SmarterMeds pharmacist and managing member, Dr. Aaron Emmel, has a diverse background in pharmacy practice. Upon earning his Doctor of Pharmacy degree from the University of Florida, he practiced as a pharmacist in community pharmacy. While he enjoyed his interactions with patients, he was frustrated at the lack of time available to provide clinical services. Looking for a better opportunity, he took a position as a clinical pharmacist at Flagler Hospital in St. Augustine, FL. He worked on several initiatives to improve patient care, developing treatment protocols and providing education to hospital staff on
numerous topics. He eventually went on to specialize in critical care medicine, helping to coordinate the care of critically ill patients. This advanced level of pharmacy practice suited him well, however he missed the daily interaction he had with his patients in the community. Looking to bridge the gap between community service and the need for a dedicated clinical pharmacy service, he formed SmarterMeds in 2011.
Dr. Emmel is licensed as a pharmacist and consultant pharmacist in the State of Florida. He holds dual specialty certifications by the Board of Pharmacy Specialties, specializing in both Nutrition Support and Pharmacotherapy. He has provided numerous speaking engagements as an expert in medication therapy, and provides lectures for the University of Florida College of Pharmacy. Additionally, he can be found on numerous social media outlets, hosting his own question and answer blog at themedicineguy.com and video blog on youtube (youtube.com/user/TheMedicineGuy).
Dr. Emmel is available for speaking engagements pertaining to medications, dietary and herbal supplements, and medical nutrition. He can be contacted at email@example.com.
SmarterMeds, PLLC. is a small business devoted to providing Medication Therapy Management services. This service includes a comprehensive medication review by an expert pharmacist and education on how to utilize all of the patient's medications appropriately. All patients receive a Personal Medication Record, an Action Plan outlining activities to help optimize their treatment, and communication to their health-care providers about any potential medication related problems.
These services have been proven in multiple scientific studies to help improve health, prevent medical harm, and reduce health-care costs for people who take medications. Patients can learn more about SmarterMeds and enroll in their service. Additionally, patients located in the St. Augustine area can coordinate an in-person medication therapy management session through a participating physician's office or pharmacy.
RxEconsult: You have practiced in community and hospital setting, what attracts you to Medication Therapy Management and how did the idea occur to you to develop SmarterMeds.
Dr. Emmel: The biggest thing that attracted me to MTM is the overwhelming need for it in the community. The concept was beginning to gain popularity when I was finishing school, so I was familiar with it. I worked in the community setting for a little while out of school, and there just wasn't any time to do it. Working in the hospital setting, I saw people coming in from the community with tons of medication problems. I never would have believed the proportion of people who are receiving suboptimal or outright inappropriate regimens had I not seen it time and time again for years. Combine this issue with the generally poor understanding that many people have of their medications, and we are talking about a serious health care problem. Considering that there are very few people providing a true MTM service in the community, I saw this as both a business opportunity and a sorely needed service to the public.
RxEconsult: Have you ever started or managed a business? How far along are you in establishing your MTM practice?
Dr. Emmel: Prior to this, I have never started a business. In fact, I've never been in a managerial role. I've always thought of business ideas, however. My dad was a small business owner, and I really admire him for what he was able to accomplish. I just wanted to have the right idea and the right situation, which I believe I have found.
My business is fully established in terms of the business and MTM model. Much of my efforts up until this point have been on creating a “brand,” and I am now really focusing on building a local network and clientele. I've done all of this up until now working a full-time job on the side. But my goal with this business is to make a living (and hopefully expand beyond that), so now that I have established the business I have stepped down from my full-time position.
RxEconsult: Can you outline the process you used to get from an idea to where you are right now?
Dr. Emmel: Absolutely. The idea occurred to me several years ago. I spent a lot of time learning about MTM and what the business model should look like. I researched what other people were doing, and conducted some market research on the different ways I could reach and serve my target market. This entire process took a very long time, as I had developed and gone through several different scenarios. I knew that developing a cost and time efficient practice model would be the key to success and profitability, so this was definitely the most important part of the process. Once I finally found something that seemed to fit, I had my website built, developed my own interactive electronic form/document/charting system, researched and developed policies to meet HIPAA/HITECH requirements, etc. Not to mention all of the business license and tax requirements. It was a lot of work!
RxEconsult: What was your estimated start up cost and how did you secure capitol to start your practice.
Dr. Emmel: One of the beautiful things about the way I have set this up is the start-up cost. Including the website, marketing materials, and some office supplies, I am still in the four figure range as far as expenditures. For an operational business, that is incredible. Operating costs are not very much either, although I do plan on investing more on marketing. Due to the relatively inexpensive cost, I have been able to fund the operation myself.
More importantly than money in my case, I have a lot of time invested in starting this business. I have spent countless hours researching, setting up the interactive forms, creating marketing materials and establishing a social brand. If you consider the time I've spent and the average pharmacist salary, the start up cost is easily in the six figure range. All while working a full-time job, attaining post-degree credentials, taking MBA classes amongst other activities. I wouldn't have been able to establish SmarterMeds with such a low start-up cost and continued income from my job if it weren't for very long hours.
RxEconsult: Marketing is crucial to success since most patients and healthcare provides are not familiar with MTM. How are you marketing your services?
Dr. Emmel: I am so glad that you asked this question, because this is easily the most important thing that will determine the success of MTM. We've seen from numerous publications that the benefits are there, and I have no doubt that if we have the opportunity to provide the service, we will continue to be able to show enough value to warrant support from the health-care system. However, no one outside of the pharmacy world knows about MTM. I haven't talked to a single non-pharmacist who knew anything about it. You can't have demand for something that people aren't aware of.
