Wellness Rx: a Prescription for Rural Healthcare

We need to have primary care access points in these communities. The communities cannot just turn around and hope that somebody will bring it to them. They got to work to bring it for their communities. Ed Ullmann is the owner and pharmacy manager of Wellness RX, a holistic and patient centered pharmacy and Tannersville, and soon Phoenicia. Far from the chainstore aesthetic or lack thereof, the Tannersville location where we met is a meticulously painted Victorian with a wraparound porch. Inside there's a warm General Store vibe with wood floors and pharmacy cases with a diverse inventory of traditional, natural, and holistic medicine, plus home goods, gifts and crafts by dozens of local vendors. Ed showed us around and then we settled into a comfortable consultation room to hear his vision for a sustainable model for rural health care. This episode of Kaatscast is sponsored by the Hanford Mills Museum. Their season begins May 15th. Explore the power of the past as you watch the waterwheel bring a working sawmill to life. Bring a picnic to enjoy by the millpond. For more information about scheduling a tour, or about the museum's new exploration days, visit HanfordMills.org, or call 607-278-5744. First of all, you have never seen a pharmacy quite like this. So we've been working on it for now 10 years. I made a decision; I wanted to see how we can become a key asset in rural communities that are getting squeezed on primary care access, their pharmacies and so on. So this model has kind of developed that way, and was to also try to bring in my other background. I was the county mental health director. So I very interested in mental health, very interested in public health, we just did almost 900 COVID vaccinations, and we do COVID testing, and we're very much involved with substance abuse, and we give them free Narcan. So what we've tried to do is to one created environment for the facilities that are warm and friendly, smell good, look good, colorful. So we felt that the environment is very critical, especially for seniors and for kids. So we have fish tanks for the kids, we have a wall of their pitchers, everything that will make them feel more comfortable. This is their wellness center. That's what we develop from a pharmacy into really a community wellness center, and how do we adapt to what our community needs. This community up here is a little poor. It has had a long history of substance abuse. So we have adapted more to that need. So we have a patient assistance fund that we can help anyone in need on the spot. We just got to like $4,000 check towards that from the church right up the road; we have a charitable trust that helps to provide free or a sliding scale of mental health services, could be emergency housing, could be food. We also in these wellness centers have to get much better at emergency medicine. So we are almost like a triage of helping people to know when they got to get to an urgent care or when they got to get to the hospital, or where something might look bad, but it's really superficial, and we can take care of it right here. And so any of these isolated areas, the Wellness Centers, just have to be more trained, be able to do that. And so they finally had to say how do we take this model, replicate it, which we now move into Phoenicia, and how do we make sure that it's sustainable, and that has permanence in a community, like a library? Thirty percent of our scripts every day make no money. It's just not a sustainable market. It's the same thing for primary care doctors. So we are going to shift to be the first community pharmacy in America to convert to a nonprofit structure, pharmacy for the public good. And what we want to do is to show that that will take us time to have this conversion. But we then know that the community will support it. Will be grants or will be public, private, support individual donations. People who have moved up in the city and want to help support their communities, and we think that model has a much greater opportunity to serve others. Ed's idea for a nonprofit pharmacy will help protect it from corporate predation. He recounts the story of a recent attempt at such a takeover in Tannersville, will bleep the name of the chain that made that attempt because, well, we all know who the national chains are, and it could just have easily been any one of them moving in for the kill. We had a representative from *bleep* a month and a half ago, she was a Senior Corporate Acquisition Specialist; such a nice title. So she came in and asked for me by name. So when you get right down to it, they want to know what your price to go away. So I said to her, I said, 'Alright, look around. Is there a more beautiful pharmacy that you've seen?' She goes, 'No.' My God, I go, 'Did you see any public transportation outside?' I go, 'There is none.' I go, 'How long did it take you to get here when you got off to throw away?' 'I don't know. I go 28 miles. That's how long a winding road.' 'So let me get this right. You just said it is the most beautiful pharmacy that you've seen. But you want to know my number to put this out of business after this community has given me their guts to make us successful?' I said, 'When you drive back, ask yourself; Is this what you really want for your career? Is this what you want your children to see?' And I go, 'But there's one last thing, you're not a pharmacist anymore. You just went to pharmacy college. So separate the two please.' The American Pharmaceutical system, the distribution system, has been skewed towards chains, especially in the urban and suburban areas. And that's not what's going on around the world or certainly in Europe. There's a much more greater respect for pharmacy and its history. But this is a recent phenomena that has only occurred in 1980s. Not a long time ago. They are a ruthless group of American capitalism may be at its best. You know, they knew exactly what to doing, they underprice bids to get the business and but they basically want to dominate; and mail orders an important part of that. All the school districts around here all went mail order. They only realize their decision to putting out small businesses that are part of the lifeblood of where their employees will live. But I think knowing something about the Chain Drugstores they're a very mediocre group. And there is this conflict between what they call their front end and then the pharmacy department, which is Jolly's small little department in the back. And they talk a big story. And they don't really do much outside of the dispensing of medications. What do I get at this pharmacy that I can't get anywhere