10/10/2017. Moving the Needle: Turning Immunizations into Year Round Profits. Justin Wilson, Pharm.D.

Transcription

1 Moving the Needle: Turning Immunizations into Year Round Profits Justin Wilson, Pharm.D. 1

2 Disclosure Justin Wilson, PharmD, Valu Med declares no conflicts of interest or financial interest in any product or service mentioned in this program, including grants, employment, gifts, stock holdings, and honoraria. Learning Objectives Outline a plan for evaluating the expansion potential of vaccination services in your market. Discuss effective methods for marketing vaccination services to patients and prescribers. Describe effective tools and resources to improve your vaccination process. 2

3 Spot Quiz Are there corporations in your area that conduct international business? Do you fill or write prescriptions for retirees? Do you have patients asking about the New Pneumonia shot? Do your patients have trouble finding someone who stocks shingles vaccine? Do the colleges in your area have study abroad programs? Do you have churches, synagogues, or mosques that sponsor mission groups? Do families in your area adopt children from other countries? 5 Agenda Immunization Market Overview Developing Your Business Plan Core Elements Business Plan Considerations Initial Setup Training Marketing Startup Timeline Discussion and Recommendations 6 3

4 Immunization Market Overview Expanded Immunization Services: Practice Builder Preventive medicine Community need Low awareness Few access points Year round immunization business Healthy revenue per patient Typically a cash business Augments pharmacy traffic Ability to position other pharmacy services Flu immunizations, diabetes, and wellness services 8 4

5 Adult Immunization Recommendations U.S. Vaccination Rates 5

6 Opportunities Adult Vaccinations Pneumo Zoster Tdap Adolescent Vaccines Meningitis HPV Travel Health Increase in International Travel In 2014 more than 68.2 million US residents traveled to international destinations. Mexico 25.9 million Canada 11.5 million Other overseas travel 30.8 million Top sites include: UK, France, Italy, Germany, Spain, China, India, Philippines, Jamaica, Japan

7 Increase in International Travel More people are exposed to rare or exotic diseases The specialty of travel medicine has evolved rapidly as a result of the massive increase in international travel and tourism. an increasing number of travelers will face the risks of exposure to many infectious diseases across the various geographic regions of the world Reference: 1: Jong EC, Zuckerman JN. Travelers Vaccines. Hamilton, Ontario: BC Decker Inc; 2004: v. Infectious Diseases of Concern to Travelers Diphtheria Tetanus Polio Hepatitis A Hepatitis B Measles Mumps Rubella Varicella Malaria Influenza Meningitis Yellow fever Japanese encephalitis Travelers diarrhea Typhoid Parasitic diseases Pneumococcal disease Rabies Cholera Dengue fever HIV/AIDS Many others 14 7

8 The CDC Advises International travelers should contact health care providers who provide pre travel health advice at least 4 6 weeks before departure for current health information and to obtain vaccinations and prophylactic medications Reference: 1. Centers for Disease Control and Prevention. Health Information for International Travel Atlanta, Ga: US Department of Health and Human Services, Public Health Service Kennedy International Airport Study 1 Latin America and Asia were the most common destinations Only 36% of travelers sought travel health advice 17% of travelers considered themselves at risk for Hep A 73% were going to areas where malaria was a high risk Only 46% were carrying anti malarial medications Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:

9 Continued 74% of travelers believed that vaccinations were effective for prevention and yet few were vaccinated for their journey: 11% Tetanus 14% Hepatitis A 13% Hepatitis B 5% Yellow fever 17 Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:23-26 Continued Where travelers got advice 60% Primary Care Physicians 30% Family and Friends 19% Internet 12% Occ Med Specialists or Co. Doctors 10% Travel Medicine Specialists Trip planning 53% 4+ Weeks 19% 2 4 Weeks 15% 1 2 Weeks 13% 1 Week 18 Reference: 1. Hamer DH, Connor BA. Travel health knowledge, attitudes and practices among United States travelers. J Travel Med. 2004;11:

10 Developing Your Business Plan What Can I Charge For? Immunizations Consultations Ancillary Supplies Prescriptions 20 10

