Dan Strause is the president and CEO of Hometown Pharmacy, which is a network of 70 independent functional pharmacies across Wisconsin and Upper Michigan that deliver patient-focused care.
The Hometown Pharmacy group seeks to connect prescribing clinicians with pharmacists to collaborate and achieve the goal of moving patients from pharmaceuticals to nutraceuticals to food. They see a critical need for pharmacists to reconnect and work with prescribing clinicians, especially to mitigate or address drug-induced nutrient deficiencies.
Building relationships between patients, prescribing clinicians and pharmacists often starts with patients asking questions and engaging with their health care. Thus, the functional pharmacy approach involves empowering and inspiring patients through health education.
Listen to this full conversation to learn from Dan about the many innovative strategies the group incorporates, including:
- Sending dieticians and nutritionists to speak within communities about functional pharmacies to educate and inspire at a grassroots level
- A test-teach-therapy-test approach with patients
- Using scientific literature and dialog to build relationships with like-minded clinicians
- Learning how to best work with patients to foster adherence
- And much, much more!
Dan Strause is a keynote speaker at the upcoming Functional Pharmacy Symposium on September 23 in Nashville, TN. He will be joined by other former Functional Forum and Evolution of Medicine podcast guests, such as James LaValle, RPh; Thomas G. Guilliams, PhD; Mark Houston, MD; and Jeff Robins, RPh. Register to attend the conference to learn more functional medicine best practices that will support the future success of your pharmacy.
Dan Strause: He had 17 hugs in four hours from patients he hadn’t seen for years because he had that kind of impact in their lives. And when he shared the journeys from folks going on 22 meds down to one or two and leading robust health, we knew we found the right person that had a good formula. But how do we scale that? How do I go back to all our pharmacists?
So, I asked if he’d come up and speak to our group, and happily he obliged. And he said, “Dan, I got 400 hours of presentations, which one do you want me to do?” And I said, “Well, we got to start square one because pharmacists, from the feedback I got, is they want to make sure the therapeutic trust is protected at all times, and they want to make sure it’s evidenced-based science.” And happily, Jeff immediately got it. He says, “Oh, talk to me like I’m talking to myself for the very first time 30 years ago.”
And I never will forget that moment because he’s in front of 100 of our pharmacists, and he says, “I’ve been a pharmacist for 30 years. I take my profession extremely seriously. I will never do anything to a patient unless I have evidence-based science.” I’ll never forget looking at the facial expressions across the crowd, an initial sigh of relief. Then he goes, “Guys, we’ve heard a lot of what functional medicine means,” and he says, “I’m going to show you.” And now, you can see everybody’s kind of eyes like, “Okay, what does this mean? What?” And he throws up the Krebs cycle and he says, “Anybody remember this?” And of course, every pharmacist smiles. “Yep, sophomore year, we had to memorize that.” And he goes, “I’m going to show you what functional medicine is and how it’s taking you back to your sophomore year.”
So, he goes, “Okay, do you remember the Krebs cycle? Here’s all the different items that make up energy to have ATP to have a 38:1 ratio. And you see all these B vitamins and you see CoQ10.” And he says, “Any of your patients on a statin?” And of course, every pharmacist in the room raises their hand. And he says, “Do any of those patients ever complain about being tired and achy?” Of course, everybody’s hand goes up. He goes, “Guys, that’s functional medicine.”
James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs and health technology, as well as practical tools to help you transform your practice and the health of your community.
This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective functional and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.
Hello and welcome to the Evolution of Medicine podcast. This week, we have a real evolution of medicine happening in Wisconsin with Hometown Pharmacy. Imagine a collection of 70 independent pharmacies focused on personalized patient care. Their tagline is, “Educate, empower, evolve.” So in line with everything that we talk about here at the Evolution of Medicine.
I’m super excited to have Dan Strause speak today. He’s the leader of this organization. We’re going to talk about how they ended up creating this network of pharmacies that has health at the center of it. It’s a really amazing story. He talked about their eight pillars. He talked about how they can work together with functional medicine providers. A lot of exciting things have come up as a result of this podcast. But I think our goal here at the Evolution of Medicine is to inspire people as to what’s possible and give them the tools. This is certainly inspirational, certainly practical, and I’m really enthused about the potential for independent pharmacies to really transform healthcare in America.
