At Moose Pharmacy the Future of Community Pharmacy Is Rooted in the Past

“Moose Pharmacy or A.W. Moose Drug Company, actually, started in 1882 and that was my great-grandfather,” said Whit Moose Jr. “His brother was the town physician. He was having to see the patients and make the drugs at that time and he was like, I can't do it all. [He] convinced his brother to go to pharmacy school, come back and open a pharmacy in town.”

Walking through the creaky front doors, it’s hard not to feel like you’re stepping back in time. Old medicine bottles with gold labels and Latin text are displayed like artifacts and upon first glance, the dark wood of the soda fountain is visible in the far back corner.

In the same moment, you also notice the automated prescription medication filling machine, computers and other state-of-the-art tools that have replaced much of the error-prone manual functions of past generations. There were easily more than 15 employees working behind the scenes that day from pharmacists, pharmacy technicians, case workers and other staff and a steady flow of foot traffic in and out of the front door.

This dichotomy seems to symbolize how Moose Pharmacy has kept close to its roots and original purpose of always taking care of the people in this community while also embracing innovative technology that prioritizes patient safety and improved, whole-person care.

“If you could roll back a hundred plus years ago, a lot of things would look the same. A lot might even feel the same. But one thing that is definitely different is the technology,” said Joe. “We try to stay on the cutting edge with technology to free up time for the human part to actually happen, that human one-on-one interaction.”

Joe Moose notes that today, “the need is less around filling prescriptions fast, accurately and cheap, and more around taking care of folks in the communities we serve.”

“We found this document that our great-grandfather had printed that talked about the purpose and it was basically take care of the people in the community you serve. If that's truly your mission, what you do inside this pharmacy and behind the scenes, is very different than just filling prescriptions. So, it truly is whatever it takes to give that person better health in that community,” Joe added.

It’s a model they’ve now replicated in six additional locations. “We've got dedicated people that have roles that include outreach and working with people where they live, work and play, not just when they walk in the door, but out there in their community, and in their environment. But it is also everybody's role here,” said Joe.

Collaboration Key to Filling Care Gaps at the Pharmacy

A pharmacist herself, Ashley Moose is Joe’s wife and an important part of the family business. She runs the Moose Pharmacy in Monroe, North Carolina, that opened in 2020.

“We wanted it [the pharmacy in Monroe] to be a place where if you just came from the hospital, or you just had a transition of care, and you walked into the pharmacy, it felt like a home for you. You were comfortable asking questions, and we knew your name,” explained Ashley.

She added that the pharmacy is filling a gap for patients as “other needs pop up that may not be able to be met quickly or efficiently or easily, in a community where there is not a lot of medical team support or declining levels of medical teams.”

“Instead of going to the hospital to wait for eight hours to be seen in the ER, or in urgent care for a more minor sickness or acute illness, could you come to the community pharmacy for some of those supports? And so that's what led to the decision of having a physician assistant available in the pharmacy [in Monroe] to be able to help with some primary care needs, particularly in a setting of physician shortages.”

One of the benefits for patients with chronic illness is its accessibility.

“A lot of individuals are looking for treatment options, cost-effective options, ongoing counseling for weight loss management. Of course there's other chronic diseases, diabetes, hypertension, and disease states that require a lot of tweaking, that you can have quick access to a provider to ask those questions or say, ‘Hey, my blood sugar's running still really high on this therapy,’ without having to wait a month or two months to seek care, they can have easy access to a healthcare team within the pharmacy setting, to help make quick management decisions.”

“We are seeing a variety of chronic disease state management there and primary care opportunities, as well as acute. Sometimes you wake up and you've got strep throat, and those kinds of things can be treated very quickly in the [pharmacy] setting,” Ashley added.

It’s also a sign of the evolution of how patients are cared for given the number of challenges facing healthcare today.

Whit points out that, “collaboration is a key word right now because every discipline has its strength and no matter what anybody says, there's no one discipline that can do it all.”

He added that collaboration is important for the sake of improved patient outcomes but can also have financial benefits and enable greater opportunities.

He said, “providers need to understand that sometimes there's strength in our collaborations too. I think that's key moving forward, too.”

Access To Patient Intelligence Is Essential to Providing Quality Care

“The more information you have, the more informed your decision,” said Joe. “Healthcare, finances, grocery shopping, whatever it is, if you know what you're trying to make for supper that night, you know what to get at the grocery store. Same thing in healthcare, we're [pharmacists] really good at helping reinforce the care plan [but] we we rarely know what the care plan is, unless it's the care plan that the pharmacy side has created.”

It would likely surprise patients that their electronic health record isn’t typically shared or accessible between different types of clinicians, like pharmacists and physicians, for example. And frankly, it’s one of the more frustrating administrative shortcomings across healthcare. But it’s also one of the more ‘fixable’ problems and an obvious opportunity to create efficiencies that will have a big impact on improved patient care.

