It’s 4pm on a blustery February day in Blackwell, a small town in northern Oklahoma. The glass door to Hutton Pharmacy swings open, jangling a bell that announces the latest customer.
Blackwell, Oklahoma, just a one-hour drive from Wichita, Kansas, sits nestled among low ridges and windswept flatlands. The nearly six-square mile town was established during the 1893 Cherokee Outlet land run.
“Hey Clark, I need some advice,” says an elderly man with a raspy voice, clad in jeans and an Oklahoma State jacket. “I’ve got a cold.”
Clark Bishop, owner, manager and chief pharmacist at Hutton Pharmacy, swings out from behind the counter to greet the man, Max Claybaker, 87, a lifelong resident of Blackwell, population 6,600.
“I think Mucinex might help,” he advises Claybaker, a retired crop insurance salesman.
“He’s my pharmacist,” says Claybaker, smiling. “I’ll be 88 on Wednesday and Clark is helping me get there. I wouldn’t go anywhere else.”
That anywhere else is just one other local pharmacy, in a town that used to support eight.
Healthcare has changed a lot since Hutton Pharmacy became a fixture on Main Street well over a century ago, but Bishop is mindful of the legacy he inherited. He keeps his eyes on his patients.
“We’ve looked at other sites in town,” says Bishop, “but if we’re to center ourselves on being a community pharmacy, we need to stay on Main Street. We’re here to stay.”
Bishop, who was awarded the National Alliance of State Pharmacy Association’s Excellence in Innovation Award in 2019, bought the independent pharmacy in 2016, in partnership with three others, after its long-time owner, Dennis Hutton, decided to retire.
Since their acquisition, the pharmacy has increased its prescription volume by 20% and doubled sales in the front of the store, which offers gifts, food, make-up and other healthcare items.
So what's the secret? How does an independent pharmacy in a small town not only survive but thrive?
In addition to Hutton, the partners own three other independent pharmacies. Their four-pharmacy network has the ability to shoulder overhead and garner better prices through economies of scale. That helps them mitigate some of the struggles other independent pharmacies are grappling with nationwide, as the healthcare industry undergoes rapid change.
Bishop, who worked at a chain pharmacy for ten years, says he and his partners are investing in their communities and the healthcare of their patients in myriad ways.
They’ve invested in technology, too.
Of course, at the foundation of everything is e-prescribing, which Bishop lauds as transformational. When he began his career 12 years ago, e-prescribing was in use, but there were still a lot of paper prescriptions floating around, ripe for forgeries or missing important information. Oklahoma also began to require the electronic prescribing of controlled substances (EPCS) in January 2020. The benefits of e-prescribing are numerous, says Bishop.
“E-scripts are always legible. They streamline the workflow and input process. They provide access to diagnosis codes and vital signs and have more complete patient and prescriber information. In addition, patients can’t lose or damage them and they’re nearly impossible to forge.”
While Bishop values the existing technology that supports the business, he has an appetite for more information and more tools.
"For instance, I’ve got a patient on two different statins from two different doctors that didn’t communicate well,” says Bishop. “And I’m the one catching the error. I’m having to call two places for clarification and it’s just not efficient.”
Tools such as Clinical Direct Messaging and RxChange could go a long way in addressing such rework, and Bishop acknowledges the efficiencies they could bring to his workflow.
Despite the challenges, Bishop seems to be the right person for the job, given the accolades he’s receiving. He’s working to build bridges in the community as well.
“It takes a good pharmacist to be able to care for the community,” said Bishop’s partner Steven Trevino, 31, a certified pharmacy technician and the director of operations for the four-pharmacy network. “We couldn’t pick a better person, because Clark truly cares for Blackwell.”
A Community in Need
Richard “Cap” McIlnay’s motorcycle rumbles to a halt in front of the pharmacy. He’s come to pick up a prescription.
McIlnay, 56, more commonly known as Pastor “Cap”, is the minister of the town’s First United Methodist Church. He and Bishop have partnered on a National Council For Behavioral Health effort called Mental Health First Aid, which they’ve used to help patients and parishioners alike who may be dealing with a mental health issue. They’re working to train the town’s local police and firefighters, too. “We have a large part of our population that has dealt with generation-to-generation poverty. There is a tremendous amount of post-traumatic stress disorder that comes with that—and a lot of these folks don’t even know they have it,” says Pastor “Cap”. “Many are close to homeless, moving from place to place, looking to find a shelter that’s safe and secure. They’re in survival mode.”