So, without further ado, check out Dan Strause. He is the keynote of a conference, the Functional Pharmacy Symposium, that is coming up at the end of September, September 23rd weekend in Nashville. I’m going to be there. We’re going to be there for the Functional Forum. Love to have you there if you can make it. If you’re a pharmacist or if you’re just a practitioner that cares about the transformation of healthcare, we’ll see you there. Enjoy.
James Maskell: So, a warm welcome to the podcast, Dan Strause. Welcome, Dan.
Dan Strause: Thank you very much. Looking forward to working with you there, James.
James Maskell: Yeah, I’m excited to hear a little bit more about your work and to learn about Hometown Pharmacy. I guess from one non-health professional to another one, how did you get involved in the pharmacy business and end up with this project?
Dan Strause: Please don’t hold it against me or I hope your audience does, but I’m actually a bean counter by trade, and my first job out was at a big six accounting firm where we had an audit. And the only reason I bring that up is every three weeks, you went to a different employer, and you had to learn how to learn.
So, later on in the career, one of my clients was a pharmacist, and he had the opportunity to buy five pharmacies and his mentor said, “You probably ought to get a business person because pharmacy’s getting more challenging.” My first reaction was, “No, thank you.” I thought it would be tough to compete, but I cared about them. We did a deep dive and we realized that independent pharmacy focused on patient care. There really is a need for that. And we started. We started with five pharmacies, and folks liked our style. And all of a sudden, we’re at seven, eight, nine, 23. And then folks liked our style, and we grew to our current family of pharmacies of 70.
James Maskell: Amazing. You mentioned it got a little bit more challenging. What is the challenges facing the community pharmacy, and how have you sought to meet those challenges?
Dan Strause: Very simple: PBMs. Have you heard of PBMs?
James Maskell: Yeah, yeah. Pharmacy benefit manager, right?
Dan Strause: Yes. So, when they were able to go out of control and own the whole supply chain from insurance companies to physicians to health systems and then to their own pharmacies, they basically have taken anybody they don’t own and tried to force them to struggle in business. So, DIR fees, clawbacks, shrinking margins. They have been a bane to almost everybody in healthcare, and we certainly are affected by their shenanigans.
James Maskell: Absolutely. Well, yeah, that’s really, really interesting. So, I guess now you own some of these pharmacies. I know you were one of the first groups to really think about lifestyle medicine, nutritional guidance, and how to strategically build that into your pharmacy. Something that’s not really obvious. I mean, if you’ve been to a CVS or a Walgreens, the first thing that you see is there’s almost nothing in that whole thing that’s healthy. So, it’s actually a very unhealthy environment. And so, I’m just wondering what was the stimulation to start to think about this in a different way for you guys?
Dan Strause: It’s an interesting story, and I have to give significant credit to my wife. She’s done about every job at Hometown except for being a pharmacist. And one particular day, she was a technician at one of our pharmacies. She comes home, and she says, “Do you know that we hurt people?” And I said, “Excuse me?” She says, “Well, how much do you know about PPIs, proton pump inhibitors?” Well, I said, “It helps acid reflux. That’s good, right?” She goes, “Yes. But I just found out today that if people are on it for a prolonged period of time, it really tears up their insides, and they have significantly more health issues down the road.”
Well, you might imagine, that was a shock to me because you’re right, I was not a scientist at that time, and my knowledge of healthcare was minimal. So, I went down the next day and I talked to our pharmacist and said, “Is this true?” And he said, “Yes.” And I said, “Well, then why are we doing it?” “Well, the patients keep on eating pizza and drinking soda, and of course, they go to the providers who keep on giving prescriptions, and we are just playing our position. We’re trying to stay in our lane.” I said, “But yes, but aren’t we kind of complicit in a long-term health issue? Aren’t we at least educating?” “Well, we don’t want to upset people.”
And I thought, wow, our job is to take care of people and patients. And so, as we’re continuing that conversation, he says, “Dan, you seem to be under the impression that pharmaceuticals heal people.” I was so naive at the time. That’s what I thought. I thought pharmaceuticals healed. And he says, “No, 95% don’t. They do alleviate symptoms. They do stop progression of disease, so they’re still very, very useful.” And I don’t want to sound like, as a pharmacy owner, that pharmaceuticals are absolutely negative, but they were certainly different than what I thought. And that was kind of a dark day for us. We were actually close to selling at that point in time because we were not who we thought we were.