It’s a sticking point that Moose Pharmacy has addressed through collaborations they’ve initiated with nearby health systems to be able to use their EHR systems to access patient health information.

Joe described how this has changed, for the better, how the community pharmacy can provide safer patient care, without additional phone calls or delays.

He recalled, “earlier today a patient was prescribed two insulins, a longer-acting and a shorter-acting, and the directions were reversed. And the pharmacist said, ‘this isn't how you take them.’ Two years ago, that would've been a phone call to the office, which is actually routed to a call center that's nowhere around here, I don't even think in state, then a message gets typed into a portal that goes to a nurse, that eventually gets to a doctor or whoever's seen it, that gets back and all that gets funneled back to us. You may hear back that day, [but] you may never hear.”

“To have that actual direct communication, or window into that electronic health record is a time saver as well as much better care.” He said, “we leave that [the EHRs] open and are working from their electronic health record the whole time we're filling prescriptions and working with that patient.”

The ability to verify information, answer their own questions by seeing the existing information in the patient’s record, plus the ability to communicate within the EHR back to the physician, is invaluable.

The Future of Pharmacy is Happening Now

Moose Pharmacies are doing something special, according to Joe. The value pharmacies are providing for patients and even health plans, include tackling the parts of patient care that often get overlooked in a traditional care setting.

Despite the value this brings to improved care, Joe states, “there's not one penny of reimbursement, but there's a high need for it, and we won't be able to stay in business if there is not some type of reimbursement for them.”

But it hasn’t stopped Moose Pharmacy from finding solutions that keep administrative costs low so they can continue fulfilling their purpose of taking care of the community.

Joe explains that creating efficiencies is essential because it leaves room to build relationships with patients and learn more about their care. He notes the value in pharmacists being able to “reinforce the care plan and get everybody on the same page. So, the physician, the pharmacist, the physical therapist, the wound care nurse that's coming in home, we're all operating with the same care plan. We're not all operating out of our own silos.”

Riley Clark, PharmD, is a community-based pharmacy resident at Moose Pharmacy. She’s following in her mom’s footsteps and credits her interest in pharmacy to growing up watching her mother care for patients as the community pharmacist in a small town in Iowa. “I really aspired to be that kind of resource for patients,” said Riley.

As a practicing pharmacist and resident, she’s gaining important specialized experience working within a community pharmacy and has also spent time in the nearby clinic with patients.

“We are a really great resource to patients who need us,” she said.

Riley recognizes the challenges ahead, “I hope people can recognize that the care that we give is really important and the impact that we can make on patients is really, really great, but we need to have some sort of revenue to continue to be here in the next hundred years.”

It’s a sentiment echoed by the Moose family when they talk about the future of their pharmacy and what community pharmacy in general might look like.

Joe shared, “the community depends on us because we've been here for so long, but there are a lot of communities that don't have access to that type of care. But the communities that have a pharmacy, like this, have over the years started to fill these needs. And if you take that away from that community, it really suffers. It doesn't just suffer in the healthcare, I don't have a place to get my drugs, but I don't have a coordinator of my care, or the jobs that we provide for the community. Community is a fabric and we're part of the weave of that fabric. And when you pull on that one thread long enough, the entire communities can crumble or dramatically change.”

“I firmly believe, with all of my heart, that if we would leave this community, the health and well-being of people who live in this area would decline.”

The Moose family is both realistic and optimistic about their role as part of healthcare.

Setting aside the challenges, “if my great-grandfather walked in today and saw what we're doing, one, I think he’d be super proud because I think we've stayed really true to that mission of taking care of the people, the community that we serve,” said Joe.

Ashley agreed, noting that, “knowing the foundation of Joe, his brother, his dad, Whit Moose Senior, they all have a very similar personality in that you can throw anything, any curve ball to them and they'll react very calmly. And they've always been good as a family of embracing change.”

“They would totally be impressed. And then when it comes to technology, that would, I'm sure, blow them away,” said Whit.

“In terms of the technology, I think he would like the fact that the technology allows us to spend more time face-to-face with folks and to really hear them out,” Joe added. “Because I never knew my great-grandfather, but I knew my grandfather very well. And it was all about listening to what folks are telling you, listening to what the community tells you, looking around seeing what the community needs and providing that.”

“That's what we're about. We want healthy food in the community. We want folks exercising. We want sidewalks and greenways and things for people to live a healthier lifestyle. And when they are in that position that they're sick, we want to make sure that we're using technology to identify that and do a really good job of communicating that.”

“So, I challenge my fellow clinicians, partners, pharmacies, physicians, health systems, everybody out there, to foster these meaningful collaborations and embrace them for better outcomes for everybody,” said Joe.