Networking with local professionals is my biggest emphasis currently. I am detailing physicians, home health care providers, nurse practitioners, etc. I am also detailing other non-health care professionals, such as financial planners/advisors and insurance providers. Basically anyone who is aware of the health care or medical expenditures of their clients. The more people that you can make aware of MTM and the benefits, the better.
I also joined my local chamber of commerce, which provides some marketing benefits. For example, I get print media and even television advertising slots as part of the membership. I am going to run a 30 second commercial on local cable, which I'm pretty excited about. So I would certainly advise anyone starting this kind of business to get involved with their local chamber. Aside from the perks that may come with it, once again you have a lot of networking opportunities that allow you to introduce the MTM concept and hopefully garner some attention.
I've been keeping an eye out for local health fairs, since I think that is a good opportunity for exposure. I also volunteer for the local COA, and I've given some presentations for other local support groups. Lastly, I use Google Adwords and I've seen some traffic and inquiries from that.
RxEconsult: How are you employing technology, social networks, blogs in your MTM practice and what is your ultimate vision?
Dr. Emmel: I was turned onto a book titled “Crush It” by Gary Vaynerchuk, which really opened my eyes to the importance of social media in today's business environment. Blogging allows you to expose yourself to a very broad audience, and publishing a lot of material makes it easier for people to stumble upon you and your business on the internet. I haven't been as consistent with it as I should be, but now with more time to dedicate to the business I plan on blogging frequently. I publish mainly video blogs, because it allows you to really show the audience what you are about. Aside from the exposure, it is also a source of credibility. If someone finds my website and is interested in the MTM service, they will be much more likely to sign up if they can see that I'm a real person and that I sound like I know what I'm talking about.
I use twitter and keep a bunch of saved searches for medication terms, so I can reach out and answer questions or join discussions about those topics. This is just another way to reach an audience and spread the word about the business. I have the mandatory facebook page, and I offer discounts to my clients who like the page. I've got some other ideas for the facebook page that I hope to have worked out shortly that I think will really attract some traffic, so I'll be sure to let you know if it is successful.
I'm also building a library of education videos for my MTM clients, covering all of the major medication classes. I believe one of your other interviewees mentioned something similar. Since the majority of my clients are not face-to-face, this still allows me to provide some sort of personal interaction to them aside from what they get on the phone or our (secure) electronic communication.
My goal is to build a very broad social outreach, but it is going to take time and more effort than I have been able to put forward. The bigger the audience I can have at my fingertips, the bigger the opportunity I will have to build SmarterMeds into something bigger than a local MTM provider. Also, I want to make people care about their health and their medications. My video blogs are intended to do that and educate people on simple things they can do to look out for themselves.
RxEconsult: Where do you meet with your patients and how do you receive payment? What services do you provide and what are your rates?
Dr. Emmel: My patients enroll in the service via the SmarterMeds website. I send them an “enrollment packet” via email. It is an interactive PDF form that allows them to enter all of their demographic, insurance, health, and medication data. When they are finished filling out the form, there is a submit button at the end that transmits the form data through my secure host and email server. I review all of the data to get a good picture of the patient's health situation, then set them up for a phone interview. Afterwards, I submit their documents to them via the secure email/messaging host I have set up. The service itself follows the AphA/NACDS core practice model. The clients pay for the service up front. I use the PayPal email invoice system that allows the clients to pay via credit card, debit card, or PayPal account. I also accept checks.
While that is the standard SmarterMeds procedure, I also provide house calls to local patients. This doesn't require the online interaction, as some people do not feel comfortable or lack the computer skills to have an effective encounter. This is especially true for the MTM target market. Additionally, I have contracted with a local independent pharmacy to provide face-to-face MTM at the pharmacy for their Mirixa referrals, although the volume has been very low. Lastly, I'm trying to set up MTM encounters at referring physician offices, although I have yet to do this.
For the cash paying clients, I charge $99 per encounter, or $129 for a renewable year long membership that allows a reassessment after any medication change. To be honest, this is not ideal, but I have not figured out a better way to structure the fees. I would prefer to have rates based on the complication of the case, whether it is number of medications or whatnot. But I'm just afraid that this would cause people to omit information, and it is much easier to advertise a flat rate.
RxEconsult: What are you your greatest challenges thus far and how are you addressing them?
Dr. Emmel: The biggest challenge is easily the lack of demand, which is directly related to the lack of education about MTM and its benefits. I think this is pretty much a universal issue, but I think it can be overcome with effective marketing. The other big issue is billing, which is why I have mainly focused on self-pay clients. Providing MTM in the manner that I do is not defined in the CPT billing codes, and is difficult with third-party payers since I do not operate out of a pharmacy. I do hope to do incident-to billing if I am able to establish MTM contracts with physician offices.
RxEconsult: How do you define success and how will you capture feed back from your clients?
Dr. Emmel: Success on the patient level is having them satisfied and knowing that I have either been able to improve their medication regimen or their use and understanding of their medications. I survey all of my clients after the service is completed. I will be happy if I am able to sustain myself financially with the business. I would consider that a success, although my vision is to employ numerous healthcare providers and expand SmarterMeds geographically.
RxEconsult: It has been a pleasure speaking with you Dr. Emmel. It is reassuring and exciting that there are motivated entrepreneurs like you taking advantage of available opportunities and advancing the pharmacy profession while improving healthcare. I will follow the growth of your practice and I look forward to inviting you back in the future.
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