Well, now then serendipity comes into play, and we live in a small town called Rio, Wisconsin. We’re very proud of our foreign exchange students, and we became very close with three, a daughter from Portugal, a son from Germany, a son from Norway, and whenever we visit, we would visit pharmacies. Well, pharmacy in Europe and Africa and Australia are fundamentally different. And this particular interaction with a pharmacy in Oslo, Norway, they had two bays of drugs in their back. They had a lot of creams, holistics, and a lot of nutraceuticals, and definitely their health and beauty products were all health-oriented.
So, I asked her a lot of questions because that was fascinating. That’s what I had aspired us to be. And I said, “I notice you only have two bays of prescriptions. Is that normal here?” She goes, “Yes. What do you have in the States?” “Well, even in our small communities, we have six to eight bays of shelves.” She looks at me kind of odd and she says, “Well, how many days do you dispense at a time?” I said, “Well, usually 30 to 90 days.” And she gives me this look that was incredulous, and I think she thought I was kind of crazy.
Then I asked her, “What do you guys do?” She says, “Dan, whenever possible, we try to single-day dose. Why do we want a patient on the most expensive, most dangerous form of a plant any longer than necessary? We try to go from pharmaceutical to nutraceutical to food.” Well, for me, the skies opened up, the sun started shining brighter because yes, that’s what I thought, that’s what I thought we were being.
So, as we’re going home from that trip, I’m thinking, “Oh, I have to say this to my pharmacist. What if they don’t like it?” Well, happily, when we presented, they all, to a person said, “That’s what we got into pharmacy for. We’re here to help people. It’s just we get out of school, we get behind the counter, and all of a sudden, we have 200 prescriptions coming at us from five different providers. We are that hub.” So, if one provider’s prescribing this, another provider’s prescribing that, we have to make sure there isn’t interactions and side effects. A lot of times, we’re just playing a referee between those two or making sure that the patient’s safe.
Then, oh, by the way, we have to fight with the PBMs because here is the proper medication a doctor prescribed, but the PBM won’t let us do it, so we have to come up with alternative and go back to the provider. So, it’s this big web of PBM games that we have to fight, which keeps us from having the proper discussions with our patients.
Well, happily, our pharmacists, they all sat around, says, “We are in this to help patients, so what do we need to do?” And they said, “Dan, go figure it out and then come back, but we are on board.”
So, with the help of Ortho Molecular and others, we started seeking who are the best in the nation? And a gentleman by the name of Jeff Robins kept on coming up again and again, and we were able to go down and Jeff was kind enough to spend a day with us just to share his journey, and he actually came up and spoke to our group. And that was a watershed moment because, as you know, pharmacists are extremely protective of the therapeutic trust, and thank goodness. That is probably our single biggest asset is our therapeutic trust, especially when it comes to biochemistry, and they don’t want to jeopardize that unless they know there’s evidence-based science.
So, that’s the last six years is we need to protect that therapeutic trust, everything we do is evidence-based science, and that’s why we’re happy to have relationships around the country, especially firms like Ortho Molecular who also are from that same ilk. So, we can always do it with patient outcomes, dosage, mechanisms of action to get good patient outcomes.
Hope I didn’t go off on too many tangents, but that’s—
James Maskell: No, that was good. The first thing that came to mind as you were talking was, well, first of all, as someone who grew up in England, and I’ve spent time in Europe, I recognized that the pharmacies in Europe are different. And I was just recently there and saw there’s homeopathics and nutraceuticals and all kinds of things at those pharmacies. And I remember 10 years ago, going to those places and taking photos because I wanted to show people there’s not just one way to do this. And so, I’m excited to hear that story and the role of the foreign exchange student because I think there’s a lot that we can learn from other countries about how to keep people healthy.
The second thing is just really thinking about, I guess, the difference between sympathy and empathy in medicine. Patients will be upset if you don’t give them their prescription. There’s this very sympathetic element to that, “Oh, poor patient. They need their meds, and they’ve been prescribed this proton pump inhibitor, and it’s our job to get that for them,” as opposed to an empathetic move would be to really see them as capable and really understand from them, what are you trying to do here? What’s the end goal? Is the end goal to… And if the end goal is to be healthy, there’s a different path that we can take you to take you away from proton pump inhibitors to rebuild the integrity of the gut lining in the stomach and create robust health.
