharmacology but I feel like while we
used to have stability in that kind of
retail job okay well I'm gonna work you
know the 40 hours we just here I think
out of Ohio there's a company that just
said something to the effect like okay
well managers will have stable positions
we're not sure how many hours the rest
are going to get and you might all have
to take a 20% pay cut so I'm not sure
about the details or the truth in that
but I am sure about the truth that
things are changing how does the job
that you have or the jobs you're
providing maybe provide stability in a
different way in a
a new economy yeah I think that's a
great question and and I definitely feel
like there has been a shift even in the
last maybe five years five to ten years
anyway I graduated from pharmacy school
probably same time around you did Tony
as well too is you could kind of write
your own check you can kind of say hey
I'm gonna kind of go wherever I want to
and those were the good old days
I read BMWs you know twenty thirty fifty
thousand dollar sign-on bonuses that
kind of stubble those days you know I
never got my BMW I guess I didn't either
I want to go certain places but but but
the landscape has changed so much since
then then too and there's so many people
to graduate and they can't find a job or
they can only get part-time or they do
can only float and and so I'm not saying
we're capitalizing on that but I think
that's also a little part of what we're
trying to look at is what does this look
like in five or ten years are we gonna
have this huge surplus of pharmacists
that can't find a traditional job or
they can't find full-time work or
whatever they're looking for they have
to you know move to someplace that they
don't really want to live but they have
to do it because you know they owe you
know two hundred thousand dollars in
student loans and you know they can't
make much money working at McDonald's
you know that kind of stuff then too is
is the reality where a lot of people are
at so I'm not saying we're you know or
focused so much on that but I think that
there can be a component to that where
there is likely going to be this surplus
a pharmacist that want to be clinical
and that's the other thing is that we've
got pharmacists that want to be in a
clinical position and that's purely what
we do I mean we're spinning our holdeth
they working with patients and
identifying drug therapy problems and be
serving your resolving those drug
therapy problems and I think that there
is a pretty interesting model there that
you know we're keep expanding on but
back to your question about stability
you know I we I have people reach out
constantly about hey I've just lost my
job or
or they just cut back our hours and now
you know I'm not making nearly what it
was before and and I think that's really
the reality and there's you know a lot
of different reasons why that's
happening a huge part of that is
reimbursement you know pharmacy just
isn't you know isn't as profitable as it
used to be and you know you have you
know most pharmacies can't afford to
have you know four pharmacists on staff
or you know whatever they can hardly
maybe afford having one pharmacist on
staff and as well too so I think there's
a lot of different reasons why that's
happening and I think that we can fit
nicely into that where we can either
supplement that for some people so we've
got a lot of folks that might work
part-time somewhere and or maybe even
full-time somewhere then they work for
us on the side part-time but we also
have a lot of folks that work for us
full-time as well too so it's definitely
changing and I I think that you know as
more pharmacy schools are opening it
seems like everywhere there's more and
more students that are applying and it's
there's this bubble and this bubble is
gonna be bursting I think in the very
near future and you know I'm concerned
about what that does to our profession
and you know I love this profession I
love what we do I love both furnaces
doing what we represent but I am a
little concerned about what this looks
like long-term and even short-term and I
think that that's where we have focused
on shifting shifting away from what does
the traditional pharmacists do to saying
what can pharmacists do what what are
some other things that pharmacists can
do that don't require you to go work
retail or go work in a hospital or go do
you know this or that and I think I
think there is something there and I
think what we really need to do is just
keep scratching away that surface and
show physicians and other healthcare
professionals and payers what
pharmacists can do and and and really
focus on that and again have it in a
scalable model we can really help move
the needle and that's something I've
always tried to focus on is again I
don't want to just have
to pharmacists that kind of help do some
things I want to have a hundreds or
thousands of pharmacist that can really
say look what we can do and look what
we've really done to impact health care
in the u.s. because we all know it's
broken we all know the health care in
the u.s. is really really it's a cluster
it's a really big mess right now and I
think pharmacists are really
underutilized and I think that there's a
huge place where we can play but we also
have to make sure financially and the
economics all makes sense with it too so
that's something that I'm always
constantly stressing is how can we make
sure that financially this is viable and
it's a model that we want to do and I'd
love to do all this for free but it's