else? Good question. If you were to look at the chain experience, you'll get hopefully the dispensing of your medication. On time, your insurance will be accepted. That might be a nod from the pharmacists 'Hi, how you doing?', but they don't have the time other than for doing immunizations. So it'd be what I call transactional. Most pharmacists have not gone outside of the box to develop other skills like natural medicine. So it's not like they don't want to, they just don't have no training at the pharmacy college; on the history of the profession and they haven't taken the time to study other cultures. That skill's a little awkward to them. CBD oil is easier for them to jump in and get involved, but the motivation would be more because it's a higher profit type of thing. Their clinical skills, they have to work on that and for it. They're very easily trained, but they're not reimbursed. Pharmacists don't have what's called Provider Status that didn't get billed for the services. So I did a consultation yesterday with someone for 40 minutes, I wouldn't get paid for it. There was just something I could do because I had my other partner here. So I think in this case, this is a true holistic look at the individuals. I have a good sense of who they are, where they come from, where they went to school. And this is all built up over a period of years and trying to reach out with them; ask them questions. We do much more public health. We do mental health. We do at home visits that would be different. We have a research and development department; and that's why we keep pushing out our wellness RX report. We do community education; I do a weekly radio show for two years with COVID every week. So we're trying to get education out, information for our community at a little bit higher level. So I think what we've been able to show is that you can provide these other services. It's economics as if people really mattered. With the access to primary care going down, pharmacists have gotta step up. And that's what we're trying to show. We're also a teaching facility that have students. Where do we need to go? We need to have a whole department for at home services. That's what people want in services, especially seniors. You can do so much more bringing services to the people. And then they can come here when they can. We need to be involved much more with mental health care, because this is what is needed. We have to find models like this that would allow doctors and mental health professionals burnt out. We just had a three to three and a half percent reduction in clinical capacity through COVID with early retirements. They're still good doctors and professionals but they don't want to work in a corporate structure. So we got to provide more beautiful models that allow people to be treated, as we might say, in a holistic way, but adapting to what it is that they need. A lot of times could be just helping with connectiveness, so they're not lonely. So that's what we're doing and that's the model we want to replicate to communities and Phoenicia will be our first. More from Ed in a moment. Kaatscast is sponsored by the Mountain Eagle; covering Delaware, Greene and Schoharie counties, including brands for local regions like the Windham Weekly, Schoharie News, and Catskills Chronicle. For more information, call 518-763-6854 or email Mountaineaglenews@gmail.com. And by the 52 Mile Catskill Mountains Scenic Byway, following New York State Route 28, through the heart of the central Catskills. For maps, itineraries, and links to area restaurants, shops and accommodations, visit sceniccatskills.com. Tell me a little bit about the interaction between your pharmacy and this village, and also about the upcoming location in Phoenicia and how that'll all work. I never thought that I would have this experience here. It has been so warm and beautiful. When I do a COVID shot, for instance, a person has to hang around for 15 minutes. So it's a great opportunity to, to to talk with the people. A pharmacist is a very trusted health professional. Take advantage of that trust, and bring it to a different level. And when you listen to people, you get something out of it, it makes you feel good. And as a health professional, you're helping to guide the individual on their terms. And so the model has worked out really well. The community has supported us across the board. You wouldn't be raising this kind of money from our Patient Assistance Fund if it didn't come from them. And the question for Phoenicia, It's my hometown. So the history of pharmacy and Phoenicia is probably similar to the history of pharmacy and most of the towns that if you trace it back, there's been a pharmacy there probably for about 80 years. And it was located on the corner 5000 square foot space, the largest commercial space in town. And it was one that tried to adapt to the needs of the community. Economically, couldn't make it any more; closed down, lights went out. So we selected the old Ricciardella restaurant on Main Street. Now with our team, I'm able to set up Phoenicia at 1/3 the price if you were trying to do it from scratch, so we get the economy of scale. We know what exactly with the look and feel. We know what the training that's required. So we're trying to show that you can get your cost down and still operate a very professional facility. And then we will adapt to what the Phoenicia community wants and needs. The pharmacists that we bring it on board Joesette; she did work at the old pharmacy with Marty Millman. So we're really happy that we're gonna have two locals come back to do this. But we need help. We're not gonna be able to do this on our own against the the odds. Well, we can with the strength of the community, and that includes individuals who have migrated from the city and want to invest into their towns. It will be from local people who have done okay, and they can help out a little bit more. It can be from the people who just throw in $10 when they can. But together that little help from the community will allow that to be a sustainable pharmacy, we also going to be partnering with mental health services and Ulster County. So, so if you look at it, the Wellness Center in a community should be the gatekeeper, it should know all the referral services that are available in the marketplace, all the doctors that are available in the marketplace, where the shortages are, where the strains are, and help guide people to where they can go efficiently; make a few calls I'm sending so and so to come. Not only did you get them there, but you follow up with them afterwards. And so we'll just continue to adapt to what Phoenicia will need I would assume