And I’m just so glad to hear the way that you described that. And it does seem that we’re at a point here in medicine. We have to transform from a sympathy-based system of just helping people in a way that doesn’t see them as capable to bringing them to see them as capable and see that reversing of your chronic illness is possible if you can participate, and we are here to foster and support that. Right?
Dan Strause: Absolutely. And I think that’s where independent pharmacies are significantly different than the chains because the chains don’t allow the time for the pharmacist-patient interaction to really develop. In independent pharmacies, that relationship is paramount, so we can actually have enough time and therapeutic trust to actually explain the repercussions and the potential paths. We’re proud of that.
The hard part now of course is just the behavior change of having those discussions, but COVID actually helped. People are asking now for more alternatives and we’re seeing kind of a shift towards, “Is there a better way?” Especially when the best-kept secret around is pharmaceutical-induced nutrient depletion. We know that occurs, but we found the vast majority of patients don’t, and if we simply share that there is that, then a percentage are much eager to learn more. So, that’s where we’re hoping that our relationships can really develop further with functional medicine providers.
James Maskell: Yeah, that’s great. I’m glad you brought that up, and we’ve had tons of content over the last four years. Since I really realized the potential of the pharmacist as a key agent of change in community, we’ve had a lot of content on it. And we’ve talked a lot about that.
And I just want to also mention Jeff Robins because not only has he been a leader in pharmacy and a great man, but also, he is very interesting in that he really developed the Peoria, Illinois functional medicine community that’s been running for almost 30 years. And he single-handedly got that going, and that’s acted as a model for all the other communities that we’ve been trying to build here for the last 10 years for the Evolution of Medicine because, ultimately, when you get pharmacists and doctors and community leaders together, you can really make change at a more meaningful level.
I’d love to just understand the early days. You said you’ve got drug-induced nutrient depletion as a starting point. What did it look like to start the journey of implementing new systems for care delivery, obviously in a profession that’s not used to it and also in an environment that’s not used to that?
Dan Strause: A great question, and happily, I get to bring up Jeff Robins again. So, we went down to interview him and just view how he handled patients, and we were thoroughly impressed. He had 17 hugs in four hours from patients he hadn’t seen for years because he had that kind of impact in their lives. And when he shared the journeys from folks going on 22 meds down to one or two and leading robust health, we knew we found the right person that had a good formula, but how do we scale that? How do I go back to all our pharmacists?
So, I asked if he’d come up and speak to our group, and happily he obliged, and he said, “Dan, I got 400 hours of presentations, which one do you want me to do?” And I said, “Well, we got to start square one because pharmacists, from the feedback I got, is they want to make sure the therapeutic trust is protected at all times, and they want to make sure it’s evidenced-based science.” And happily, Jeff immediately got it. He says, “Oh, talk to me like I’m talking to myself for the very first time 30 years ago.”
And I never will forget that moment because he’s in front of 100 of our pharmacists and he says, “I’ve been a pharmacist for 30 years. I take my profession extremely seriously. I will never do anything to a patient unless I have evidence-based science.” I’ll never forget looking at the facial expressions across the crowd, an initial sigh of relief. Then he goes, “Guys, we’ve heard a lot of what functional medicine means,” and he says, “I’m going to show you.” And now, you can see everybody’s kind of eyes like, “Okay, what does this mean? What?” And he throws up the Krebs cycle and he says, “Anybody remember this?” And of course, every pharmacist smiles. “Yep, sophomore year we had to memorize that.” And he goes, “I’m going to show you what functional medicine is and how it’s taking you back to your sophomore year.”
So, he goes, “Okay, do you remember the Krebs cycle? Here’s all the different items that make up energy to have ATP to have a 38:1 ratio. And you see all these B vitamins and you see CoQ10.” And he says, “Any of your patients on a statin?” And of course, every pharmacist in the room raises their hand. And he says, “Do any of those patients ever complain about being tired and achy?” Of course everybody’s hand goes up. He goes, “Guys, that’s functional medicine.” And they’re all going like, “Well, what do you mean?”
Well, what does a statin do? Well, it blocks the body’s ability to make cholesterol, right? Yes. Isn’t that the same cascade that makes CoQ10? Yes. So, if your body no longer makes a sufficient amount of CoQ10, your 38:1 ratio is going to be eight to nine, which means you’re tired and achy, right? And you can see everybody’s like, “Oh my goodness, that was right in front of us. We never put two and two together.”