Think Outside the Bench
Back inside the pharmacy, it’s bustling. A patient holding a brown toy poodle on his lap is chatting with several others waiting in a small seating area. Behind the counter, 27-year-old Justun Kukuk, Hutton’s other pharmacist, as well as four pharmacy technicians, are busy filling and checking prescriptions, advising patients and ringing the cash register.
Bishop became an independent pharmacist because he wants to be available to each person who comes in the door, he says. His business model enables him to keep a large staff plus another pharmacist on payroll, allowing them to deliver high-touch patient care that is a critical differentiator for independent pharmacies. At Hutton, they know all their patients by their first names.
“So that even when we’re busy my patient knows they’ll be able to get my attention for an extended period of time,” he added in an aside. “I have to be staffed well enough in order to handle that.”
Standing at the far end of the counter, Bishop raises his voice in order to reach a patient amidst the din.
“Beverly are you still waiting for that prescription?” he asks Beverly Wooderson, 64, who runs Living Water Community Clinic, a non-profit that provides healthcare to the town’s uninsured.
Bishop volunteers at the monthly clinic as often as he can.
“We’re only open in the evenings,” explains Wooderson, “and I often have to tell Clark to not stay too long.” Bishop lives in Oklahoma City, an hour and a half commute one way.
Lifelong resident Tracee Bonewell, 57, who came in for her monthly shot that prevents her debilitating migraines, was once a skeptic of the change in ownership at Hutton’s. No longer.
“Now I call to see if Clark is in,” says the teacher at Blackwell Middles School, adding that he’s the only clinician in town she lets administer her monthly shots. “I’ll ask if he’s at the pharmacy, and if not, I’ll wait until he’s back.”
Bishop and his team have worked hard to show their commitment to Blackwell. In addition to volunteering at Wooderson’s clinic and deploying Mental Health First Aid with Pastor “Cap”, Bishop works once a week at Green’s Country Clinic, whose patient population is mainly on Medicaid. He’s also a member of Blackwell’s Chamber of Commerce.
All these relationships help his business to thrive. Relationships are key for independent pharmacies, says Bishop, and he’s got a few more tips.
“As a community pharmacy, you’ve got to think outside the bench,” he says. “What are you doing besides dispensing? Think about what you can do for providers that benefits both that practice and your pharmacy.“
“God bless this guy,” says Phil Green, 50, a physician assistant and owner of Green’s Country Clinic. “Everyone’s concerned about costs these days. Many times I’ll send over a prescription to Hutton and it doesn’t fit the patient’s formulary or tier. Clark will advise me to switch over to another drug with equally good results. Or Clark will tell me, ‘Hey, this drug is going to interact poorly with this other medication.’ I mean, the feedback I get from Clark is just amazing. Plus, he knows all my patients.”
“It’s a win-win for both of us,” says Bishop. “Together, we’re impacting patient lives in positive ways that separately we couldn’t do.”
Sitting Under the Shade of a Family Tree
After a long and busy day, things are starting to wind down. The staff are closing shop and clicking open lockers to gather their things. Bishop is feeling reflective as he prepares for his long drive home.
Operating at the Top of Their License
Bishop exemplifies the critical role that independent pharmacists play in their communities. Empowering a more efficient workflow, which is our goal, allows pharmacists to more closely collaborate with prescribers and care for their patients:
With the migration to the new NCPDP SCRIPT e-prescribing standard (version 2017071), more and more pharmacists are using RxChange to electronically request changes to a prescription within their workflow. The technology, which gives pharmacists an easier way to collaborate with prescribers, grew considerably in 2019, with 11.7 million RxChange transactions crossing the Surescripts network.
Pharmacists are stepping away from paperwork and gaining precious time using Clinical Direct Messaging. More than 648,000 individuals and organizations—including nearly 24,000 pharmacies—used Clinical Direct Messaging in 2019.
Postscript: The world has changed a lot since we reported this story in February. COVID-19 has put our healthcare system under severe stress, limiting the number of available providers, while also calling overdue attention to the critical role of pharmacies and pharmacists. We checked in with Clark Bishop to see how the crisis has impacted Hutton Pharmacy and patient care.
While they haven’t allowed any foot traffic inside the store since early March, they are delivering medications and set up curbside pick-up.
“It’s not ideal, but we’ve made it work,” said Bishop. “We have done our best to deliver the same quality of service in a few different ways to keep us and our patients safe. Our communication with clinicians across town has also seen a dramatic increase.”
Bishop said that the perception of pharmacists as essential care providers has been widely accepted for some time, but now the decision makers and legislators have started to take more notice, which is a bright spot amidst the crisis. He expects, “if the science is there,” to be administering the COVID-19 vaccine when it becomes available.
Another bright spot? “The smiles and gratitude of our patients that we see every day.”