really hard to recruit pharmacists that
well let's let's talk about that because
I think that's one of the biggest
barriers to being an entrepreneur or
being on your own I was a real estate
agent for seven years and the big change
for me was going from you know working
at the pharmacy and then doing the real
estate thing and having variable income
so I made the switch in February which
is probably the worst time to do it
because there's no income coming in
people buy and sell houses in April so
like you I you know I went in I dove in
the pool and it's like it's awfully
shallow where's the water what happened
so but I didn't have wife and kids at
the time so I guess my my my first
question is you went into a variable
income job but you were always working
these other jobs getting other skills at
the same time so that whole you know ten
percent of businesses are gonna succeed
after a year and then of those ten
percent will still be there in five
years doesn't really apply as much when
you've been really working this job at
the same time as you've been working
traditional jobs can you talk a little
bit about what it is to have variable
income and how to kind of set up the
nest egg I'm absolutely petrified of it
so I keep two years worth of salary in
the bank and my wife's like you can't
invest that and I was like I am in my
peace of mind okay
but but tell me about variable income
because I think that's the big things
like oh no no it's too risky to leave my
position when you know a week later
their positions God and they're like
alright well maybe that wasn't risky
right and I think I mean yes it is very
risky of course but but I'm also I'm I'm
captain of my own ship as well too and
that doesn't mean that tomorrow you know
something could happen we could go
completely belly-up but but that's the
reality of any job that you have and I
think that that's what that's a veil but
I think we need to kind of remove from
people's eyes a little bit of oh well
I've got a stable job and I work at fill
in the blank and oh yeah they're not
gonna have any cutbacks and then the
next week you know you're not the one
making that decision you're really at
the whim of those folks that are above
you and those you know stockholders or
whatever whatever that looks like then
too so you know variable income can be
very very challenging and as I kind of
mentioned on the first podcast we had
done is that you just have to be okay
with that you just have to have a
comfort level of knowing that this could
all go away tomorrow and and that's
really not that's not unique in business
at all I mean any company could really
go belly-up you as an employee may not
really know that until you know the memo
comes out or you get the phone call that
tomorrow we're shutting the doors or
whatever then too so it is it is a
different type of risk but for me it is
risk that at least I have some control
over a little bit at least or I I'm able
to pivot and say oh that didn't work
we're gonna pivot we're gonna try as he
saw the things into and and for me I've
got insight into that of course I know
kind of how things are going and I know
what's in our sales pipeline and I know
what discussions we've had and and so I
have some comfort level with that
because I know and I have insight into
that and that's something we try to be
really transparent with everybody that
we work within as well too so all of our
pharmacists and stuff we try to give
them ideas of hey this is what's coming
or hey this is what's happening because
I don't feel like it's fair to keep that
kind of information from them because
they have to make those kind of
decisions as well too and so it's it is
I wish I had two years of income and my
savings however you did that that's
great I mean we're not I'm not quite
there yet but but but it is a it is a
struggle I would say to really try to
figure that out like really try to
stabilize what that income looks like
and I feel like at this point we're
fairly stable I mean we know what you
know what's coming down the road and and
you know what deliverables and what you
know what invoices we have coming in and
that kind of stuff and so we're pretty
comfortable with where we're sitting at
but we're constantly you know looking to
bring on new business and what that
looks like that as well too and having
different partnerships as well then so
again I think when you get to the point
of just saying I'm okay if tomorrow
everything just went away you you just
have to be okay with that and you just
have to kinda I mean you could get hit
by a bus tomorrow and you know then
you're not gonna hit that sounds again
back to cliches I mean it but it does
I can't live your life constantly in
fear of what's gonna happen tomorrow or
next month or next year and that doesn't
mean you don't think about those things
you you don't try you know plan and and
be prepared for those things but having
those conversations in your head
constantly is counterproductive and from
my perspective and that I could have
really focused on what's going on right
this second and really try to be in the
moment try to be mindful of that and I
think that's for me just a philosophical
belief that I've got is that I can't
change what happened in the past
I really can't change what's gonna
happen in the future all I can do is
just kind of focus on what's going on
right now and and that can be it might
be cheesy but that can be really freeing
as well too because I don't have any
control over that and all I can do is
just focus on whatever what I'm doing
right now then - and oh yeah back to you