And he says, “Now, go back to your statin patients and just give them two days of the quality.” And here’s the difference between quality CoQ10 and the poorly constructed. The poorly constructed you get from the change, you open it up, it’s thick, it’s granular. That’s not going to get to the cell level where we need it. So, the good stuff is liquified, fortified with vitamin E, so it actually gets to the cellular level. And a handful of our pharmacists did that in the next week and their patients are coming back in 48 hours giving them a hug saying, “I haven’t felt this good in years. You’re my hero.” That’s functional medicine.
So, when they saw the science and the two and two together, and then they had the patient affirmation of the hug, then they said, “What else can I learn?” And so then we went back to more pharmaceutical-induced depletion, and of course, CoQ10 and a couple other items, you tend to have a faster turnaround as far as patients actually feeling the difference. And once we did that, then we could start talking about magnesium and vitamin D. Those you don’t feel so much different immediately, but now they understood the science and trusted us.
So, I like to bring up that story because he did a great job at connecting it at the base level that it’s things they’ve already learned, they just have to relearn it, educate a patient, and then when they get patient affirmation, then they’re hungry for more. So, I wish there was a one-step process, but we saw all of those were needed to start getting traction.
James Maskell: Got it. Yeah, it makes a lot of sense. So, I guess I’m interested in learning about how you work with doctors locally because there are some pharmacists who listen to this podcast, and I’m sure they’ll be inspired to see the journey that you’ve gone on to build this whole network—and now to use that in such a way that you’re able to create health at some sort of scale. But a lot of people who listen to this and doctors and practitioners aren’t a pharmacist and maybe might find some value in building relationships with their own local community pharmacy or maybe get involved with supporting something like that.
Do you have a collaborative approach with functional medicine doctors? What does that look like? And what is your… I’d actually like to really understand the business model of all of this because I understand the business model of you only make a dollar from a drug, and so then you can sell a nutraceutical supplement. I understand that sort of business model, but what about, is there any other fees? How do you work with insurance? Can a pharmacist do a patient appointment? What does that look like?
Dan Strause: Great question and multiple technicals to that question. So, I’m going to answer a couple and hopefully will get your feedback if it accomplishes the goal or not.
First and foremost, that relationship between local providers, we’re excited about rebuilding that. I believe a generation ago, the pharmacist-doctor relationship was closer, and I think the last 30 years, there’s been kind of a health system is one and a chain. So, there’s a lot of fear out there. There’s a fear of pharmacists to talk to doctors just because we don’t want to upset them. And it’s interesting because in some systems, some of those doctors are basically told that vitamins are expensive urine. So, sometimes, it’s an uphill battle. And for those relationships, we go science. Here’s evidence-based science to build those relationships.
With functional providers, like your listeners, that excites us. And I think a lot of times, we just simply need to know that each other’s there to be supportive. We like to think that… Our analogy is we’re the left tackle and they’re the quarterback. Our job is to protect them from blindside, support them, give them more and more information on evidence-based science when it comes to nutraceuticals and build from there.
When it comes to the business part, we know patient outcomes is what the mutual goal is going to be, and that’s where the future is, is we have to get better patient outcomes if we’re going to lower healthcare cost. So, we know there’s DPC doctors, and there’s an interesting model that has been innovated out of Indianapolis that we like. It’s a combination concierge where it’s functional doctors and pharmacists working together. And with that comes the ability to have more access points, and it makes it easier for customer patients to access healthcare.
There’s a white paper written about 20 years ago that if a physician, pharmacist and patient work together early and often, we can prevent 80% of disease. When I first heard that, I’m thinking, “Wow, if that’s true, why aren’t we doing it?” And then you realize the bulk of healthcare is usually driven by systems who are owned by insurance companies who are owned by Wall Street companies. And I guess I’ll keep my opinions to myself as far as the current system is patient-oriented or profit-oriented, but I believe that the listeners in your podcast is consistent with us is we want to be patient-oriented.
So, having this concierge model and patient outcome models, we believe, are part of the future. And you did mention it earlier that we have to fill about 20% of our prescriptions at losses. So, if we can go from pharmaceutical to nutraceutical to food and no longer fill prescriptions at losses, but get better patient outcomes through nutraceuticals and food, that’s a much more sustainable business model and it’s patient-oriented.
So, not that we enjoy the current system that PBMs do, but it’s forcing us to reinvent ourselves. And happily, as you mentioned, we should be following Europe and Australia and Africa where only 30% of the revenues are on prescriptions and the rest is on test-teach-therapy-test, and having very early access points to be able to get the early test so we can predict stuff way before it happens.