11 Immunization Business Plan Considerations Competitive analysis Licensing and regulatory requirements Financial modeling Pre trip consultation software Patient forecasting Rollout timeline and checklist Developing: policies, procedures and protocols Training resources Vaccine purchasing Vaccine inventory, storage, and shelf life Marketing your clinic 21 Competitive Analysis For Illustration Purposes Only Proposed Locations Certified Yellow Fever Vaccination Sites 1 Austin 12 Houston 60 San Antonio 12 Total 84 Yellow fever certified does that make them a travel clinic? A rising tide lifts all boats! 22 Reference: 1. CDC. Yellow Fever Locator. Accessed February 6,

12 Financials For Illustration Purposes Only Proposed Locations International Travelers 1 Austin 120,592 Houston 663,256 San Antonio 90,444 Total 874,292 Assumption: Capture 1% of Total 8,743 Assumption: Year 1-25% of 1% 2186 Total Patients Per Week 42 Patients Per City Per Week Reference: 1. ITA Office of Travel & Tourism Industries Profile of U.S. Resident Travelers Visiting Overseas Destinations Raw Data Telephone Contact. Financials For Illustration Purposes Only Example Travel Health Revenue Model Billing Typically, Fee For Service Payment Cash, Check, or Credit Card Charges Vaccine Cost (50-100% Mark Up) Consultation Fee $25 - $100 Directions: Tab through model, fill in green areas What is Your Annual Patient Population? 874,292 % of Your Patients Traveling Internationally? 0.250% Travel Patients Per Year 2,186 Travel Patients Per Week 42.0 The average # of Travel Immunizations Per Patient Is: 3 Average Revenue Per Immunization? $85 Consultation Fee Per Patient? $40 Revenue Per Traveler $295 Total Revenue Per Year $644,790 Consultation Minutes Spent With Patient? 20 Revenue Per Hour $885 For Illustrative Purpose Only: Please be advised that some vaccines in this business model may be reimbursed by health plans, please see the individual patient's health plan for details

13 Financials: Initial Startup Budget ~$2,500 For Illustration Purposes Only Exotic Vaccine Inventory hr Delivery Under $400 Initial Continuing Education Training Recommended $0 Additional Immunization Supplies Based on Patient Volume a $0 Refrigerator $0 Marketing Budget $0 CDC Yellow Fever Clinic Locator ~$2,000, 6 Month Referral Postcard Campaign $0 $100 Social Media Join International Society of Travel Medicine $90 $150 Online Consultation Software Service, Trial Subscription $0 25 a Assumption: Pilot Sites currently Offering Routine Adult Immunizations What Are Travel Immunizations? Required vs. Recommended Immunizations? All the vaccines listed on this slide can be considered travel immunizations. Recommended US Adult and Adolescent Immunizations 1 Travel Specific Immunizations Influenza Pneumococcal Hepatitis A Diphtheria, Tetanus, and Acellular Pertussis Meningococcal Hepatitis B HPV (Human Papillomavirus Vaccine) Measles, Mumps, Rubella Varicella Zoster Inactivated Polio Typhoid Fever Yellow Fever Japanese Encephalitis Rabies Inactivated Polio Cholera 26 Reference: 1. Centers For Disease Control and Prevention. Advisory Committee on Immunizations Practices. Accessed January 23,

14 Travel Prescriptions 1 Antibiotics Ciprofloxacin Norflaxacin Oflaxacinn Levofloxacin Azithromycin Rifaximin Tinidazole** Amoxicillin/Augmentin Clarithromycin Penicillin VK Tetracycline or Doxycycline Altitude Sickness Acetazolamide (Diamox) Dexamethasone (Decadron ) Meclizine Anti-malarials* Chloroquine (Aralen ) Mefloquine (Lariam ) Atovaquone/Proguanil (Malaron ) Doxycycline (Vibramycin ) Primaquine Miscellaneous Sleep Aids Pain Relievers Routine Prescriptions (Patient Specific) 27 Reference: 1. Shoreland, Inc. Clinic Operations, Vaccines and Medicines. Accessed January 23, Ancillary Products Sunscreens and lipscreens Insect repellent (Deet) Maps Hand cleansers Trip-Size toiletries Travel pillows Compression hose Travel journals Luggage tags Travel games Folding canes Protective clothing Anti-diarrheas Travel health handbooks or first aid guides Emergency first aid kit Digital thermometer Water filters Water purification tablets Tincture of iodine Motion sickness treatment Dramamine and Bonine Oral rehydration and salts packets Potable Aqua tablets Tincture of iodine Topical nasal sprays 28 Reference: 1. Shoreland, Inc. Clinic Operations, Patient Education. Accessed January 23,