Phoenicia will also need emergency medicine, like we found up here because of the tourism. It's well adapt accordingly, pharmacy will be just one department within the rest of the store. Is the transition to a nonprofit model essential for small pharmacies to stay aloft and what would be your advice to other pharmacies in the area? You can increase and diversify your revenue like we have with natural medicine, and clinical services. And that helps to mitigate it. But every year, I think they'll be the same situation going 'Oh my god, I thought I had a good year and didn't make any more money.' And that kind of wears on you, wears on a family, and it wears on doctors why they are retiring and record numbers. But I think the bigger issue is that if they were to move into a nonprofit structure, effect, liquidate their assets so that they hopefully will get as much as if they sold to a chain drugstore. They're doing something much more important, and then they can do more public health, more issues of what they're needed by the community. And if we think that primary care medicine is just gonna come back to rural communities, then we're drinking a lot of bourbon, because that's just not going to happen. And there'll be pockets. For instance, Brian Callahan is Jointed Medical Associates in Kingston, which is the largest of the independent doctors. What a great timing; Boice would close down, and that would have been it; curtains with the practice. We need to have primary care access points in these communities. The communities can not just turn around and hope that somebody will bring it to them, they gotta work to bring it for their communities; and the anchor is the pharmacy. The town has to be involved, the educational system has to be involved, the library has to be involved, and then the synergy. There comes a time where you get to the threshold where you feel empowered as a community that no we're not backing down, we are going to do this. It's the right thing to do for for our community. Then, if you can affiliate with one of the other health systems that are consolidating, like we can't believe, but I'm telling you from the economics, no health system makes any money from rural primary care. Why did they do it? They do it because they want the referral revenue going to their central services, because they can bill at a higher rate. A lab test; a lab test can be billed at the office, but it can be billed at a higher at the hospital, outpatient surgeries, whatever. So they're in a competitive environment. So they use rural healthcare, as feeder systems, but they're not profitable. So therefore, at any given moment, they can get closed down, like Boice just got closed down. We got to do better for our kids. We've got to get out of ourselves and plan for the next generation. Because in 20 years, they run the country. And they're going to run the country from their experiences that they have. What does that look like? So we got to be thinking of how do we use the wisdom of seniors to give back to their community, so they feel a sense of value, and connect these generations together, to have learned from each other and to have fun. And if we don't do this in the small communities, and the people who are migrating will go migrate back. Or just keep it as a summer home that they'll come up, you know, once every three months. That's not what they want. There's a thirst for community integration and come out of COVID even more so. No reason why we can't have every storefront in in Phoenicia fully occupied and humming, but it all has to feed off each other. It's a echo system where you are gonna all rise or you're all gonna go down. The pharmacy and the Wellness Center is important because we see more people who are coming into that community than anyone else. Blood is blood. If they're hurt, they're hurt. So we see the travelers and tourists, we see the second family homes, we see the locals. Also, what you'll find is that when people move into an area, their first point of entry for primary care is their pharmacy. But I think in the future, it has to be done as a community. So a nonprofit makes sense to me; because is healthcare really a for profit enterprise? Why haven't we declared it is a basic human right? Like water? Like education? What will the nonprofit structure do to insulate pharmacies like this? When I played this thing out, and I said, 'Alright, when I retire, there will be another pharmacist where they they buy me out, or they become a partner, and I get phased out, what are they going to do when the *bleep* representatives come on a continual basis? Just a reminder, the bleep here is not to censor Ed's salty language. It's to anonymize a national chain, which again, could be any national chain. At some juncture, they are gonna have a bad quarter, and they're gonna have no choice but to sell. And it's lights out. The moment you shift to a nonprofit, you have a board of directors. No board of directors is going to sell the pharmacy to *bleeps*. Not that a pharmacist selling is bad or good, they have no choice. The community then has the choice to say, 'Okay, we need to do more fundraising. Okay, we need to do more grant writing. Okay, we need to go to the county government.' So you have many more tools in order to meet whatever deficits you might have. But the goal is not to be having a traditional nonprofit that needs grants every year in order to survive. But it will allow the community to invest into public services that are needed by people. There will be someone who loves what we're doing, and will make an endowment. A lot of these health care companies have foundations, and they're gonna understand what we're doing. Everyone gets treated the same, everyone is equal. They're all welcome here. And I think the financing will come from the community and from the grants. It just takes time. It's not an overnight event, but I have absolute confidence that we'll be successful. Thanks to Ed Ullmann, Greg, and Angie, and to everyone at Wellness RX. And thanks to our sponsors, Hanford Mills Museum, the Catskill Mountains Scenic Byway, and the Mountain Eagle. Production intern Jared Lyman. Kaatscast has a brand new website with expanded coverage, links to our sponsors and a search feature, and you can click the donate button to support this podcast with as little as a dollar a month. All this and more at kaatscast.com. Kaatscast is a free biweekly production of Silver Hollow Audio; and we were nominated for Best Regional Podcast by Chronogram magazine. Click in the show notes to cast your vote. I'm Brett Berry. Thanks for listening, and we'll see you again in two weeks. 

Transcribed by https://otter.ai / JL