The amount of science out there available for us to prevent disease is fantastic, it’s just patients don’t know that we, as a society, have that to offer. And of course in the most systems, those tests are cost-prohibitive. So, if we get those tests to be very affordable and we’re a local access point, and our dream and part of what we’ll talk about later is the eight pillars, is now to work hand in hand with providers, that it’s more accessible and we can lower admin cost. Now, can we be an alternative to prevent the significant amount of people that are going to disease state?
Oh, you’re on mute.
James Maskell: All right. Yeah. Well, let’s jump into those eight pillars then because I’d love to understand how you organize care and also how you’ve trained your team. You’ve got 70 pharmacies, how many pharmacists?
Dan Strause: A little over 100.
James Maskell: 100 pharmacists. So, I’d love to understand how they’re trained to execute on this, and then just the eight pillars and where that came from, and what you’ve got.
Dan Strause: Okay. The training part is a combination. We sat down, and we had 50 of our partners, and we said, “What do we need to do to support you?” And they each kind of said something similar is, “First, we need to have some white papers and some science.”
So, we had our clinical pharmacist accumulate those white papers, and then we brought it down into a more manageable form, and we have an intranet. So, we house a lot of white papers there, but we also created videos. And well, part of the videos was science-based, but also how do we talk to patients? Because we lovingly call this the Mike Kuckes Conundrum, and this is probably the single biggest thing we have to overcome. You’re going to ask, what in God’s name is a Mike Kuckes Conundrum?
So, we did an extensive amount of training and we all committed across all 70 stores that we were going to teach patients about the foundational six. And our foundational six is a good multivitamin, it’s a reactive magnesium, it’s vitamin D3-K2, we had CoQ10 in there, fish oil, and a probiotic that we knew that the vast majority of folks needed. And we put together significant training on all the above. And we launched it about five years ago and we saw a significant lift, but it was still maybe only 20% to where we thought we’d be.
So, we had to ask why. And here’s the fascinating response that we found out, and it came from one of our pharmacists named Mike Kuckes. He says, “Dan, if a patient asked me a question about the foundational six, we’re the best in the business of teaching it. They have close to 100% acceptance rate.” He said, “But if James doesn’t ask me that question,” then each one of them as a patient comes through, they’re going, “Well, will James like this? Will he yell at me? Can he afford it? Will the doctor get mad at me?” And they’ll have 10 different questions that goes on in their head, and only if the answer is yes to all 10 will they share that information or initiate the conversation. Wow. So, here’s something the patient… And he said, “Dan, your challenge is can you find a way to have the patient ask us a question? Because if you can, then we’re fantastic. If you can’t, then we usually have to wait for there’s a unique situation.”
So, I bring that up on your show here because there’s our item that we see across healthcare is can we give patients information enough for them to ask questions? Because if they get engaged in their healthcare, then between both physicians and pharmacists, we can do an awful lot to help. So, we’ve done some things and we’re creating some apps and other messaging just to make patients aware of pharmaceutical-induced nutrient depletion as well as, as an overall society, we have significant nutrient deficiencies. We live in a time where we’re exposed to more chemicals and toxins than ever before. It’s hard to get quality food just because of the way our current food system is. So, what can we do to be able to teach people about nutrition? So, there’s the big conundrum.
James Maskell: That’s great. I know also it is interesting you mentioned that because I’ve seen over the years, diagrams of total use of Roundup in America, and the different colors are the difference of concentrations, and I feel like maybe Illinois is the most, but Wisconsin’s not far behind it. And so you’ve got a lot of that toxic influence just in the agriculture there that obviously you are really fighting downstream in a certain way. And so it is critical that you could do that, and you’ve got the sort of infrastructure, I guess, to really have a go at it.
That’s great. Yeah, really, really cool. Well, I love that. And getting the patients to be inquisitive is critical. What’s the best? What have you found over time to be the best way to draw patients out to ask questions? What’s been the most effective tool that you’ve discovered?
Dan Strause: One might be an open-end question is, how can I help you today? Is there anything that is bothering you or what’s creating pain? Because everybody has some form of pain. And then just listening to folks.