just have to be comfortable with with
that kind of risk and if you're not
you're kind of you know you're year
you're maybe a little deer in the
headlights that again tomorrow you could
lose your job and there's
really no such thing instability yeah
okay well let's I'm gonna be posting a
carry out here in an hour and ten
minutes and I guess the visual that I
have of somebody going in the the chat
is about what it is to be a pharmacist
in a physician's office how does that
work and all of that and I guess I feel
like the way that many students look at
it is so let's say they go into the
physician's office the receptionist
comes up says oh hi are you a drug rep
nope nope I'm a pharmacist yeah but so
you're here as a drug rep no no I'm here
to work with the physician so I get it
you're gonna help us learn about
medicines but no no I'm here to work in
the physician's office so I guess
there's really misconceptions about what
it is to be a pharmacist in a
physician's office as part of the
chronic health team and then also
talking kind about population health
what would you talk about in that chalk
and you're welcome to come on the
Twitter chat hopefully you'll be able to
make it but what would you kind of say
in terms of first of all how does the
pharmacist work within the office and
then how does working within the office
impact population health in general
yeah I think it's it's really hard to
paint a broad you know a broad stroke
and just say every physician and these
this this this and this I mean I think
if you talk and generalize terms you
know most physician offices are they're
very busy I mean you know these Doc's
they have to see so many patients per
hour I mean you know you talk about we
have to feel so many prescriptions per
hour well physicians in that point where
they have to see so many patients per
hour than - so whatever you can do to
help decrease that time without
impacting quality or actually improving
quality if at all possible and if you
think about that patient that walks in
the door that oh my gosh they're on 30
meds and they've got you know 17
different disease states and all of this
kind of stuff and so if you can really
help that physician by taking some of
that load off of their shoulders and you
know it's something we struggle with is
how do you get reimbursed for that kind
of service so so what we focus on is
chronic care management also complex
chronic care management and because
those are available services also some
other things
focus on is transitions of care because
if you can help ensure that you know
that patients been discharged from the
hospital and you've done follow-up
within 48 hours with that patient and
you've done the medication
reconciliations and and that type of
stuff then when that patient comes in
you know within seven to fourteen days
that's an additional service or that's
an additional billable service that the
physician can bill for now because this
is really a transition of care versus a
traditional EMM CPT code that they would
use so there is you know understanding
the economics involved in that because
you know physicians are their business
people as well too and you know you to
go to an office and say hey I'd like you
to pay me a hundred thousand dollars a
year to be your pharmacist they're gonna
say okay well that's great but how do we
afford that like you know what can you
bill for and that kind of stuff then -
and and really thinking through that I
think it's really important but over and
beyond just what can you bill for its
also focusing on what are physicians
being held accountable for what what
types of metrics are they being graded
on now which is impacting their
reimbursement just the same way the
pharmacies and hospitals and health
systems and they're being held
accountable as well - and and their
reimbursement is is moving away from a
fee-for-service and more you know for
other types of you know value-based you
know reimbursement and that type of
stuff then as well - so I think being
able to talk to a physician or an office
manager regarding what kind of revenue
can you bring into the clinic but also
being able to talk about how much
additional savings you can you can help
that physician you know not getting
dinged you know not not not getting bad
report cards and and and being able to
stay in-network and and get a higher
reimbursement than what their their
colleagues would I think that's really
important I think that's a huge part of
a pharmacist can be doing but also
easing the work burden from their staff
as well to you know taking time or
allowing more time for the physician
allowing more time for the nurse and the
pharmacist being really a big part of
that care team you know I think the
other challenge is that traditionally
those positions have been may be filled
by academic you know pharmacists
pharmacists work in you know pharmacies
of school or their students and that
kind of stuff them as well too and I
think that's a great place to start but
it's not back to scalability it's not
scalable and it's we need to be able to
almost move away from that model of
saying hey here are these you know these
free pharmacists or free pharmacy
students that can do this work we need
to figure out how do we convert that
over and say well this is there's value
to this and it's not just a free service
we're gonna offer pharmacy we're really
good about giving away stuff for free
stop it just stop it yeah I know
I know as a business person I can't do
this for free I can't just go to a
clinic say yeah this is great look what