15 Training Travel Continuing Education Various CE programs available Travel Resources Travel Specific Software CDC Website 15

16 Marketing Social Media Website/Blog In Store Signage Post Card Marketing campaigns Physician Communication Churches, Schools, Travel Agents Referrals 31 IMMUNIZATION MARKETING CALENDAR 16

17 Website Website 17

18 Website Website 18

19 Website Blogs 19

20 Store Signage Initial Setup Identify a person, or a team of people, to implement your travel health business plan Work out a detailed 10 week roll out plan to stay on track Your first week you should focus on the following: Research your state s immunization rules and regulations Establish immunization health policies, procedures, and protocols Review online consultation software services Immunization Recommendations Travel Advisory (eg, crime) Consular Information Basic Precautions (eg, insects, food and water, pre travel checklist Apply for a yellow fever stamp with your state health department 1 Identify a medical director or partnering physician 40 Reference: 1. Centers for Disease Control and Prevention. Travel Clinics State health departments websites. Accessed January 23,

21 Example: Startup Timeline Week 1 Apply for yellow fever certification with your state health department Request international certificate of vaccination (ICV) cards Review travel health consultation software packages Join the International Society of Travel Medicine (ISTM) (optional) Week 2 Travel vaccine and disease training Vaccine procurement Various Wholesalers Vaccine specific vendors Identify a local infectious disease physician if you need to refer your patient for post travel care or for complicated pre travel consults that may be beyond your scope of expertise 41 Example: Startup Timeline Week 3 Review policies, procedures, and protocols Determine patient flow Establish fee structure Identify products other than vaccines: Prescriptions, OTC s, ancillary Week 4 Subscribe to travel consultation software that you evaluated in week one Create a consultation and immunization area Inside Marketing: Techniques for Your Own Customers Outside Marketing: Begin to assemble Referral Marketing Campaign Week 5 Begin to plan your grand opening event Host a travel health open house for referral sources such as local physicians Public relations Send your first wave of referral marketing postcards Hang posters and implement inside marketing materials Educate your staff 42 21

22 Example: Startup Timeline Week 6 Add travel health to your menu of services Get listed be sure your travel health clinic is listed on the following Web search engines fever State Department of Health Website List on store website.improve SEO Week 7 Throw open the doors of your travel health center Week 8 Grand opening event Week 9 Send your second wave of postcards follow up mailings every five weeks Week 10 Initial marketing review continue to perform at three month interval 43 Patient Consult 22

23 Initial Patient Contact Phone Triage Ask Questions!!!!! Where are you going? When do you leave? How long is your stay? Are you current on your adult vaccinations? When was your last Tetanus shot? Who is your PCP? Initial Preparation Set appointment Make sure to leave plenty of time for vaccines needing multiple doses Research destination recommendations Online travel software Contact PCP for RXs, if required by state law Don t forget malaria prevention, if needed 23

24 Print Patient Traveler s Reports Order vaccines Allow hours Traveler s Reports 24

25 Patient Arrival Intake Forms/Consent forms Can these to patient in advance New online technology options Vaccine Information Statements Yellow Fever Certification, if needed Basic Intake Form 25

26 Travel Intake Form Patient Consent Form 26

27 Vaccine Information statement CDC Form

28 Patient Counseling Review Travel Health Report Vaccine preventable diseases Safe food and water consumption Malaria prevention Crime or travel advisories Discuss vaccine options Required versus Recommended Patient Counseling (Continued) Administer appropriate vaccines Monitor for adverse reactions Document Patient records Lot numbers Expiration dates Physician records 28

29 Physician Letter Patient Exit Give additional travel tools Travel checklists Refer to your Ancillary Travel Products! Travel Health Tip Booklets Language barrier pointer cards Ask for a postcard! 29

30 Travel Checklist Conclusion Preventive Health Positive revenue for your practice Become a health care destination! Resource for other Health Care Professionals 30

31 Justin Wilson, Pharm.D Questions and technology demo to immediately follow CE portion of the presentation 31