The other part is we know based on what pharmaceutical they’re on, what their nutrient deficiency probably is, and what that might be resulting. For instance, like metformin, if that is depleting their B vitamins, they’re probably lacking in energy. So, we can ask a question, “Hey, you’re on metformin. You ever have any issues with energy or being tired?” And then they can say yes. They go, “Well, do you realize it’s because of nutrient deficiency?” And we’ve been very pleasantly surprised on the response rate by patients to ask about pharmaceutical-induced nutrient depletion.
I have to kind of back step here a little bit because we’ve used utilized something we call community stitchers. A community stitcher is a dietician nutritionist that we have go out in the community to explain to them the different things we’re doing because like you said, with pharmacy, people expect that, well, you fill prescriptions. So, as we’re doing test-teach-therapy-test and these other programs, we want to go out there on the grassroots level and explain what we’re doing and just getting their responses.
Happily, the response rate has been outstanding. And one of the first things we lead with is we’re a pharmacy that wants to get you off pharmaceuticals, but then we also say, “Are you aware of pharmaceutical-induced nutrient depletion?” And it has been amazing how consistent the response rate is. The first one is, “Oh, I didn’t know that.” The second emotion is a little bit of anger. “Well, why didn’t anybody tell me this before?” And then third, there’s hope. “Really? I’m on metformin and that’s depleting me of B vitamins? That’s why I don’t feel so good and if I replete my B vitamins, I can feel better?” Yes, it’s body chemistry. It’s science. And then of course when they execute, now you’re their hero, and then they want to know what else can we do?
So, we believe we have to reeducate the consumer that they don’t have to feel the way they feel because I think we’ve all been conditioned, once you hit 30, it’s a long downward spiral. We’re supposed to feel worse and worse, which we know is not true.
James Maskell: Well, that is the reality, but it doesn’t mean that it’s meant to be like that, you know? That is what is happening, but it doesn’t have to be like that and you can buck that trend and yeah, that’s really amazing.
Well, look, I guess I just want to acknowledge just what an amazing job you guys have done. I think it’s an incredible vision that’s been executed so well. And I look forward to seeing the journey here and I look forward hopefully to other entities taking this on, maybe even some of the big boys because ultimately, this is what’s needed. And one of the things that you’ll see is as medicine moves to outcome-based and outcomes become more important than volume, I think you’re in a good spot there for the future.
Before I get into that, because I do have a particular question that I want to ask you, what is the vision here moving forward? Now that you have an incredible… If you just go to the Hometown Pharmacy website, I looked at it briefly before this meeting, you’ve got almost complete penetration of Wisconsin. You’ve got one in every town. So, then what does it look like from here and what’s the dream moving forward? And what are some of the goals that you guys have as an organization?
Dan Strause: Teamwork. There’s a white paper out there and CMS wants patients to have access to PCMHs, patient-centered medical homes, because what they found is if a patient can go into one spot and have access to a physician, a pharmacist, musculoskeletal and behavioral health, patient outcomes rise dramatically because overall health is usually combination with four skillsets. So, to do that, there has to be an access point and make it easy to connect.
So, trying to have all four of those professions under one roof in-person can be challenging, but with today’s technology and relationship-building, we hope to be able to build relationships with functional medicine doctors and say, “Hey, we can expand your footprint.” If we have a consult room in our pharmacies that now with telehealth, we can come in and say, “Hey, we can access you to a doctor who is proactive health-oriented.” Now we can make the world smaller and access more like-minded, more importantly for the patients to have access.
So, a big part of our vision is that we want to be access points to be able to connect key people. Can we actually, instead of a physician having to have 70 locations, can they have their one but then be able to work with multiple pharmacies to be able to help their patient base? Same with the musculoskeletal. And most importantly, if those four providers are all talking about the same patient, and I’ll use an example of musculoskeletal in pharmacy. We worked with the group that they said, “Dan, we were reluctant to talk to you because we don’t like pharmacy because in our world, pain is always treated with an opioid, and we don’t think that’s right.” And I said, “We agree.”
And when they found out more of our model, then we started connecting and what we found is for the patient to execute the musculoskeletal physical therapy, they have to feel good. And we go back to folks on statins. Most of those folks were not willing to maintain their physical therapy regimen. And we said, “Okay, if they’re on a statin, here’s what’s occurring. Let’s get them some CoQ10 to be able to get their energy level, get their ATP cycle up.” We did that. All of a sudden, the patient felt better, they actually did their physical therapy more robustly and more completely, and they got better outcomes overall.