all we can do and we'll just do it for
free because it's just it's the right
thing to do because you know I get where
you're going focus on or struggle with
sometimes well let's talk about I was at
Drake next to you literally your table
was there you were talking to students
that are gonna be doing a PPEs with you
can you tell me a little bit about what
an AP PE experience would be like with
case op consulting yeah that's great yes
so our students will get to experience a
lot of different opportunities so you
know a huge part and our bread and
butter has really been a renowned MTM or
medication therapy management so the
students to be spending a lot of time
doing that and focused on you know case
management that kind of goes along with
that and and presenting those patients
and and you know focusing on what does
MTM look like in kind of a traditional
model but we're also trying to look at
it from a virtualized Network and and
how does that all work done to so that's
a big part of what we do the students
also be really involved in chronic care
management so we've got clients that you
know our physician offices where we are
doing the chronic care management with
those patients and
working directly with physicians and
creating care plans and uploading that
information to the electronic medical
records and that's another huge
component is trying to navigate those
waters with interoperability and getting
access to EMRs and some of that kind of
stuff in as well also another big part
of what they would be spending time
doing is we do medication
synchronization as well too so we have
clients where we are working on behalf
of the clients or their pharmacies where
we are helping adherence rates by doing
centralized medication synchronization
so we're reaching out to patients on
behalf of their pharmacy we're syncing
up those patients kind of getting those
those pharmacies prepped and ready for
them to start taking over the
appointment based model as well too so
we think that's pretty interesting as
well and as we keep growing and and
bringing on new business you know we
just keep expanding and I think
understanding or realizing there's a
whole myriad of additional types of
things that pharmacists can be doing and
we've got that ability to try out those
different models and see what kind of
works so but really the students will be
focused a lot on that also be doing like
drug information so you know we've with
all of our pharmacists we've got there's
oftentimes there's a question that comes
up and says oh hey I've got this patient
that's on you know to calcium channel
blockers and we can't really figure out
why is there any like studies out there
so the students will be helping grab
some of that information or doing some
research and you know you know though
the be doing article you know case
reviews and articles or reviews and that
kind of stuff - well - but we think is
gonna be fun we were hoping the students
are really gonna enjoy it and hopefully
open their eyes to some additional
opportunities that might be out there
that they hadn't really thought of
before okay well that's a final question
right now you you don't I don't believe
you have a residency right now your
residency is well I can't hire you as a
resident but I can give you full time
pay or double residency pay and then you
can learn a lot of stuff that maybe you
would have learned in a residency but
let's just imagine that you had a
residency or you created one what would
be a perfect residency for you or maybe
what would be a good experience that
someone's had in Arezzo
see that would prepare them to work with
you yeah I think you know and I've got
some experience with residency's you
know when I worked at high B I helped
set up a residency with the University
of Iowa and hyvee that's been a number
of years ago but I think residency is
really important for for certain folks I
mean for some people I ended up not
doing a residency I just decided for me
that wasn't the best why do we feel so
bad about that you have to apologize I'm
sorry I'm hiring 300 pharmacists but I
didn't do a residency and it's like a
black mark on the record not knocking
residency's cuz again it for some people
it's it's it's great honestly I felt a
lot of guilt because I was getting a lot
of pressure from my faculty okay you
really need to do residency and again
that's fine but I just decided that
wasn't for me but I feel like for us
kind of perfect residency or what we
would really want to get out of with a
residency is really focused on not so
much the clinical I mean clinicals are
important but it's more the business
side like how do you have a sales call
what types of programs can we offer
understanding you know what what does
this look like how do you how do you
build a business and how do you maintain
that business from an operation
standpoint what reporting are you
looking at and some of those types of
things into so I would see it it's
almost more like a managed care type of
residency versus you know at RIT it
wouldn't be like a traditional pgy one
or two I - or anything like that but
it's more focused on business with
clinical involved as well - but really
focus more on the business aspects of it
okay what would be with the managed care
half of Maurin accredited so you have to
deal with that so that's kind of nice so
that's okay well you've been really
generous with your time thanks so much
for being on the pharmacy leaders
podcast they study preciate support for
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