So, that’s what we think we see when there’s a collective team that’s helping a patient because so often, if we’re our own little silos, we don’t realize we actually need each other to actually get that patient to execute to get those outcomes.
James Maskell: Interesting. Well, I want to finish with one question that actually came from a recent podcast that I did. So, I did a podcast, one of the last ones that came out was with Robert Pearl, Dr. Robert Pearl, who was the previous CEO of the Kaiser Permanente group and really took it from almost going out of business in 1997 to great success. And we talked about lifestyle medicine. He’s a huge proponent of it now, and one of the things that he said was that if you have a network of doctors or if you have a network of something that is capable of reversing chronic disease, you could actually have an extremely exciting business opportunity because you could take risk on a big Medicare Advantage contract as an example, once you have that.
Now, I saw the potential of that in, let’s say, these community meetups that we’ve built here at the Evolution of Medicine where you have 50 doctors that know each other and have some coherence by meeting together quarterly or whatever, but I just wonder whether that has ever come into your mind because ultimately, you have the access points, like you said, you have an ability to reverse chronic illness or to work with people to reduce their lifetime costs by getting them off medication and keeping them well. Is there anything in that side of things that is sort of on your radar as far as now that you’ve got this footprint, could you have a bigger impact in the state of Wisconsin by proving your outcomes and taking some of the business away from the industrial complex that just puts everyone on opiates and doesn’t really care what happens to them?
Dan Strause: That’s absolutely our goal. And it’s incumbent upon us to build relationships with like-minded physicians and providers and functional medicine doctors because the team matters. So, functional doctors, we are incredible fans of, it’s just trying to find enough. And then when you have those folks, they have to work awful hard for their business model, and it’s usually in just that one realm. So, we go back to the teamwork. If we’re able to work together… Because the one thing about a pharmacy is an average patient will visit their doctor three to four times a year, they visit the local pharmacy about 33, so 10 times. And our access point is free of charge and easy.
So, it’s about can we be access points and give that information to the doc and then can we have that time spent on each side to be appropriate? For instance, if it’s a UTI, they can do a test-teach-therapy-test, we can take care of them there, but then let the doc know that we’re seeing that because the data point and the transfer of information is so vital, right? We’ve also had some cases where we know adherence matters or how do we move from pharmaceutical nutraceutical to food and what protocols can occur there?
And we find the best relationships we have are with the doctors that we’re talking to, saying, “Hey, how do we solve this?” And between the two, it usually goes much quicker. And then sometimes, the patient needs to hear it from the provider, sometimes they need to hear it from a pharmacist. And when they hear it from both, it’s usually gold.
So, I’ll go back to, I always think teamwork. We just want to play our position, but we believe that if the provider’s the quarterback and we’re the left tackle, we can do some good things.
James Maskell: Great. Well, Dan, I really look forward to meet you in person at the Functional Pharmacy Symposium in September. I know you’re going to be the keynote speaker and kicking off the whole conference. And now that we’ve had a chance to connect, I really think it’s going to be extremely powerful, and I know Jeff Robins will be there as well. It’ll be like a coming home party for everyone. I’ve really enjoyed going to these Functional Pharmacy conferences the last few years to just really understand what’s possible there.
And actually, this conversation has got my brain worrying about some things that I could see doing together because if the community pharmacy is the hub for the community, I think we’ve been, for 10 years, really been trying to create communities of like-minded health professionals that could work together. And I think you’ve got a great foundation there.
So, if this resonated with you and you want to come and hang out with Dan and I, will be in Nashville the weekend of the 22nd and 23rd of September, the Functional Pharmacy Symposium. We’ll have all the details in the show notes. Dan, congratulations on what you built. I’m really excited to hear the scope and the breadth of what you’ve done. I love the eight pillars. I love the six supplements that you guys are using, and I’m excited to continue on in the journey together. Thank you so much.
Dan Strause: I sure appreciate our time together, James. Thanks for the invitation.
James Maskell: Thanks. Well, this has been the Evolution of Medicine podcast. I’m your host, James Maskell. We’ve been with Dan Strause, the leader and Chief Servant of Hometown Pharmacy. You can check out HometownPharmacyRX.com, a little bit more about them. Check out the website. I love the tagline, “Educate, empower, evolve.” This is the evolution of medicine. This is evolved community pharmacy. Thanks so much for tuning in and we’ll see you next time.
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